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PubMed2003

[Squamous cell carcinoma of the renal pelvis with giant hydronephrosis].

We report a case of squamous cell carcinoma of renal pelvis associated with giant hydronephrosis. A 71-year-old woman presented to our hospital with a complaint of abdominal fullness due to the right giant hydronephrosis. Although the diagnosis of her hydronephrosis was made about 20 years ago at another hospital, it had been left untreated. Computed tomography showed the right hydronephrosis of 20 x 20 x 25 cm in diameter and no evidence of tumor or calculus in the right urinary tract. For relief of her complaint, right nephrectomy was performed. The fluid content was bloody and 4,200 ml in volume. Histological examination revealed a flat type squamous cell carcinoma of the renal pelvis. This is the 30th case of renal pelvic malignant tumor associated with giant hydronephrosis reported in Japan. The literature was reviewed and the management of giant hydronephrosis was discussed.

Aged↗
PubMed1989

[Hydronephrosis caused by Crohn's disease: a case report--review of 41 cases with urinary tract complication reported in Japan].

A 34 year-old man, who had been under care with diagnosis of Crohn's disease in the department of gastroenterology of our hospital since 1983, was referred to our urological clinic on May 21, 1987, because of right hydronephrosis found on ultrasonography. He did not complain of any urological symptoms. He underwent further roentgenographic examinations and a diagnosis of hydronephrosis complicated with Crohn's disease was made. On surgery of July 30, resection of ileocecal lesion, end-to-end ileocolostomy, right ureterolysis were performed. He is now visiting our clinic without recurrence of hydronephrosis up to present (7 months). In addition, we reviewed the 41 cases of urological disorders complicated with Crohn's disease in the literature reported in Japan. The cases were of vesicoenteric fistula including pericystitis (33 cases), hydronephrosis (10 cases), urolithiasis (2 cases) and ureterocolonic fistula (1 case). The patients were from 10 to 57 years (27.2 years in average) old. Sex distribution was uneven, 39 of patients were men and 2 were women. Urologic surgery was performed in almost all of the cases except for the patient with urolithiasis. All the patients having vesicoenteric fistula had urological complaints but the patients with hydronephrosis were relatively free from urological complaints. Thus, Crohn's disease has been recognized as an important gastrointestinal disease for urologists, and we will emphasize that periodical abdominal ultrasonography and urography for the patients with this disease should be necessary for checking up other complications such as hydronephrosis.

Adult↗
PubMed1988

Incidence of hydronephrosis among several production colonies of outbred Sprague-Dawley rats.

The incidence of hydronephrosis was determined in nine production colonies of Crl:CD (SD) BR rats (CD rats). Kidneys from 3909 rats were examined and 79 (2.0%) had unilateral or bilateral hydronephrosis. A colony with a relatively high incidence of hydronephrosis (4.1%) was chosen for further study. In unselected rats from this colony the incidence in females (87/1882, 4.6%) was not significantly different from that in males (79/1862, 4.2%). In the same group of rats, hydronephrosis was observed most frequently in the right kidney only (2.3%), followed by bilateral involvement (1.2%) and the left kidney only (0.8%). By selection and inbreeding, the incidence of hydronephrosis was increased dramatically (to 33.6%) in two generations. Hydronephrosis in the CD rat appears to be a highly heritable trait, most likely involving more than one gene.

Animals↗
PubMedDate not supplied

[Hydronephrosis surgically treated in the 1st year of life. Short- and long-term radiologic and functional evaluation].

Hydronephrosis in infancy and childhood is a frequent urinary malformation and is almost always congenital. In over 80% of the cases it is due to ureteropelvic junction obstruction; much less frequently it is due to anomalous renal vessels, sometimes associated to ureteropelvic junction obstruction. In this paper the Authors analyze their experience in the surgical treatment of this urinary malformation. 234 hydronephrosis out of 222 patients were operated on from January 1972 to June 1985. 61 hydronephrosis were operated on in 55 infants under 1 year. Primary nephrectomy was carried out only in 9 of the 234 hydronephrosis operated on (3.9%) and in 3 of the 61 hydronephrosis operated on in infants less than 1 year old (4.9%). All the 55 infants but one showed a significant radiological improvement after pyeloplasty. 28 infants but one showed a significant radiological improvement after pyeloplasty. 28 infants for a total of 30 hydronephrosis had a glomerular filtration rate determination during sequential scan for individual kidney function assessment. 90% of the kidneys operated on showed a normal or slightly reduced glomerular filtration rate. Recent advances in prenatal echographic diagnosis and relationship between obstructive uropathy, renal development and pulmonary hypoplasia are discussed. The Authors stress out the importance of early diagnosis to improve surgical results.

Adolescent↗
PubMed1985

[A case of giant hydronephrosis and a review of 324 cases in the literature].

A case of giant hydronephrosis due to ureteropelvic junction obstruction in an 18-year-old boy is reported. The patient had been told to undergo an operation for the left hydronephrosis at 2 years of age. However, he stayed away from hospital until he presented at our clinic with nausea caused by a large abdominal mass. Radiological evaluation revealed a left giant hydronephrosis with no function and slight compensatory hypertrophy in the right kidney. Left nephrectomy was performed and the pelvic capacity was approximately 7,700 ml. Histopathological examination showed muscular hyperplasia at the ureteropelvic junction. The term giant hydronephrosis may be defined as a hydronephrosis the contents of which are greater than 1,000 ml. Three hundred twenty four cases of giant hydronephrosis in the literature are reviewed and the age, sex, side involved, pelvic capacity, etiology, and relation to hypertension are discussed.

Adolescent↗
PubMed1998

The role of micturating cystourethrography in antenatally detected mild hydronephrosis.

BACKGROUND: The postnatal imaging of infants with antenatally detected mild hydronephrosis remains controversial. OBJECTIVE: Our aim was to establish the role and timing of micturating cystourethrography (MCUG) in mild hydronephrosis. MATERIALS AND METHODS: We performed a retrospective study of 61 infants (122 kidneys) referred with an antenatal diagnosis of hydronephrosis who showed persistent postnatal dilatation. All had follow-up postnatal ultrasound (US) and MCUG performed. The degree of dilatation at each follow-up scan was recorded. RESULTS: Of the 122 kidneys, 65 showed mild hydronephrosis. A substantial proportion of these (21.5%) demonstrated reflux. Serial US of these infants showed that the 6-week scan was the most informative and that any changes that warranted further investigation had occurred by this time. CONCLUSION: We recommend that all infants with mild hydronephrosis should undergo MCUG. MCUG need not be delayed until 3 months but could be performed following a 6-week US scan.

Female↗
PubMed2002

Doppler sonographic renal resistance index and resistance index ratio in children and adolescents with unilateral hydronephrosis.

The aim of this study was to evaluate Doppler renal resistance index (RI) and RI ratio (RIR) in differentiating between obstructive and nonobstructive hydronephrosis in children and adolescents. The RI and RIR were measured in 32 healthy examinees (control group) and 29 patients with unilateral hydronephrosis. Ten patients had acute obstruction caused by a ureteric stone. Seven had obstructive hydronephrosis due to uretero-pelvic junction (UPJ) obstruction. Twelve patients had nonobstructive hydronephrosis. In controls the mean RI+/-S.D. was 0.615+/-0.04, and RIR 1.045+/-0.033. In children with acute obstruction RI was 0.692+/-0.035 and RIR 1.148+/-0.037. In UPJ obstruction RI was 0.631+/-0.054 and RIR 1.059+/-0.047. In nonobstructive dilatation RI was 0.61+/-0.038 and RIR 1.043+/-0.042. The RI and RIR differences were statistically significant between controls and patients with acute colic ( p<0.01), and between patients with acute obstruction and with nonobstructive hydronephrosis ( p<0.01). In detecting acute obstruction RI>/=0.70 was found to have a 70% sensitivity and a 92% specificity. The RIR>/=1.10 was found optimal to distinguish obstructive from nonobstructive dilatation (sensitivity 90%, specificity 83%). Both RI and RIR are significantly elevated in patients with acute obstruction. Renal Doppler seems to be useful in children and adolescents for the detection of acute renal obstruction, although it cannot differentiate chronic obstruction due to the UPJ obstruction and nonobstructive renal collecting system dilatation.

Adolescent↗
PubMed2006

Mild hydronephrosis in newborns and infants: can ultrasound predict the presence of vesicoureteral reflux.

The objective of our study was to determine the significance of mild hydronephrosis in newborns and infants as an indicator of vesicoureteral reflux (VUR). The voiding cystourethrography (VCUG) of 573 patients aged 0-18 months with mild, sonographically detected hydronephrosis were reviewed for VUR. Patients with secondary reflux or anomalies making an exact reflux grading impossible were excluded. Normal kidneys, contralateral to hydronephrotic ones, were included. Each kidney was considered separately, forming a total of 1,146 renal units. Mild hydronephrosis was defined as an anteroposterior diameter of the renal pelvis of 0.5-1.5 cm without caliectasis. The International Grading System was used to grade VUR. Seven hundred and thirty-six kidneys had mild hydronephrosis. VUR occurred in 189 out of 736 (25.7%) of these kidneys, and in 108 out of 410 (26.3%) non-distended kidneys, contralateral to hydronephrotic ones (p=0.806). No statistical differences in the frequency of VUR and dilatation were found between the subgroups of patients with and without infection, except for a higher grade of reflux in the group with infection. The frequency of VUR in mildly dilated kidneys was not significantly different from that in non-distended ones. There was a poor correlation between VUR and mild hydronephrosis. The latter should not be considered in itself an indication for VCUG in asymptomatic neonates and infants.

Female↗
PubMed1988

Hydronephrosis during pregnancy: a literature survey.

The occurrence of hydronephrosis and hydroureters during pregnancy has been termed physiological, inasmuch as it is seen in more than 80%, most frequently and most pronounced in primigravida. The dilatation develops during the second trimester, and becomes more prominent on the right side, is only seen above the linea terminalis and disappears within a few weeks after birth. The condition is not seen in women whose ureters do not cross the pelvic brim. The extent of the dilatation can be reduced by placing the woman on the side least affected or in the knee-elbow position. After a survey of the literature, the conclusion is reached that today there is every probability that hydronephrosis during pregnancy develops as a result of compression of the ureters between the pregnant uterus and the linea terminalis. It has not been demonstrated that the change in hormonal balance during pregnancy is of importance. The clinical significance of hydronephrosis lies in the association between ureteral obstruction and the high frequency of ascending urinary tract infection during pregnancy and in the understanding of the importance--in the treatment of infection--of improving drainage by means of a change in position. Isotope renographic studies seem to show a possible relationship between bilateral ureteral obstruction and the development of pre-eclampsia. Similarly, it appears that acute hydronephrosis or worsening of an existing hydronephrosis has been somewhat overlooked as a possible cause of uncertain abdominal pain during pregnancy. These conditions should be examined by means of ultrasonography, and an attempt at treatment by a change in position should be made. In cases of continued pain or affected renal function, treatment should consist of the insertion of a ureteral catheter.

Animals↗
PubMed1990

Characterization of the peak period of sensitivity for the induction of hydronephrosis in C57BL/6N mice following exposure to 2,3,7, 8-tetrachlorodibenzo-p-dioxin.

2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) is an extremely potent teratogen in mice. Hydronephrosis and cleft palate are the most sensitive measures of teratogenicity in mice following exposure to TCDD and other structurally related polyhalogenated aromatic hydrocarbons. Despite a relatively long half-life, investigators have identified a critical window for the induction of cleft palate in C57BL/6N mice. To characterize the critical period for renal teratogenesis, pregnant C57BL/6N mice were treated once by gavage with 0-24 micrograms TCDD/kg body wt on Gestation Day (GD) 6, 8, 10, 12, or 14. All dams were killed on GD 18, and the fetuses were examined for the presence of hydronephrosis and cleft palate. Maternal liver-to-body weight ratios were significantly elevated above controls on all days, while maternal weight gain was unaffected. Fetal mortality was increased relative to controls only at 24 micrograms TCDD/kg on GD 6. There was no significant difference in fetal body weights between control and TCDD-treated fetuses. The incidence of cleft palate increased in a dose-related fashion from GD 6 to GD 12, and identification of GD 12 as the critical window for induction of clefting of the hard palate was confirmed. Hydronephrosis was observed at all dose levels, regardless of exposure day, and the incidence was close to 100% at 3 micrograms TCDD/kg and higher doses on GD 12 and earlier. At all doses on GD 14, both the incidence and severity of hydronephrosis were decreased relative to all other days. There was a dose-related increase in the severity of the renal lesion on each day, but between GD 6 and 12 severity was constant. Thus, while palatal sensitivity to TCDD increased with gestational age between GD 6 and 12, there was no difference among these days in development of hydronephrosis. The data suggest, however, that on GD 14 the urinary tract may be less sensitive to TCDD.

Animals↗
PubMed2005

Extracorporeal shock wave lithotripsy in the treatment of proximal ureteral stones: Does the presence and degree of hydronephrosis affect success?

OBJECTIVES: We investigated the relation between the presence and degree of stone induced hydronephrosis and the outcome of extracorporeal shock wave lithotripsy (SWL) in patients with solitary proximal ureteral stones. METHODS: 130 patients with or without hydronephrosis were treated with SWL. The degree of hydronephrosis was defined by renal ultrasound. Patients were divided into four groups according to the degree of stone induced hydronephrosis. Group 0 (24%) had no urinary system dilatation, group 1 (31.2%) had a mild dilatation of the renal pelvis, group 2 (40%) had a moderate and group 3 (4.8%) a severe dilatation of the renal pelvis and calices. The stone size, number of shock waves applied and number of sessions required to achieve stone clearance were recorded. RESULTS: Mean stone size was 8.2 mm+/-2.5 mm. Mean time to stone clearance was 13.7 days+/-16.3. In 74.4% of patients stone clearance was observed. Additional 4.8% harbored residual fragments < or =3 mm after 3 months. Differences among the four groups in terms of stone size, time to stone clearance and treatment failure were not significant. CONCLUSIONS: The presence or degree of hydronephrosis caused by a proximal ureteral stone does not affect the time to stone clearance or success rate after SWL.

Adult↗
PubMed2003

Antenatal hydronephrosis: negative predictive value of normal postnatal ultrasound--a 5-year study.

AIM: To determine whether normal postnatal ultrasound, as part of a strict screening protocol for the detection and follow-up of antenatal hydronephrosis, effectively excludes the majority of babies with congenital urinary tract abnormalities that would otherwise present with a urinary tract infection. MATERIALS AND METHODS: We retrospectively reviewed all babies who had postnatal follow-up of antenatally detected hydronephrosis over a 5-year period at our institution, a district general Trust with a specialist paediatric unit. We then studied all babies presenting with urinary tract infection before their first birthday to our institution over the same period. By cross-referencing these two study groups we were able to determine which babies developed a urinary tract infection having been previously discharged after normal postnatal ultrasound. RESULTS: Four hundred and twenty-five babies had postnatal follow-up of antenatal hydronephrosis. Of these, 284 were investigated with ultrasound alone. In the same 5-year period, 230 babies presented with urinary tract infection before their first birthday. Only three of these babies had been previously discharged after normal postnatal ultrasound. The negative predictive value of a normal postnatal ultrasound was therefore 98.9% (281/284) for babies who subsequently presented with a urinary tract infection before their first birthday. CONCLUSION: Careful antenatal and postnatal ultrasound with strict protocols is effective in detecting congenital renal tract abnormalities. Infants discharged after normal postnatal ultrasound are highly unlikely to still have an undetected urinary tract abnormality. We suggest that all babies with antenatal hydronephrosis are started on prophylactic antibiotics at birth, pending further investigation. All babies without features of severe obstruction antenatally should have their postnatal ultrasound delayed for a month. We recommend selective use of micturating cystourethrogram (MCUG), and delaying this investigation until the baby is 3 to 4 months old to allow for spontaneous resolution of vesicoureteric reflux. We do not believe that all babies with antenatal hydronephrosis require MCUG, providing a clear protocol is followed.

Algorithms↗
PubMed1999

A multicenter outcomes analysis of patients with neonatal reflux presenting with prenatal hydronephrosis.

PURPOSE: Approximately 10 to 30% of prenatal cases of hydronephrosis result in the postnatal diagnosis of vesicoureteral reflux. Using a new generic prenatal-postnatal data sheet developed by the Society for Fetal Urology the characteristics, natural history and outcome of prenatal hydronephrosis confirmed postnatally to be vesicoureteral reflux were documented at 3 centers. MATERIALS AND METHODS: We performed a retrospective multicenter review of Society for Fetal Urology data sheets completed for each patient in whom prenatal hydronephrosis was proved to be postnatal vesicoureteral reflux from 1993 to 1998. RESULTS: In 56 male and 15 female patients with prenatal hydronephrosis a total of 116 refluxing renal units were confirmed postnatally. Of the 116 renal units 112 were hydronephrotic prenatally. During gestation increased hydronephrosis was noted with voiding in 4 cases. Of the 112 hydronephrotic renal units only 26 ureters in 15 patients were seen prenatally. The obstetrician considered the diagnosis of vesicoureteral reflux in only 24% of the cases. Postnatally 116 refluxing renal units were identified. Initial postnatal ultrasound was normal in 25% of the cases. Bilateral reflux was present in 36 male and 9 female patients. In 10 of the 19 uncircumcised patients (53%) urinary tract infection developed despite antibiotic prophylaxis. In 15 of the 74 renal units with grades III to V reflux the condition resolved at an average patient age of 0.9 and 2.1 years in boys and girls, respectively. A total of 27 refluxing renal units were reimplanted. CONCLUSIONS: The majority of prenatal reflux occurs in boys, and it is high grade and bilateral. The data sheets designed by the Society for Fetal Urology are useful data collection instruments. The presentation and natural history of vesicoureteral reflux are different in male and female individuals. In a significant number of renal units high grade reflux resolves spontaneously. Early circumcision may decrease the incidence of breakthrough urinary tract infection in this subpopulation. In addition, the effective management of prenatally detected reflux depends on multispecialty communication.

Female↗
PubMed2006

Increased echogenicity as a predictor of poor renal function in children with grade 3 to 4 hydronephrosis.

PURPOSE: Prenatally diagnosed hydronephrosis is a common finding that often requires further radiological evaluation to determine whether it is associated with compromised renal function. We hypothesize that findings on postnatal renal sonography may help determine which patients require more extensive evaluation of renal function in the assessment for prenatal hydronephrosis. We show that increased renal parenchymal echogenicity on postnatal US is a strong predictor of compromised renal function. MATERIALS AND METHODS: A total of 97 patients diagnosed with prenatal hydronephrosis presented to our institution for furosemide (99m)technetium MAG3 renogram evaluation of renal function between January 2000 and December 2001. All patients had SFU grade 3 to 4 hydronephrosis noted on postnatal US before age 6 months. For these 97 patients (178 renal units) we correlated the degree of renal parenchymal echogenicity and parenchymal thinning on the first postnatal sonogram with the differential renal function as determined by furosemide MAG3 renography. RESULTS: Among 97 patients diagnosed with prenatal hydronephrosis 10 of 20 renal units (50%) with markedly increased echogenicity had severely decreased relative renal function of less than 10%, while 136 of 151 (90%) with normal echogenicity exhibited normal relative renal function of 40% or greater. Increased echogenicity on US yielded a sensitivity of 100% and specificity of 99% for predicting relative renal function of 20% or greater. In predicting relative renal function of 40% or less sensitivity and specificity were 48% and 100%, respectively. CONCLUSIONS: Increased renal parenchymal echogenicity found on the first postnatal ultrasound can be used as a predictor of impaired relative renal function as measured on furosemide MAG3 renogram.

Female↗
PubMed2000

Circulating adhesion molecules and neutral endopeptidase enzymuria in patients with urolithiasis and hydronephrosis.

OBJECTIVES: To measure the concentrations of adhesion molecules (intercellular adhesion molecule-1 ¿ICAM-1, E-selectin, and L-selectin) in the serum of patients with renal stones and patients with hydronephrosis caused by obstructive ureteral stones. Renal tubular enzymes were examined from their urine samples to evaluate whether neutral endopeptidase (NEP) behaved as traditional tubular enzyme markers (N-acetyl-beta-glucosaminidase ¿NAG and beta-galactosidase ¿beta-GAL) in their disease state. METHODS: Three groups were studied. Group 1 included 15 normal volunteers, group 2 included 12 patients with ureteral stones and ipsilateral hydronephrosis, and group 3 included 17 patients with renal stones in one kidney without hydronephrosis or hydrocalycosis. A single, overnight fasting blood and urine sample was collected from each subject. Serum levels of ICAM-1, E-selectin, and L-selectin were measured by enzyme-linked immunosorbent assay. NEP, NAG, and beta-GAL were measured from urine samples, and the enzyme activities were expressed per gram of creatinine. RESULTS: Serum levels of ICAM-1 were higher in groups 2 and 3 (522 +/- 95 and 329 +/- 42 ng/mL, respectively), but the differences were only significant between group 2 and group 1 (263 +/- 32 ng/mL) and group 2 and group 3 (P <0.05). Serum levels of L-selectin were lower in group 3 and were significantly different when compared with groups 1 and 2 (P <0. 05). The serum levels of E-selectin were not significantly different among these three groups. Urinary levels of NEP were lower in group 2, although the levels of NAG and beta-GAL were more elevated than in group 1. CONCLUSIONS: Serum levels of ICAM-1 were elevated in patients with unilateral hydronephrosis caused by a ureteral stone, and E-selectin and L-selectin levels did not change significantly. These findings suggest that ICAM-1 may play a role in renal immune injury to ureteral obstruction. The urinary NEP values were lower in patients with hydronephrosis caused by ureteral stones, and the traditional lysosomal enzymes were increased. The lower urinary NEP values might suggest impairment of ipsilateral renal function. Renal stones per se resulted in no significant changes in serum adhesion molecule levels, although the levels of L-selectin were significantly decreased.

Cell Adhesion Molecules↗
PubMed2003

Down-regulation of inducible nitric oxide synthase (iNOS) in rat with congenital hydronephrosis.

BACKGROUND: Most of our knowledge concerning obstructive uropathy has been derived mainly from surgically manipulated animal models, and the pathogenesis of congenital obstructive hydronephrosis is not fully elucidated. Nitric oxide (NO) acts as an important biological modulator with diverse physiological functions, which can be either toxic or protective depending on the situation. NO is synthesized from l-arginine by nitric oxide synthase, and in the kidney iNOS is expressed spontaneously. The aim of our study is to investigate the expression of iNOS protein and its relationship with tubulointerstitial fibrosis and tubular cell apoptosis in congenital hydronephrosis. METHODS: We conducted histological studies on 18 kidneys of six-week-old-rats from an inbred colony of congenital hydronephrosis with reference to the histological grading of the affected kidney, tubulointerstitial fibrosis, renal tubular atrophy, and tubular cell apoptosis. Renal transforming growth factor-beta1 (TGF-beta1) level was determined by a sandwich ELISA assay and the expression of iNOS was analyzed by western blotting. RESULTS: Most of the hydronephrotic kidneys were markedly enlarged with dilatation of the collecting system, parenchymal thinning, tubular atrophy, interstitial infiltration and fibrosis. Renal TGF-beta1 level was higher in hydronephrotic kidneys than normal control kidneys (364.81 +/- 52.60 vs. 221.19 +/- 22.53 pg/mg protein, P < 0.05). Tubular apoptotic score in hydronephrotic kidneys was also significantly higher than in the normal control kidneys (1.97 +/- 0.42 vs. 0.14 +/- 0.02/HPF, P < 0.01). The expression of iNOS protein was lower in the affected kidneys compared with the normal control kidneys (8.79 +/- 0.78 vs. 14.00 +/- 0.83 arbitrary unit, P < 0.01). There was a negative correlation between iNOS expression and histological grading in congenital hydronephrosis. The iNOS expression also correlated negatively with renal interstitial fibrosis, TGF-beta1 level and tubular cell apoptosis. CONCLUSION: Our study confirmed the down-regulation of iNOS expression in affected kidneys from rats with congenital hydronephrosis, in which the cytoprotective effect of NO may be lost or weakened.

Animals↗
PubMed2001

Use of sonography and radioisotope renography to diagnose hydronephrosis in patients with spinal cord injury.

OBJECTIVE: To study the accuracy of sonography and radioisotope renography in detecting hydronephrosis in patients with spinal cord injury (SCI). DESIGN: Prospective, blinded comparison study. SETTING: Rehabilitation hospital affiliated with a medical college. PARTICIPANTS: One hundred and nine patients with SCI (21 women, 88 men) participated. INTERVENTIONS: Comprehensive urologic examinations including clinical evaluation, laboratory tests, intravenous urography (IVU), sonography, radioisotope renography (renal scan), voiding cystourethrography, and cystometry. The findings at sonography and renal scan were separately compared with the final diagnosis interpreted by IVU and clinical findings. MAIN OUTCOME MEASURES: Effective renal plasma flow, pyelocaliectasis, and positive and negative predictive value. RESULTS: A total of 235 kidneys were analyzed. Sonography correctly excluded the presence of hydronephrosis in 173 of 192 nonobstructed kidneys. Sonograms were interpreted as positive in 41 of 43 kidneys with documented hydronephrosis. Renal scan correctly excluded 161 nonobstructed kidneys. The renal scan detected 39 of 43 kidneys with hydronephrosis. The sensitivity of sonography was.96 with a specificity of.90. Renal scan reached a sensitivity of.91 with a specificity of.84. CONCLUSION: Sonography and renal scan are safe, sensitive, and specific for detecting hydronephrosis. Combined use of both methods appears to be a reliable alternative to IVU in the long-term follow-up for patients with SCI with neurogenic bladder dysfunction.

Adolescent↗
PubMed1999

Are patients with antenatally diagnosed hydronephrosis being over-investigated and overtreated?

BACKGROUND: It is usually recommended that neonates with antenatally diagnosed hydronephrosis are put on prophylactic antibiotics and undergo the following investigations--ultrasound, MCU and a radio-isotope renogram. OBJECTIVE: To question the need for such an extensive protocol in antenatally diagnosed hydronephrosis on the basis of an improved understanding of this condition. METHODS: Over a 3-year-period, persistent postnatal hydronephrosis was seen in 42 neonates; in 12 it was bilateral. Antibiotic prophylaxis was stopped in the unilateral cases. An MCU was done mainly in the following circumstances: bilateral hydronephrosis, dilated ureter(s) or presence of UTI. A renogram was avoided if the AP diameter of the renal pelvis was below 15 mm and the calyces were not dilated. RESULTS: 1) The AP diameter of the pelvis was recorded in 40 renal units as follows--< 15 mm--22, 15-20 mm--10, 20-40 mm--6, > 40 mm--2. Both the patients in the latter group needed a pyeloplasty--their AP diameter exceeded 8 cms and an RNS showed depressed function. 2) In those patients who did not receive antibiotics or had a MCU, none has had a UTI. 3) Four unilateral hydronephrotic kidneys showed a paradoxical supranormal function, ranging from 54-60%. The contralateral kidney was completely normal on the RNS. CONCLUSION: 1) The vast majority of antenatally diagnosed hydronephrosis have a benign course, only 2/54 or 3.7% required a pyeloplasty. 2) Invasive investigations like an MCU are not necessary in most cases. 3) Routine antibiotic prophylaxis is not required in all unilateral cases and in bilateral ones after VUR has been excluded.

Antibiotic Prophylaxis↗