Grading and imaging modalities for hydronephrosis

1. MUHIMBILI UNIVERSITY OF HEALTH
AND ALLIED SCIENCES
RADIOLOGY DEPARTMENT
GROUP 1 PRESENTATION

2. HYDRONEPHROSIS
IMAGING AND GRADING

3. INTRODUCTION
• Hydronephrosis (plural: hydronephroses) is defined as dilatation of
the urinary collecting system of the kidney (the calyces, the
infundibula, and the pelvis).
• causative factors : RUNS Mnemonic
• R: retroperitoneal fibrosis
• U: urolithiasis
• N: neoplastic mass (cervical cancer)
• S: stenosis of pelvi-ureteric junction

4. Differential diagnosis
• renal sinus cysts
• extrarenal pelvis
• pseudohydronephrosis

5. IMAGING MODALITIES
• Abdominal ultrasound; more convenient, cheap, readily available,
less invasive and doesn’t emit radiations.
• Others;
• Abdominal CT
• magnetic resonance urography
• Intravenous pyelography
• Diuretic renography

6. grading system of hydronephrosis
Developed by the Society of Fetal Urology (SFU) was devised to assess
the degree of hydronephrosis. This particular system is thought to be
the most common in use and was originally designed for grading
neonatal and infant pelvicalyectasis:
• grade 0
• no dilatation, calyceal walls are apposed to each other.
• grade 1 (mild)
• dilatation of the renal pelvis without dilatation of the calyces (can also occur
in the extrarenal pelvis)
• no parenchymal atrophy

7. • grade 2 (mild)
• dilatation of the renal pelvis (mild) and calyces (pelvicalyceal pattern is
retained)
• no parenchymal atrophy
• grade 3 (moderate)
• moderate dilatation of the renal pelvis and calyces
• blunting of fornices and flattening of papillae
• mild cortical thinning may be seen
• grade 4 (severe)
• gross dilatation of the renal pelvis and calyces, which appear ballooned
• loss of borders between the renal pelvis and calyces
• renal atrophy seen as cortical thinning

12. COMPUTED TOMOGRAPHY

13. Intravenous urography

14. MAGNETIC RESONANCE RENOGRAPHY

15. DIURETIC RENOGRAPHY