Diagnostic accuracy of Onen’s Alternative Grading System combined with Doppler evaluation of ureteral jets as an alternative in the diagnosis of obstructive hydronephrosis in children

PeerJ

article

Jose de Bessa Jr¹  Cicilia M. Rodrigues¹  Maria Cristina Chammas²  Eduardo P. Miranda³  Cristiano M. Gomes⁴  Paulo R. Moscardi⁴  Marcia C. Bessa⁵  Carlos A. Molina¹  Ricardo B. Tiraboschi¹  Jose M. Netto⁶  Francisco T. Denes⁴ 

[1] Division of Urology/Public Health, Medical School, Universidade Estadual de Feira de Santana;Department of Radiology, Medical School, Universidade de São Paulo;Division of Urology, Medical School, Universidade Federal do Ceará;Division of Urology, Medical School, Universidade de São Paulo;Division of Pediatrics, Medical School, Universidade Estadual de Feira de Santana;Division of Urology, Hospital e Maternidade Therezinha de Jesus of the School of Medical Science and Health of Juiz de Fora ,(HMTJ-SUPREMA), Universidade Federal de Juiz de Fora

关键词: Hydronephrosis;    Urinary tract obstruction;    Doppler ultrasound;    Diuretic renogram;    Children;    Diagnostic test;    Ureteral jets;    Grading system;   

DOI  :  10.7717/peerj.4791

学科分类：社会科学、人文和艺术（综合）

来源: Inra

【 摘 要 】

IntroductionUreteropelvic junction obstruction (UPJO) is a common congenital anomaly leading to varying degrees of hydronephrosis (HN), ranging from no apparent effect on the renal function to atrophy. Evaluation of these children is based on Diuretic Renal Scintigraphy (DRS) and Ultrasonography (US). Recent studies have suggested that new parameters of conventional and color Doppler ultrasonography (CDUS) may be useful in discriminating which kidneys are obstructed. The present study aims to assess the diagnostic accuracy of such parameters in the diagnosis of obstruction in children with UPJO.MethodsWe evaluated 44 patients (33 boys) with a mean age of 6.53 ± 4.39 years diagnosed with unilateral high-grade hydronephrosis (SFU grades 3 and 4). All underwent DRS and index tests (conventional US and CDUS to evaluate ureteral jets frequency) within a maximum interval of two weeks. Hydronephrotic units were reclassified according to the alternative grading system (AGS) proposed by Onen et al. Obstruction in the DRS was defined as a differential renal function 20 minutes after the administration of furosemide, and a plateau or ascending pattern of the excretion curve.ResultsNineteen hydronephrotic units (43.1%) were obstructed. Some degree of cortical atrophy—grades 3 (segmental) or 4 (diffuse)—was present in those obstructed units. AGS grades had 100% sensitivity, 76% of specificity and 86.4% of accuracy. The absence of ureteral jets had a sensitivity of 73.68%, a specificity of 100% with an accuracy of 88.6%. When we analyzed the two aspects together and considered obstructed the renal units classified as AGS grade 3 or 4 with no jets, sensitivity increased to 78.9%, accuracy to 92%, remaining with a maximum specificity of 100%. These features combined would allow us to avoid performing DRS in 61% of our patients, leaving more invasive tests to inconclusive cases.ConclusionsAlthough DRS remains the mainstay to distinguishing obstructive from non-obstructive kidneys, grade of hydronephrosis and frequency of ureteral jets, independently or in combination may be a reliable alternative in the mostly cases.This alternative approach has high accuracy, it is less invasive, easily reproducible and may play a role in the diagnosis of obstruction in pediatric population.

【 授权许可】

CC BY