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Hydronephrosis
Jennifer Schroeder, MD; Amie M. McPherson, MD; Paige Bennett, MD
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KEY FACTS

  • Imaging

    • Clinical Issues

      TERMINOLOGY

      • Definitions

        • Hydronephrosis
          • Dilation of renal collecting system and renal enlargement due to obstruction of urinary outflow
            • Anatomic/physical or mechanical obstructive causes: Ectopic ureter, ureteral stenosis, ureteropelvic junction (UPJ) stenosis, nephrolithiasis, mass
            • Functional causes: Failure of peristalsis, patulous system due to prior mechanical obstruction
          • May persist after obstruction has resolved, making follow-up with anatomic imaging alone difficult
        • Renal scintigraphy with Tc-99m MAG3
          • Characterizes hydronephrosis as mechanical ("obstructed") or functional ("nonobstructed")
            • Can also determine if mechanical obstruction is low grade or high grade
          • Estimates relative renal function
            • Percentage of function each kidney supplies to overall function (100% total)

      IMAGING

      • Nuclear Medicine Findings

        • Imaging Recommendations

          • Radiographic Findings

            • CT Findings

              • MR Findings

                • Ultrasonographic Findings

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      CLINICAL ISSUES

                      • Presentation

                        • Treatment

                          DIAGNOSTIC CHECKLIST

                          • Consider

                            Selected References

                            1. Bayne CE et al: Diuresis renography in the evaluation and management of pediatric hydronephrosis: What have we learned? J Pediatr Urol. 15(2):128-37, 2019
                            2. Jacobson DL et al: The correlation between serial ultrasound and diuretic renography in children with severe unilateral hydronephrosis. J Urol. 200(2):440-7, 2018
                            Related Anatomy
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                            Related Differential Diagnoses
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                            References
                            Tables

                            Tables

                            KEY FACTS

                            • Imaging

                              • Clinical Issues

                                TERMINOLOGY

                                • Definitions

                                  • Hydronephrosis
                                    • Dilation of renal collecting system and renal enlargement due to obstruction of urinary outflow
                                      • Anatomic/physical or mechanical obstructive causes: Ectopic ureter, ureteral stenosis, ureteropelvic junction (UPJ) stenosis, nephrolithiasis, mass
                                      • Functional causes: Failure of peristalsis, patulous system due to prior mechanical obstruction
                                    • May persist after obstruction has resolved, making follow-up with anatomic imaging alone difficult
                                  • Renal scintigraphy with Tc-99m MAG3
                                    • Characterizes hydronephrosis as mechanical ("obstructed") or functional ("nonobstructed")
                                      • Can also determine if mechanical obstruction is low grade or high grade
                                    • Estimates relative renal function
                                      • Percentage of function each kidney supplies to overall function (100% total)

                                IMAGING

                                • Nuclear Medicine Findings

                                  • Imaging Recommendations

                                    • Radiographic Findings

                                      • CT Findings

                                        • MR Findings

                                          • Ultrasonographic Findings

                                            DIFFERENTIAL DIAGNOSIS

                                              PATHOLOGY

                                              • General Features

                                                CLINICAL ISSUES

                                                • Presentation

                                                  • Treatment

                                                    DIAGNOSTIC CHECKLIST

                                                    • Consider

                                                      Selected References

                                                      1. Bayne CE et al: Diuresis renography in the evaluation and management of pediatric hydronephrosis: What have we learned? J Pediatr Urol. 15(2):128-37, 2019
                                                      2. Jacobson DL et al: The correlation between serial ultrasound and diuretic renography in children with severe unilateral hydronephrosis. J Urol. 200(2):440-7, 2018