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Objective To investigate the value of morphological features in differentiating between tuberculous hydronephrosis and non-tuberculous obstructive hydronephrosis.Methods The abdominal enhanced-CT examination data of 33 patients with renal tuberculosis and 37 patients with non-tuberculous obstructive hydronephrosis were retrospectively collected.All patients were examined in Peking University First Hospital from September 2009 to November 2016 and confirmed by surgical pathology or clinical manifestation.The longest diameter and largest area of all dilated calices,the anteroposterior longest diameter and the area of renal pelvis at the renal hilum level were measured.The standard deviation of dilated calyx's longest diameter and largest area in each case,the ratio of the mean value of dilated calyx's longest diameter to the anteroposterior longest diameter of renal pelvis and the ratio of the mean value of dilated calyx's largest area to the area of renal pelvis were calculated.These data were compared between the two groups with the t test.Based on the ratio of dilated calyx's longest diameter and largest area to those of renal pelvis,receiver operating characteristic (ROC) curves were used to calculate cut-off values for diagnosis of tuberculous hydronephrosis.Results The standard deviation of dilated calyx's longest diameter and largest area were significantly different in the renal tuberculosis group and the non-tuberculosis group (P＜0.01).The ratio of dilated calyx's longest diameter and largest area to those of renal pelvis of tuberculosis group were significantly larger than those of non-tuberculous group (P＜0.01).ROC analysis of the ratio of dilated calyx's longest diameter to that of renal pelvis showed that the area under the curve was 0.87 (95％ confidence interval 0.77-0.94),the best cut-off point was 0.73,with 81.8％ sensitivity (27/33) and 81.1％ specificity (30/37).ROC analysis of the ratio of dilated calyx's largest area to that of renal pelvis,the area under the curve was 0.90 (95％ confidence interval 0.80-0.95),the best cut-off point was 0.42,with 81.8％ sensitivity (27/33) and 86.5％ specificity (30/37).Conclusions In tuberculous hydronephrosis,the dilatation of calices is more obvious than renal pelvis,and the size of dilated renal calices is remarkably different.In non-tuberculous obstructive hydronephrosis,the dilatation of renal pelvis is more obvious than calices,and the size of dilated renal calices is similar.The morphological differences are helpful in differentiating tuberculous and non-tuberculous hydronephrosis.
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Objective To explore the value of hydronephrosis volume measured by 64 slice CT scan, evaluating renal function in patients with obstructive hydronephrosis.Methods The patients performed with both single photon emission computed tomography(SPECT) renal dynamic imaging and 64 slice CT scan in three days were chosen, 176 cases included finally.The images of renal dynamic imaging were divided into normal renal function group, mild renal impairment group, moderate renal impairment group and severe renal impairment group according to glomerular filtration rate (GFR) measured by SPECT.At the same time, CT three-dimensional reconstruction technique has been used to measure the volume of hydronephrosis, compare the differences of hydronephrosis volume among these groups, and future analyze the correlation of hydronephrosis volume with renal GFR value.Results The hydronephrosis volume of the four groups were respectively (31.47±3.81) cm3,(83.43±7.81) cm3,(208.53±15.47) cm3 and (577.31±61.32) cm3.There was statistical significance among these groups (P<0.01),except between normal renal function group and mild renal impairment group.The volume of hydronephrosis showed positive correlations with renal GFR (r=-0.614).Conclusion The volume of hydronephrosis measured by 64 slice CT has positive correlation with GFR measured by SPECT, which could reflect renal function to some extent.
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Introducción: el ultrasonido diagnóstico prenatal realizado en los embarazos normales ha demostrado que por cada 500 embarazos debe aparecer una anomalía importante del tracto urinario. En diferentes situaciones puede sugerirse o recomendarse la interrupción del embarazo, que puede ser aceptado o rechazado por los padres. Objetivos: comparar el diagnóstico pre y posnatal, y valorar la evolución en 8 pacientes en los que se propuso la interrupción, pero el embarazo continuó. Resultados: en 6 de los fetos se propuso la interrupción por el diagnóstico de hidronefrosis bilateral; en uno, por quistes renales bilaterales, y en otro por hidronefrosis unilateral y displasia renal multiquística contralateral. En 2 recién nacidos hubo coincidencia total entre el diagnóstico prenatal y el posnatal, en uno con reflujo de alto grado se encontró ureterohidronefrosis bilateral en el estudio prenatal, mientras que en 2 solamente hidronefrosis; un paciente tiene megauréter bilateral no obstructivo, y otro pielectasia bilateral. En el feto que se plantearon los quistes renales bilaterales, el estudio posnatal mostró un doble sistema excretor derecho con el superior obstruido, y reflujo vesicoureteral grado III del inferior con riñón izquierdo normal. Durante el tiempo de seguimiento la conducta médica varió de acuerdo con el diagnóstico posnatal. Al concluir el período de seguimiento, un paciente tiene una enfermedad renal crónica etapa 3, y los 7 restantes tienen función renal conservada. Conclusiones: la indicación de interrupción del embarazo por el diagnóstico ultrasonográfico prenatal de una anomalía renal o de tracto urinario tiene un margen de error que es necesario seguir estudiando y buscar indicadores de alto riesgo vital, porque los factores predictivos no están bien precisados
Introduction: prenatal ultrasound diagnosis performed in normal pregnancies has shown that one significant urinary tract anomaly occurs per 500 pregnancies. Under different circumstances, termination of pregnancy may be suggested or recommended, which may be accepted or rejected by parents. Objectives: to compare the pre-and postnatal diagnoses, and to assess the progress in 8 patients who were recommended to terminate their pregnancies, but they rejected this idea. Results: in 6 cases, the termination of pregnancy was suggested on account of bilateral hydronephrosis diagnosis in their fetuses; in one case due to bilateral renal cysts diagnosis and in the other case due to unilateral hydronephrosis and contralateral multicystic renal dysplasia. There was full agreement between the prenatal and postnatal diagnoses in 2 newborns; in a neonate with high grade reflux, the prenatal study revealed bilateral ureterohydronephrosis whereas this study showed just hydronephrosis for other two fetuses. One patient has non-obstructive bilateral megaureter and the other presents bilateral pyelectasy. The fetus with bilateral renal cysts presented, according to the postnatal study, a double right excretory system, being the upper obstructed and the lower with grade III vesicoureteral reflux, but his left kidney was normal. In the follow-up period, the medical behavior varied according to the postnatal diagnoses. Upon finishing this period, one patient had phase III chronic renal disease and the other seven had preserved renal function. Conclusions: the indication of termination of pregnancy based on the prenatal ultrasonographic diagnosis of a renal or urinary tract anomaly has an error index that must be further studied, and it is necessary to look for high life risk indicators because the predictive factors are not well detailed