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Renal pyramid thickness as a metric to predict obstruction in patients with congenital non-refluxing megaureter
Abigail B. George, MD1, Christopher Cooper, MD2, Theresa Kluthe, MS1, Angelena Edwards, MD1.
1University of Louisville, Louisville, KY, USA, 2University of Iowa, Iowa City, IA, USA.
BACKGROUND: Early identification of obstruction in pediatric patients with congenital hydroureteronephrosis is an ongoing clinical concern. Renal medullary pyramid thickness (PT) with isolated hydronephrosis is a marker of obstruction and predictor of renal function and pyeloplasty. The aim of this study is to determine the prognostic value of PT in predicting clinically significant obstruction in patients with congenital non-refluxing megaureter.
METHODS: A retrospective chart review of children with hydroureteronephrosis from 2007-2021 was performed. Inclusion criteria include diagnosis of hydroureteronephrosis with initial renal ultrasound performed >48 hours and prior to 4 months of life, as well as a voiding cystourethrography and nuclear renography. Exclusion criteria include vesicoureteral reflux, ureteropelvic junction obstruction, ureteral duplication, ureterocele, bladder or urethral abnormalities.
RESULTS: 44 patients (8 female, 36 male) including 6 (13.6%) with bilateral hydroureteronephrosis were included for a total of n=50 affected kidneys and n=38 normal contralateral kidneys who met inclusion criteria. PT was smaller in affected kidneys (p<0.001). PT and APD were inversely correlated in affected kidneys (p=0.024). Patients who underwent conservative management had larger PT (p=0.005) and smaller APD (p=0.001) at their follow-up. In SFU Grade 3-4 kidneys, the optimal cutoff values of PT, distal ureteral diameter, and APD on the first post-natal ultrasound beyond 48 hours for predicting surgical intervention was 2.8mm,7.6mm, and 1.9cm, respectively.
CONCLUSIONS:There was a significant difference in the PT of the affected kidney with hydroureteronephrosis, compared to the contralateral normal kidney. PT was inversely correlated with APD and increased in patients undergoing conservative management. PT
< 2.8 mm was identified as an independent risk factor for predicting surgical intervention.
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