IRNA NUR SYAFINAZ ALI ZAINI 08-5-25 HYDRONEPHROSIS IN CHILDREN : GRADING AND ITS IMPORTANCE

Hydronephrosis is graded on a scale from zero to four, with zero being no hydronephrosis and four

being severe. Grading System of Society for Fetal Urology (SFU) Propose 5 points numerical grading system based on the postnatal appearance of the renal pelvis, calyces, and renal parenchyma.

IRNA NUR SYAFINAZ ALI ZAINI 08-5-25 HYDRONEPHROSIS IN CHILDREN : GRADING AND ITS IMPORTANCE

SFU Grade 0 1

Pattern of renal sinus splitting

No splitting. Urine in pelvis barely splits sinus. Dilatation of the renal pelvis without dilatation of the calices. Prominent reflex of the renal sinus without signs of parenchymal atrophy. Urine fills intrarenal pelvis. Dilatation of the renal pelvis and calices. Attenuated sinus reflex. No signs of parenchymal atrophy. Urine fills extrarenal pelvis. Major calyces dilated. SFU Gr 2 and minor calyces uniformly dilated and parenchyma preserved. Missing or marginal sinus reflex. Minor signs of organ atrophy present (flat papillae and blunt fornices). SFU Gr 3 and parenchyma thin. Massive dilatation of the renal pelvis and calices. Borders between renal pelvis and calyces are missing. Significant signs of renal atrophy (thin parenchyma).

2 3

IRNA NUR SYAFINAZ ALI ZAINI 08-5-25 HYDRONEPHROSIS IN CHILDREN : GRADING AND ITS IMPORTANCE

Importances of Grading The degree of hydronephrosis is used to assist in decision making with regard to treating the underlying cause of the hydronephrosis and the ultimate prognosis of patients. More severe grades of hydronephrosis are associated with closer pediatric urology follow-up. For example, grade III and IV hydronephrosis (not due to vesicoureteral reflux) typically require a renal scan.

IRNA NUR SYAFINAZ ALI ZAINI 08-5-25 HYDRONEPHROSIS IN CHILDREN : GRADING AND ITS IMPORTANCE

Typically, non-obstructive hydronephrosis (ie, hydronephrosis secondary to dilation at the ureterovesical junction, the place where the ureter meets the bladder; Grade I to III hydronephrosis secondary to uretero-pelvic junction type hydronephrosis do not need surgical intervention and resolve over time. The timing of resolution depends on the severity of the hydronephrosis and is different for each child. Children diagnosed with dilation from uretervesical junction abnormalities called megaureters rarely need surgical repair. Patients with grade IV hydronephrosis (severe) are the most likely to require surgery to prevent renal damage and recurrent infection.

REFERENCES 1. http://urology.ucsf.edu/patient-care/children/Hydronephrosis 2. http://www.urology-textbook.com/hydronephrosis.html 3. http://www.uab.edu/images/peduro/SFU/sfu_grading_on_web/sfu_grading_on_web.htm