HYDRONEPHROSIS IN INFANTS AND CHILDREN— VALUE OF HIGH DOSAGE EXCRETORY UROGRAPHY IN PREDICTING RENAL SALVAGEABILITY

¹ Department of Surgery (Urology), Albert Einstein College Hospital, Bronx, New York. Formerly: Fellow in Pediatric Urology, Columbia Presbyterian Medical Center, New York, New York.

A working classification of hydronephrosis, based on high dosage excretory urography, is presented.

The spectrum of hydronephrosis ranges from Grade I (acute obstruction in a previously normal kidney) through Grade II and III (longstanding obstruction with increasing renal damage) to Grade IV, a mere shell of nonfunctioning kidney.

The roentgenographic findings are well correlated with renal salvageability. Retrograde pyelography is rarely needed since high dosage excretory urography usually defines the site of obstruction.

The taking of early roentgenograms is stressed (including the nephrogram, the "crescent" sign of collecting tubule ectasia and the "scalloped" layering of contrast medium within dilated calcyes) with delayed roentgenograms showing the point of obstruction. All signs reflect ongoing glomerular filtration and salvageable renal tissue except in Grade IV where only a vascular "rim" is noted.

The correction of hydronephrosis (whether by antibiotics in the child with reflux due to infection or by surgery where actual obstruction exists) is aided by the contribution of high dose excretory urography in establishing an accurate diagnosis of the site and cause of the hydronephrosis.

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