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Urinary obstruction in azotemic patients: detection by sonography
K J Stuck1, G M White, D S Granke
1Department of Radiology, University of Michigan Medical School, Ann Arbor.
AJR. American Journal of Roentgenology
|December 1, 1987
Summary
Renal sonography rarely identifies urinary tract obstruction in patients without suggestive symptoms. This study found hydronephrosis in 9% of cases, but only 2.6% had clinically significant obstruction, highlighting the importance of clinical history in interpreting results.
Area of Science:
- Nephrology
- Radiology
- Urology
Background:
- Renal sonography is commonly used to evaluate elevated creatinine levels, often to rule out urinary tract obstruction.
- The clinical utility of renal sonography in patients with newly discovered azotemia or worsening renal failure requires further evaluation.
Purpose of the Study:
- To assess the diagnostic value of renal sonography in identifying urinary tract obstruction in patients presenting with azotemia or worsening renal failure.
- To determine the incidence of hydronephrosis and its correlation with clinically significant obstruction in this patient population.
Main Methods:
- A prospective study was conducted on 189 patients with newly discovered azotemia (creatinine > 1.8 mg/dl) or worsening renal failure.
- Patients with known obstructive uropathy, renal calculi, renal mass, or hematuria were excluded from the study.
- Renal sonography was performed to evaluate for hydronephrosis.
Main Results:
- Hydronephrosis was detected in 17 (9%) of the 189 patients.
- Of these, 11 had unilateral and six had bilateral hydronephrosis.
- Clinically significant obstruction was confirmed in only five patients (2.6%), all of whom had a strong clinical history suggestive of obstruction.
Conclusions:
- Renal sonography has limited utility in detecting clinically significant urinary tract obstruction in patients without a suggestive clinical history.
- The presence of bilateral hydronephrosis on sonography is uncommon in the absence of clinical indicators of obstruction.
- Clinical correlation is crucial for interpreting renal sonography findings in patients with elevated creatinine levels.