Correlation of Pre-Operative Sonographic and Nuclear Scan Parameters with Intraoperative Renal Histopathology in Children with Congenital Pelviureteric Junction Obstruction
Iranian Journal of Pediatric Surgery,
Vol. 12 No. 1 (2026),
20 May 2026
,
Page 69 - 81
https://doi.org/10.22037/irjps.v12i1.49570
Abstract
Introduction: Congenital pelviureteric junction obstruction (PUJO) is a leading cause of pediatric hydronephrosis and potentially reversible renal dysfunction. Pre-operative imaging plays a crucial role in surgical decision-making, yet its correlation with histopathologic renal injury remains underexplored.
To evaluate the relationship between pre-operative sonographic and nuclear scan parameters with intraoperative renal histopathology in children with congenital PUJO and identify imaging predictors of significant renal damage.
Materials and Methods: A prospective observational study was conducted among 60 children (<12 years) with unilateral PUJO undergoing Anderson–Hynes pyeloplasty. Pre-operative ultrasound parameters—Society for Fetal Urology (SFU) grade, anterior–posterior pelvic diameter (APD), cortical thickness, and Doppler resistive index (RI)—and nuclear parameters—differential renal function (DRF), drainage half-time (T½), and renogram curve—were recorded. Renal cortical biopsies were graded using Elder’s histopathology scoring system. Significant histologic damage was defined as moderate/severe injury (score ≥6). Statistical correlations and ROC analyses were performed.
Results: High-grade hydronephrosis (SFU III–IV) was seen in 70%, APD ≥20 mm in 66.7%, and RI ≥0.70 in 45%. Nearly half had DRF <40%. On biopsy, 73.3% showed significant damage. Strong associations were observed for APD ≥20 mm (p=0.017), SFU ≥III (p=0.018), and RI ≥0.70 (p=0.030). ROC analysis showed fair predictive accuracy—AUC: SFU = 0.707, RI = 0.697, APD = 0.640.
Conclusion: SFU grade ≥ III, APD ≥ 20 mm, and RI ≥ 0.70 strongly correlate with histopathologic injury in PUJO and serve as practical, non-invasive predictors of parenchymal damage. Integrating these with renography may optimize surgical timing and preserve renal function.
- APD
- Histopathology
- PUJ Obstruction
- Resistive Index
- Ultrasound
How to Cite
References
1. Klein J, Gonzalez J, Miravete M, Caubet C, Chaaya R, Decramer S, et al. Congenital ureteropelvic junction obstruction: human disease and animal models. Int J Exp Pathol. 2011 June;92(3):168–92.
2. Viteri B, Calle-Toro JS, Furth S, Darge K, Hartung EA, Otero H. State-of-the-Art Renal Imaging in Children. Pediatrics. 2020 Feb;145(2): e20190829.
3. Passoni NM, Peters CA. Managing Ureteropelvic Junction Obstruction in the Young Infant. Front Pediatr. 2020 May 27; 8:242.
4. Hassan MG, Elmahdi TSA, Alotaibi M, Fallatah E, Nasser FA. Accuracy of Sonographic Renal Pelvic Diameter in Assessment of Renal Function among Patients with Ureteropelvic Junction Obstruction using Scintigraphy as a Gold Standard. Int J Med Sci. 2025 Jan 21;22(4):897–902.
5. Zhang D, Sun X, Chen X, Yu B, Li T, Cheng Y, et al. Ultrasound evaluation for prediction of outcomes and surgical decision in fetal hydronephrosis. Exp Ther Med. 2019 Aug;18(2):1399–406.
6. Nam JK, Lee SD, Chung MK. Modified Differential Renal Function Measurement Revised by Renal Cross-Sectional Area in Children with Ureteropelvic Junction Obstruction. Korean J Urol. 2010 Apr 1;51(4):271–5.
7. Lee H, Han SW. Ureteropelvic Junction Obstruction: What We Know and What We Don’t Know. Korean J Urol. 2009;50(5):423.
8. Sachpekidis C, Schepers R, Marti M, Kopp-Schneider A, Alberts I, Keramida G, et al. 99mTc-MAG3 Diuretic Renography: Intra- and Inter-Observer Repeatability in the Assessment of Renal Function. Diagnostics. 2020 Sept 17;10(9):709.
9. Kumar K, Ahmad A, Kumar S, Choudhry V, Tiwari RK, Singh M, et al. Evaluation of Renal Histopathological Changes, as a Predictor of Recoverability of Renal Function Following Pyeloplasty for Ureteropelvic Junction Obstruction. Nephro-Urol Mon. 2015 July 29;7(4): e28051.
10. Mohammad SA, Rawash LM, AbouZeid AA. Imaging of urinary tract in children in different clinical scenarios: a guide for general radiologists. Egypt J Radiol Nucl Med. 2021 Dec;52(1):205.
- Abstract Viewed: 8 times
- PDF Downloaded: 20 times