MDCT-Based Grading of Perirenal Changes Secondary to Acute Unilateral Upper Urinary Tract Obstruction.

Background: Unilateral upper ureteral obstruction is one of the most common causes of acute kidney function impairment. Grading perirenal changes secondary to acute unilateral upper urinary tract obstruction (AUUTO) with multidetector spiral computed tomography (MDCT) and exploring its association with kidney function are useful for diagnosing and assessing damage to the ipsilateral kidney. However, the correlation between renal function impairment and the severity of perinephric changes secondary to AUUTO has not been reported.

Objective: This study aimed to investigate the association of perirenal changes secondary to AUUTO with hydronephrosis and serum creatinine levels, as well as white blood cell counts.

Methods: This retrospective study included 376 patients with acute unilateral upper ureteral obstruction, all of whom were subjected to MDCT scans. They were classified into four grades (0-III) according to their perirenal changes on MDCT images. The severity of hydronephrosis was classified into four grades based on MDCT scans. The serum creatinine level and leukocyte counts were compared among the MDCT grade groups, and logistic regression analysis was conducted.

Results: Among 376 patients, 77 (20.5%), 103 (27.4%), 140 (37.2%), and 56 (14.9%) cases were graded into MDCT 0, I, II, and III, respectively. The proportions of patients who had normal kidneys in MDCT 0, I, II, and III were 20 (26.0%), 10 (9.7%), 11(7.9%), and 3 (5.4%), respectively. The proportions of patients who had mild hydronephrosis in MDCT 0, I, II, and III were 55 (71.4%), 83 (80.6%), 118 (84.2%), and 46 (82.1%), respectively. The proportions of patients who had moderate and severe hydronephrosis in MDCT 0, I, II, and III were 2(2.6%), 10 (9.7%), 11 (7.9%), 7 (12.5%), respectively. Serum creatinine levels and white blood cell counts were significantly different among the MDCT grade groups (P < 0.001). Univariate and multivariate logistic regression analyses indicated that the serum creatinine level and white blood cell counts were positively associated with the MDCT grades (P < 0.001).

Conclusion: Perinephric changes secondary to AUUTO on MDCT images were associated with the degree of obstruction. The severity of perinephric changes can reflect the functional impairment in the ipsilateral kidney. The MDCT grades may aid clinicians in assessing renal function impairment early in patients with AUUTO, which may help patients receive early intervention and avoid the potential risk of infection and deterioration of renal function.