Color Doppler ultrasound (CDU) in the diagnosis of obstructive hydronephrosis in pregnant women.

PURPOSE: Color Doppler ultrasound (CDU) accuracy of kidneys and bladder in the diagnosis and treatment of hydronephrosis and/or renal colic in pregnancies was evaluated.

METHODS: Between January 2010 and September 2012, 234 pregnant women asymptomatic in 204 cases and with unilateral renal colic in 30 (median 26 years) were evaluated. A CDU of the urinary tract was performed using a sonograph GE Logiq 500 PRO with a multifrequency (3-5 MHz) convex probe. The following parameters were evaluated: resistive index (RI) of the arciform arteries of both kidneys and bilateral ureteric jets. A renal RI > 0.70 and/or a 10 % difference between the kidneys and an asymmetric and/or reduced ureteric jet from the ureteric orifices were considered as diagnostic of obstructive uropathy.

RESULTS: Overall incidence of hydronephrosis was equal to 27 % (63 out 234 cases); the incidence of hydronephrosis, RI > 0.70 and abnormal ureteric jet in asymptomatic vs symptomatic pregnant women was equal to 30.9 vs 50 %, 16.1 vs 50 %, 3 vs 60 % (p < 0.05), respectively. In the 63 pregnancies with asymptomatic hydronephrosis RI and ureteric jet evaluation were abnormal in 39 (19.1 %) and 6 cases (3 %), respectively. In the 30 pregnancies with renal colic conventional ultrasound vs CDU, findings were abnormal in 15 (50 %) vs 20 (66.7 %) (p = 0.015) cases, respectively.

CONCLUSIONS: Color Doppler ultrasound in pregnancies with hydronephrosis and/or renal colic improves conventional ultrasound accuracy; in fact, CDU adds a functional evaluation of the urinary tract when combined with clinical findings allows performing the appropriate management.