{"id":1256,"date":"2018-03-03T00:49:09","date_gmt":"2018-03-03T00:49:09","guid":{"rendered":"http:\/\/emultrasound.sdsc.edu\/?p=1256"},"modified":"2020-07-21T23:59:44","modified_gmt":"2020-07-21T23:59:44","slug":"hydro-grading","status":"publish","type":"post","link":"https:\/\/emultrasound.ucsd.edu\/index.php\/2018\/03\/03\/hydro-grading\/","title":{"rendered":"Can The Degree of Hydronephrosis on Ultrasound Predict Kidney Stone Size?"},"content":{"rendered":"<div class=\"mp-row-fluid motopress-row mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-clmn mp-span12  mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-text-obj\">\n<h2 style=\"text-align: center;\">Background<\/h2>\n<p style=\"text-align: center;\"><span style=\"vertical-align: inherit;\"><span class=\"goog-text-highlight\" style=\"vertical-align: inherit;\"><span style=\"font-size: 1rem;\">Symptomatic renal colic is a common complaint presenting to the emergency department (ED), with a rate of 126 to 226 per 100,000 ED visits [1]. In the ED, CT is frequently used to make the definitive diagnosis as it allows for determination of stone size and location, degree of hydronephrosis, and evaluation of other pathology that may mimic renal colic. However this is a particularly worrisome approach in patients with recurrent ureteral stones who have been exposed to numerous previous CT imaging studies. Previous data has shown that emergency physician performed ultrasound is accurate at identifying hydronephrosis, which in combination with hematuria, is sufficient for the diagnosis of renal colic [2,3]. Furthermore,&nbsp; an ultrasound first approach has been shown to be safe and reasonable as an initial evaluation for suspected renal colic [4]. What ultrasound does not tell us about renal colic is the size of the ureteral stone, which can be useful in determining the need for immediate intervention versus medical management. The following study seeks to determine if the degree of hydronephrosis seen on ultrasound performed by emergency physicians, can be predictive of ureteral stone size.&nbsp;<\/span><\/span><\/span><\/p>\n<p style=\"text-align: center;\"><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20837260\" target=\"_blank\">Can the degree of hydronephrosis on ultrasound predict kidney stone size?<\/a><\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"mp-row-fluid motopress-row mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-clmn mp-span12  mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-accordion-obj motopress-accordion motopress-accordion-dark\" data-atts=\"{&quot;active&quot;:&quot;false&quot;,&quot;collapsible&quot;:true,&quot;header&quot;:&quot;&gt; div &gt; h3&quot;,&quot;heightStyle&quot;:&quot;content&quot;}\">\n<div class=\"motopress-accordion-item\"><h3>Clinical Question<\/h3><div>\n<p>Can the degree of hydronephrosis on ultrasound predict kidney stone size?<\/p>\n<\/div><\/div>\n<div class=\"motopress-accordion-item\"><h3>Methods &amp; Study Design<\/h3><div>\n<ul>\n<li><strong>Design<\/strong>\n<ul>\n<li>Retrospective chart review of emergency department (ED) patients at a single academic medical center<\/li>\n<\/ul>\n<\/li>\n<li><strong>Population + Inclusion Criteria\u00a0<\/strong>\n<ul>\n<li>Adult patient presenting to the emergency department who had confirmed ureterolithiasis on noncontrast CT and a focused emergency renal ultrasound performed<\/li>\n<\/ul>\n<\/li>\n<li><strong>Exclusion criteria<\/strong>\n<ul>\n<li>No specific criteria<\/li>\n<\/ul>\n<\/li>\n<li><strong>Intervention<\/strong>\n<ul>\n<li>A focused renal ultrasound was performed in the ED by an emergency medicine resident or attending to evaluate for the presence of hydronephrosis as an indicator of obstructive ureterolithiasis<\/li>\n<li>All ultrasound examinations were subsequently reviewed for quality assurance by an emergency ultrasound fellowship trained emergency physician<\/li>\n<\/ul>\n<\/li>\n<li><strong>Outcomes<\/strong>\n<ul>\n<li>Each focused renal ultrasound classified the degree of hydronephrosis as none, mild, moderate, or severe and this was compared to the ureteral stone size on noncontrast CT\n<ul>\n<li><em>Definitions<\/em>:\n<ul>\n<li><em>Mild hydronephrosis<\/em> was defined as enlargement of the calices withpreservation of the renal papillae<\/li>\n<li><span style=\"font-size: 1rem;\"><em>Moderate hydronephrosis<\/em> was defined as rounding of the calices with obliteration of the<\/span>renal papillae<\/li>\n<li><span style=\"font-size: 1rem;\"><em>Severe hydronephrosis<\/em> was defined as caliceal ballooning with cortical thinning<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Ureteral stone size was stratified into 2 groups, those 5mm or smaller and those larger than 5 mm, based on the likelihood of successfully spontaneous stone passage<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div><\/div>\n<div class=\"motopress-accordion-item\"><h3>Results<\/h3><div>\n<p><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-1259 size-full\" src=\"https:\/\/i0.wp.com\/emultrasound.sdsc.edu\/wp-content\/uploads\/2018\/03\/Screen-Shot-2018-03-02-at-3.02.54-PM.png?resize=525%2C195\" alt=\"\" width=\"525\" height=\"195\" srcset=\"https:\/\/i0.wp.com\/emultrasound.ucsd.edu\/wp-content\/uploads\/2018\/03\/Screen-Shot-2018-03-02-at-3.02.54-PM.png?w=548&amp;ssl=1 548w, https:\/\/i0.wp.com\/emultrasound.ucsd.edu\/wp-content\/uploads\/2018\/03\/Screen-Shot-2018-03-02-at-3.02.54-PM.png?resize=300%2C112&amp;ssl=1 300w\" sizes=\"auto, (max-width: 525px) 100vw, 525px\" \/><\/p>\n<p><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-1258\" src=\"https:\/\/i0.wp.com\/emultrasound.sdsc.edu\/wp-content\/uploads\/2018\/03\/Screen-Shot-2018-03-02-at-3.02.46-PM.png?resize=525%2C242\" alt=\"\" width=\"525\" height=\"242\" srcset=\"https:\/\/i0.wp.com\/emultrasound.ucsd.edu\/wp-content\/uploads\/2018\/03\/Screen-Shot-2018-03-02-at-3.02.46-PM.png?w=550&amp;ssl=1 550w, https:\/\/i0.wp.com\/emultrasound.ucsd.edu\/wp-content\/uploads\/2018\/03\/Screen-Shot-2018-03-02-at-3.02.46-PM.png?resize=300%2C139&amp;ssl=1 300w\" sizes=\"auto, (max-width: 525px) 100vw, 525px\" \/><\/p>\n<p>Increasing degree of hydronephrosis seen on focused ultrasound was associated with an increasing proportion of ureteral calculi larger than 5 mm. 113 (87.6%) patients with less severe hydronephrosis\u00a0 (none or mild) had ureteral calculi 5 mm or smaller. Of the remaining 16 (12.4%) patients with less severe hydronephrosis, none of these patients had ureteral stones larger than 10 mm. There was good interobserver agreement between the degree of hydronephrosis as determined by the performing emergency physician and the quality assurance review (k = 0.847).<\/p>\n<\/div><\/div>\n<div class=\"motopress-accordion-item\"><h3>Strengths &amp; Limitations<\/h3><div>\n<ul>\n<li><strong>Strengths<\/strong>\n<ul>\n<li>Majority of ultrasound examinations performed by ED physicians making this applicable to point-of-care ultrasound<\/li>\n<li>Gold standard was size of ureteral stone on noncontrast CT<\/li>\n<li>Good interobserver agreement between ED ultrasound operator and quality assurance review<\/li>\n<\/ul>\n<\/li>\n<li><strong>Limitations<\/strong>\n<ul>\n<li>Retrospective chart review<\/li>\n<li>This study only enrolled patients who both a focused renal ultrasound and confirmed ureterolithiasis on noncontrast CT; this would have missed patients who only had either a focused renal ultrasound or noncontrast CT alone (selection bias)<\/li>\n<li>No patient centered outcomes data<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div><\/div>\n<div class=\"motopress-accordion-item\"><h3>Authors Conclusion<\/h3><div>\n<p style=\"text-align: center;\">\"In conclusion, our results demonstrate a relationship between the degree of hydronephrosis as determined by emergency physicians on focused emergency ultrasound and ureteral calculi size; patients with less severe hydronephrosis were less likely to have larger ureteral calculi. This suggests that ultrasound can help identify many, but not all, patients who are at lower risk for having larger ureteral calculi.<span class=\"s1\">\u201d<\/span><\/p>\n<\/div><\/div>\n<div class=\"motopress-accordion-item\"><h3>Our Conclusion<\/h3><div>\n<p class=\"p2\" style=\"text-align: center;\"><span class=\"s1\">This paper identifies a correlation between the degree of hydronephrosis on ultrasound and ureteral stone size seen on noncontrast CT. Essentially, patients with minimal or no hydronephrosis are very unlikely to have have a large (>5 mm) ureteral stone. Unfortunately, focused ultrasound is not perfect, and in this study\u00a0 ~12.4% of patients with minimal or no hydronephrosis still had a large ureteral stone. What I found reassuring was that in this group, none of the patients had a ureteral stone > 10 mm, which at most institutions is the cut off for allowing a trial of passage. Even dissecting the data further, of the patients with moderate hydronephrosis, only 2 out of 43 (4.6%) patients had a stone > 10 mm. <\/span><\/p>\n<p class=\"p2\" style=\"text-align: center;\"><span class=\"s1\">This study suggests that focused renal ultrasound can be used to screen patients with suspected renal colic and potentially avoid an unnecessary CT scan. As with any focused ultrasound, the decision to obtain a CT should not be based solely the degree of hydronephrosis but also in conjunction with the clinical history, physical exam and other pertinent factors (previous ureteral stone, previous need for stone intervention, other concerning diagnoses on differential, pain control, institutional culture, urinalysis, etc).\u00a0<\/span><\/p>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"mp-row-fluid motopress-row mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-clmn mp-span12  mpce-prvt-449-595bfa801309a mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-text-obj\">\n<h2 style=\"text-align: center;\">The Bottom Line<\/h2>\n<h3 style=\"text-align: center;\"><span style=\"vertical-align: inherit;\"><span style=\"vertical-align: inherit;\">Ultrasound can be used to identify many, but not all, patients who are at lower risk for having larger ureteral calculi.\u00a0<\/span><\/span><\/h3>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"mp-row-fluid motopress-row mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-clmn mp-span12  mpce-dsbl-margin-left mpce-dsbl-margin-right\">\n<div class=\"motopress-accordion-obj motopress-accordion motopress-accordion-dark\" data-atts=\"{&quot;active&quot;:&quot;false&quot;,&quot;collapsible&quot;:true,&quot;header&quot;:&quot;&gt; div &gt; h3&quot;,&quot;heightStyle&quot;:&quot;content&quot;}\">\n<div class=\"motopress-accordion-item\"><h3>Authors<\/h3><div>\n<p>This post was written by Michael Macias, MD, Ultrasound Fellow at UCSD.<\/p>\n<\/div><\/div>\n<div class=\"motopress-accordion-item\"><h3>References <\/h3><div>\n<ol>\n<li style=\"list-style-type: none;\">\n<ol>\n<li>\n<p class=\"p1\">Teichman JMH. Clinical practice. Acute renal colic from ureteral calculus. N Engl J Med 2004;350:684-93.<\/p>\n<\/li>\n<li>\n<p class=\"p1\">Rosen CL, Brown DFM, Sagarin MJ, et al. Ultrasonography by emergency physicians in patients with suspected ureteral colic. J Emerg Med 1998;16:865-70.<\/p>\n<\/li>\n<li>\n<p class=\"p1\">Gaspari RJ, Horst K. Emergency ultrasound and urinalysis in the evaluation of flank pain. Acad Emerg Med 2005;12:1180-4.<\/p>\n<\/li>\n<li>Smith-Bindman R, e. (2018).\u00a0Ultrasonography versus computed tomography for suspected nephrolithiasis. - PubMed - NCBI\u00a0.\u00a0Ncbi.nlm.nih.gov. Retrieved 3 March 2018, from https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25229916<\/li>\n<li>S, G. (2018).\u00a0Can the degree of hydronephrosis on ultrasound predict kidney stone size? - PubMed - NCBI\u00a0.\u00a0Ncbi.nlm.nih.gov. Retrieved 3 March 2018, from https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20837260<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"Background Symptomatic renal colic is a common complaint presenting to the emergency department (ED), with a rate of 126 to 226 per 100,000 ED visits [1]. In the ED, CT is frequently used to make the definitive diagnosis as it allows for determination of stone size and location, degree of hydronephrosis, and evaluation of other &hellip; <p class=\"link-more\"><a href=\"https:\/\/emultrasound.ucsd.edu\/index.php\/2018\/03\/03\/hydro-grading\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> \"Can The Degree of Hydronephrosis on Ultrasound Predict Kidney Stone Size?\"<\/span><\/a><\/p>","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_eb_attr":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[5],"tags":[33,23,51],"class_list":["post-1256","post","type-post","status-publish","format-standard","hentry","category-journal-club","tag-hydronephrosis","tag-renal","tag-ureterolithiasis"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Can The Degree of Hydronephrosis on Ultrasound Predict Kidney Stone Size? - UCSD Ultrasound<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/emultrasound.ucsd.edu\/index.php\/2018\/03\/03\/hydro-grading\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Can The Degree of Hydronephrosis on Ultrasound Predict Kidney Stone Size? - UCSD Ultrasound\" \/>\n<meta property=\"og:description\" content=\"Background Symptomatic renal colic is a common complaint presenting to the emergency department (ED), with a rate of 126 to 226 per 100,000 ED visits [1]. In the ED, CT is frequently used to make the definitive diagnosis as it allows for determination of stone size and location, degree of hydronephrosis, and evaluation of other &hellip; Continue reading &quot;Can The Degree of Hydronephrosis on Ultrasound Predict Kidney Stone Size?&quot;\" \/>\n<meta property=\"og:url\" content=\"https:\/\/emultrasound.ucsd.edu\/index.php\/2018\/03\/03\/hydro-grading\/\" \/>\n<meta property=\"og:site_name\" content=\"UCSD Ultrasound\" \/>\n<meta property=\"article:published_time\" content=\"2018-03-03T00:49:09+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2020-07-21T23:59:44+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/emultrasound.sdsc.edu\/wp-content\/uploads\/2018\/03\/Screen-Shot-2018-03-02-at-3.02.54-PM.png\" \/>\n<meta name=\"author\" content=\"UCSD Ultrasound\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@ucsdsono\" \/>\n<meta name=\"twitter:site\" content=\"@ucsdsono\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"UCSD Ultrasound\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/2018\\\/03\\\/03\\\/hydro-grading\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/2018\\\/03\\\/03\\\/hydro-grading\\\/\"},\"author\":{\"name\":\"UCSD Ultrasound\",\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/#\\\/schema\\\/person\\\/b29066b4104637bc43b8a1c79c2cda34\"},\"headline\":\"Can The Degree of Hydronephrosis on Ultrasound Predict Kidney Stone Size?\",\"datePublished\":\"2018-03-03T00:49:09+00:00\",\"dateModified\":\"2020-07-21T23:59:44+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/2018\\\/03\\\/03\\\/hydro-grading\\\/\"},\"wordCount\":986,\"commentCount\":1,\"publisher\":{\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/2018\\\/03\\\/03\\\/hydro-grading\\\/#primaryimage\"},\"thumbnailUrl\":\"http:\\\/\\\/emultrasound.sdsc.edu\\\/wp-content\\\/uploads\\\/2018\\\/03\\\/Screen-Shot-2018-03-02-at-3.02.54-PM.png\",\"keywords\":[\"Hydronephrosis\",\"Renal\",\"Ureterolithiasis\"],\"articleSection\":[\"Journal Club\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/2018\\\/03\\\/03\\\/hydro-grading\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/2018\\\/03\\\/03\\\/hydro-grading\\\/\",\"url\":\"https:\\\/\\\/emultrasound.ucsd.edu\\\/index.php\\\/2018\\\/03\\\/03\\\/hydro-grading\\\/\",\"name\":\"Can The Degree of Hydronephrosis on Ultrasound Predict Kidney Stone Size? 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