The grading system of hydronephrosis developed by the Society of Fetal Urology (SFU) was devised to assess the degree of hydronephrosis.
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Usage
This system is considered the most commonly used and was originally designed to grade neonatal and infant pelvicalyectasis ref.
Classification
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grade 0
no dilatation, calyceal walls are opposed to each other
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grade 1 (mild)
dilatation of the renal pelvis without dilatation of the calyces (can also occur in the extrarenal pelvis)
no parenchymal atrophy
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grade 2 (mild)
dilatation of the renal pelvis (mild) and calyces (pelvicalyceal pattern is retained)
no parenchymal atrophy
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grade 3 (moderate)
moderate dilatation of the renal pelvis and calyces
blunting of fornices and flattening of papillae
mild cortical thinning may be seen
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grade 4 (severe)
gross dilatation of the renal pelvis and calyces, which appear ballooned
loss of borders between the renal pelvis and calyces
renal atrophy seen as cortical thinning
All hydronephrosis grading systems are controversial in terms of their intra- and interobserver reliability 4.
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