Livoa LogoLivoa
GRAY-PUJO Algorithm
Grey-zone Risk-stratified Analysis for Young patients with PUJO
Antenatal Hydronephrosis
Serial Ultrasounds
± VCUG
Diuretic Renogram ± Cortical Transit Time
Grey Zone Surveillance
Stable DRF (40-60%) Trough CTT Normal Cortex
Renal Elastography Baseline + Follow-Up
● Trend USG + SWE ● Patient Factors
Improvement → Continue Follow-Up
Deterioration → Surgery
High-Risk or Declining
DRF < 40% Fall > 10% Delayed Drainage
Thinning Cortex Infections / Pain
Early Pyeloplasty ± Stent / Nephrostomy
High-Risk Special Cases
Solitary Kidney
Bilateral PUJO
Stone or VUR
Ectopic / Horseshoe Dual Obstruction (PUJO + VUJ)
Prioritise Drainage Stage Surgery
Consider function, drainage, and patient risk equally – Operate timely, not too soon or too late.

SK

by SAN

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