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Hydronephrosis grading Mild hydronephrosis In mild hydronephrosis, the renal papillae — the point of transition between pyramids and minor calyces — are preserved while the major calyces are enlarged due to increased urinary volume and pressure. Sonographically, this appears as an anechoic triangle at the renal pelvis, tapering to the proximal junction with the ureter. Moderate hydronephrosis Moderate hydronephrosis is characterized by further dilation of the calyces, obliteration of the renal papillae, and blunting and rounding of the pyramids.
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