Antenatal diagnosis of urinary tract abnormalities by ultrasonography after 28 weeks' gestation: Incidence and outcome

Gunn, Tania R.; Mora, J D; Pease, P. W. B.

doi:10.1016/0002-9378(95)90560-x

Cited by 157 publications

(93 citation statements)

References 24 publications

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“…In the first series oi Gunn et al [8] as well fetal hydronephrosis without dilatation of the bladder was not diagnosed in any fetal examination before 28 weeks of ges tation. In a later study [12] dealing with the echography value, carried out only after 28 weeks (threshold value >15 mm), the rate of true positives amounted to 1.17% (45/4,856) for the detection of the urinary tract anomaly; this rate is altogether comparable to rates obtained in other studies carried out with a lower threshold and echographies done before 28 weeks of gestation (table 3). In a popula tion of 6,542 patients, Economou et al [13] detected 130 cases of pyelectasis measuring 2-3 mm at the 18-to 20-week echography.…”

Section: Fetal Pyelectasissupporting

confidence: 71%

Antenatal Diagnosis of Upper Urinary Tract Dilation by Ultrasonography

Langer¹,

Simeoni

Montoya³

et al. 1996

Fetal Diagn Ther

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The criteria for the detection of fetal pyelectasis are still controversial. Prenatal and postnatal data from 2,170 consecutive pregnant women who underwent at least one antenatal ultrasound scan were prospectively studied. Fetal pyelectasis was defined on the basis of a mean renal pelvis dimension > 5 or 10 mm before or after 28 weeks of gestation, respectively. Pyelectasis was detected in 95 (4.4%) fetuses. Eighty-nine among them were explored after birth. In 13 (13.7%) cases, an obstructive urinary tract abnormality, a severe vesicoureteral reflux, or a megaureter were diagnosed postnatally. In 29 (30.5%) cases, pyelectasis was confirmed postnatally, while complementary investigations ruled out an obstruction of the urinary tract. The incidence of urinary tract malformations was thus 0.60%, while the positive predictive value was 13.7%. We recommend to use a value not < 10 mm of the renal pelvis mean dimension beyond 28 weeks of gestation as a threshold for detection of fetal upper urinary tract obstruction, in the absence of ureteric and/or bladder dilation. Any value between 5 and 10 mm measured during the 2nd trimester of gestation should be confirmed by a second ultrasound examination performed during the 3rd trimester, before being considered pathological.

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Section: Fetal Pyelectasissupporting

confidence: 71%

Antenatal Diagnosis of Upper Urinary Tract Dilation by Ultrasonography

Langer¹,

Simeoni

Montoya³

et al. 1996

Fetal Diagn Ther

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“…This mouse phenotype is reminiscent of human congenital PUJO, a common birth defect that is sometimes associated with significant kidney damage caused by urinary flow impairment (Decramer et al, 2006;Gunn et al, 1995;Ismaili et al, 2006). PUJO ureters are not anatomically blocked, but have aberrantly arranged SM in the region where the proximal ureter joins the renal pelvis (dell'Agnola et al, 1990;Zhang et al, 2000).…”

Section: Tshz3 Mutant Is a Model For Functional Obstruction Linked Tomentioning

confidence: 99%

“…A dilated renal pelvis, or hydronephrosis, occurs in 0.9-7.7% of human gestations, the exact incidence depending on the criteria used to define the upper normal limit of the pelvic diameter (Ek et al, 2007;Gunn et al, 1995;Ismaili et al, 2006). Although most such dilatations are transient normal variants, others persist after birth and thus represent congenital malformations.…”

Section: Introductionmentioning

confidence: 99%

“…Although most such dilatations are transient normal variants, others persist after birth and thus represent congenital malformations. In this context, a common diagnosis is unilateral or, less often, bilateral pelvi-ureteric junction obstruction (PUJO), present in up to 0.3-0.4% of all babies (Ek et al, 2007;Gunn et al, 1995;Ismaili et al, 2006). PUJO ureters are not anatomically blocked but have aberrant SM arrangement where the proximal ureter joins the renal pelvis (dell'Agnola et al, 1990;Zhang et al, 2000).…”

Section: Introductionmentioning

confidence: 99%

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Teashirt 3 is necessary for ureteral smooth muscle differentiation downstream of SHH and BMP4

Lye²,

et al. 2008

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Ureteric contractions propel foetal urine from the kidney to the urinary bladder. Here, we show that mouse ureteric smooth muscle cell (SMC) precursors express the transcription factor teashirt 3 (TSHZ3), and that Tshz3-null mutant mice have congenital hydronephrosis without anatomical obstruction. Ex vivo, the spontaneous contractions that occurred in proximal segments of wildtype embryonic ureter explants were absent in Tshz3 mutant ureters. In vivo, prior to the onset of hydronephrosis, mutant proximal ureters failed to express contractile SMC markers, whereas these molecules were detected in controls. Mutant embryonic ureters expressed Shh and Bmp4 transcripts as normal, with appropriate expression of Ptch1 and pSMAD1/5/8 in target SM precursors, whereas myocardin, a key regulator for SMC differentiation, was not expressed in Tshz3-null ureters. In wild-type embryonic renal tract explants, exogenous BMP4 upregulated Tshz3 and myocardin expression. More interestingly, in Tshz3 mutant renal tract explants, exogenous BMP4 did not improve the Tshz3 phenotype. Thus, Tshz3 is required for proximal ureteric SMC differentiation downstream of SHH and BMP4. Furthermore, the Tshz3 mutant mouse model of 'functional' urinary obstruction resembles congenital pelvi-ureteric junction obstruction, a common human malformation, suggesting that TSHZ, or related, gene variants may contribute to this disorder.

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“…The estimated incidence of antenatal hydronephrosis is 1-5% and this is one of the most common antenatally detected ultrasound anomalies. [1][2][3][4] Though majority of the cases of antenatally detected hydronephrosis resolves spontaneously, some may be a marker of serious underlying urinary tract abnormalities such as pelviureteric junction obstruction (PUJO), vesicoureteralreflux (VUR), urethral obstruction, megaureters, posterior urethral valve etc. Hence strict postnatal followup becomes a necessity to prevent the subsequent morbidity and mortality due to chronic kidney diseases.…”

Section: Introductionmentioning

confidence: 99%

A study on postnatal evaluation and follow-up of infants with antenatally detected hydronephrosis

Balasankar

Balasubramanian

2017

Int J Contemp Pediatr

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Background: Antenatal hydronephrosis(ANH) has now become a frequent diagnosis with the increasing use of antenatal ultrasonography. Objective of present study was to evaluate and follow up infants with antenatally detected hydronephrosis and to determine whether there is significant correlation between anteroposterior renal pelvic diameter detected in antenatal USG and urinary tract anomalies detected postnatally.Methods: After obtaining an informed consent, all neonates with antenatal ultrasound showing hydronephrosis (n=80) were enrolled in the study. Postnatal ultrasound was done at 3 days ,1 month and 6 months of postnatal life. Atleast 6 months followup was done to look for spontaneous resolution or other significant pathology. Micturating cystourethrography/radionuclide scan done in selected cases.Results: Out of 80 cases ,43 had mild,24 had moderate and 13 had severe degrees of hydronephrosis.31 of them (9 mild,10 moderate and 12 with severe hydronephrosis) had postnatal anomaly detected.14 of them (1 mild, 4 moderate and 9 with severe hydronephrosis) underwent surgery. As the grade of antenatal hydronephrosis increases from mild, moderate to severe, the relative risk of postnatal anomaly and requirement of surgical intervention also increased (p value<0.0001).Conclusions: Antenatal hydronephrosis may be associated with significant postnatal urinary tract anomaly with risk quantified by the measurement of anteroposterior renal pelvic diameter(APPD).

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Antenatal diagnosis of urinary tract abnormalities by ultrasonography after 28 weeks' gestation: Incidence and outcome

Cited by 157 publications

References 24 publications

Antenatal Diagnosis of Upper Urinary Tract Dilation by Ultrasonography

Antenatal Diagnosis of Upper Urinary Tract Dilation by Ultrasonography

Teashirt 3 is necessary for ureteral smooth muscle differentiation downstream of SHH and BMP4

A study on postnatal evaluation and follow-up of infants with antenatally detected hydronephrosis

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