Antenatal ultrasonography to detect fetal renal abnormalities: a prospective screening programme.

Livera, L N; Brookfield, D. S. K.; Egginton, J. A.; Hawnaur, JM

doi:10.1136/bmj.298.6685.1421

Cited by 195 publications

(24 citation statements)

References 10 publications

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“…The prevalence of congenital anomalies of the kidney and the urinary tract as detected during the antenatal period has been reported as being between 0.1% and 0.7%. [ 3 4 5 ] There is a major paucity of literature related to the prevalence of antenatally diagnosed kidney and urinary tract anomalies in Saudi Arabia. The high rate of consanguinity marriages in Saudi Arabia[ 6 ] compared to the developed countries necessitates recognition of the prevalence and pattern of these anomalies in order to take the appropriate steps in prevention and management, thereby reducing end-stage renal disease in Saudi society.…”

Section: Introductionmentioning

confidence: 99%

Antenatal diagnosis, prevalence and outcome of congenital anomalies of the kidney and urinary tract in Saudi Arabia

Bondagji

2014

Urol Ann

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Objective:To study the prevalence, pattern of distribution, and the outcome of different types of kidney and urinary tract anomalies (CAKUT) diagnosed during the antenatal period. The second objective is to test the accuracy of antenatal diagnosis of CAKUT.Materials and Methods:In a cross-sectional hospital-based study, all cases diagnosed antenatally with urinary tract anomalies at King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia, were studied. The prevalence, pattern of distribution, and immediate postnatal outcomes, in addition to the accuracy of antenatal diagnosis, of those cases are reported.Results:One hundred and forty-one cases of urinary tract anomalies were antenatally diagnosed; postnatal diagnosis was confirmed in 128 cases (90.1%). The prevalence of CAKUT in our population is 3.26 per 1000 births. The most common abnormalities detected were hydronephrosis, polycystic kidney disease, multicystic dysplastic kidney, and renal agenesis, in descending order of frequency. The perinatal mortality rate among fetuses with CAKUT is 310 per 1000, the majority of these cases (90%) occurred in cases with renal parenchyma involvement.Conclusions:The prevalence of different types of CAKUT is higher than that reported in developed countries. Urinary tract anomalies can be accurately diagnosed and classified in the antenatal period using ultrasonography imaging. Antenatal diagnosis is a helpful tool in planning immediate postnatal care and deciding the place for delivery. This might prevent or slow renal function deterioration and help in early identification of patients who need early surgical intervention.

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Section: Introductionmentioning

confidence: 99%

Antenatal diagnosis, prevalence and outcome of congenital anomalies of the kidney and urinary tract in Saudi Arabia

Bondagji

2014

Urol Ann

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“…Other studies confirm that the severity of hydronephrosis correlates positively with postnatal hydronephrosis, need for surgery and risk of UTI, and negatively with spontaneous resolution. [5723252728] While fetuses with minimal pelvic dilatation (5-9 mm) have low risk of postnatal pathology,[2930] APD > 15 mm at any gestation represents severe hydronephrosis and requires close follow-up. [7822232531–33]…”

Section: Antenatal Evaluation and Monitoringmentioning

confidence: 99%

“…[432] Patients with persistence or worsening hydronephrosis in the third trimester show higher rates of postnatal pathology and require close follow-up. [45621233262] Sairam et al ., found that 88% cases with mild ANH resolved in utero or neonatal period, while one in three neonates with moderate to severe hydronephrosis persisting in the third trimester required postnatal surgery. [6] Hence, an ultrasound in the third trimester is valuable for identifying fetuses that require postnatal evaluation and follow-up.…”

Section: Antenatal Evaluation and Monitoringmentioning

confidence: 99%

“…[76] Patients with persistent postnatal hydronephrosis require additional evaluation, the intensity of which is determined by the severity of findings. [15710] A systematic review of 31 studies concluded that the risk of postnatal pathology was 10.8% in infants with a normal postnatal ultrasound, compared to 54.7% in those with persisting hydronephrosis. [11] In another study, the negative predictive value of a normal postnatal ultrasound for UTI was 98.9%.…”

Section: Postnatal Evaluation and Managementmentioning

confidence: 99%

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Revised guidelines on management of antenatal hydronephrosis

Sinha

Bagga

Krishna³

et al. 2013

Indian J Nephrol

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Widespread antenatal screening has resulted in increased detection of anomalies of the kidneys and urinary tract. The present guidelines update the recommendations published in 2000. Antenatal hydronephrosis (ANH) is transient and resolves by the third trimester in almost one-half cases. The presence of oligohydramnios and additional renal or extrarenal anomalies suggests significant pathology. All patients with ANH should undergo postnatal ultrasonography; the intensity of subsequent evaluation depends on anteroposterior diameter (APD) of the renal pelvis and/or Society for Fetal Urology (SFU) grading. Patients with postnatal APD exceeding 10 mm and/or SFU grade 3-4 should be screened for upper or lower urinary tract obstruction and vesicoureteric reflux (VUR). Infants with VUR should receive antibiotic prophylaxis through the first year of life, and their parents counseled regarding the risk of urinary tract infections. The management of patients with pelviureteric junction or vesicoureteric junction obstruction depends on clinical features and results of sequential ultrasonography and radionuclide renography. Surgery is considered in patients with increasing renal pelvic APD and/or an obstructed renogram with differential renal function <35-40% or its subsequent decline. Further studies are necessary to clarify the role of prenatal intervention, frequency of follow-up investigations and indications for surgery in these patients.

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“…Fetal hydronephrosis (HN) is the most common anomaly detected on antenatal ultrasonography, with an estimated prevalence of approximately 2–5.5% [ 1 – 3 ]. In most cases, HN is diagnosed in the absence of urinary tract obstruction, when the anteroposterior diameter of the renal pelvis is just above the normal range for gestational age [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Appropriate timing of performing abdominal ultrasonography and termination of follow-up observation for antenatal grade 1 or 2 hydronephrosis

et al. 2020

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Background Most cases of antenatal the Society of Fetal Urology (SFU) grade 1or 2 hydronephrosis (HN) improve or resolve spontaneously with conservative treatment. However, there is no consensus on the duration of follow-up for cases of grade 1or 2 HN. The aim of this study was to determine the need for continuous follow-up period and new management of children with antenatal grade 1or 2 HN. Methods Subjects underwent ultrasonographic assessment for HN according to the SFU classification. We retrospectively evaluated 112 patients with postnatal grade 1 HN and 69 with grade 2 HN using abdominal ultrasonography between January 2010 and December 2017. We examined the change in HN grade on repeat ultrasonography. Kaplan–Meier method was used to show the effect of HN grade on the rate of HN changes. Results The mean follow-up duration was 44.9 ± 36.4 months (range 12–274). Initial SFU grade 1 HN disappeared in 47.0% of cases at 12 months, 66.4% at 24 months and 73.2% at 48 months. Initial SFU grade 2 HN showed improvement in grade in 74.7% of cases at 12 months, 88.3% at 24 months and 89.5% at 48 months. However, 14.6% of SFU grade 1 and 2.8% of SFU grade 2 cases increased in grade and of the 17 cases, 16 cases worsened within the first 6 months. No cases with increased grade required pyeloplasty. Initial disappearance and later reappearance of HN occurred in 40.5% of SFU grade 1 and 2 cases. The mean duration of later reappearance of HN was 39.1 ± 36.2 months (range 12–137). No cases showed reappearance of HN after more than 1 year. Conclusions Ultrasonography within the first 6 months was necessary for management of children with antenatal grade 1or 2 HN, because some patients showed worsening. After that, it is considered safe to spread the follow-up interval for stable cases. Most cases of grade 1or 2 HN resolved spontaneously, however a few cases reappeared within 1 year. Therefore, ultrasonography after 1 year was necessary in children with HN that spontaneously disappeared. The appropriate time to end the follow-up was considered to have been after 1 year or more has passed since the disappearance was confirmed.

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Antenatal ultrasonography to detect fetal renal abnormalities: a prospective screening programme.

Cited by 195 publications

References 10 publications

Antenatal diagnosis, prevalence and outcome of congenital anomalies of the kidney and urinary tract in Saudi Arabia

Antenatal diagnosis, prevalence and outcome of congenital anomalies of the kidney and urinary tract in Saudi Arabia

Revised guidelines on management of antenatal hydronephrosis

Appropriate timing of performing abdominal ultrasonography and termination of follow-up observation for antenatal grade 1 or 2 hydronephrosis

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