Clinical outcome and follow-up of prenatal hydronephrosis

Abstract

Between 1987 and 1991, 160 hydronephrotic kidneys were diagnosed prenatally and confirmed postnatally in 100 infants. The aim of the study was to describe the natural history and management of primary hydronephrosis detected prenatally. We devised a new classification of obstructive uropathy outcome using ultrasonography and the diethylenetriamine penta-acetic acid scan. Accordingly, we classified the patients as having mild, moderate or severe hydronephrosis. Nine patients had pyeloplasties and 5 had ureteric reimplantations. We conclude that in most cases there is no need for immediate surgery, and that the initial approach to the management of congenital hydronephrosis should be conservative. We suggest that anti-bacterial prophylaxis be conventionally given to infants with vesicoureteral reflux and for the first 6 months of life to infants demonstrating moderate to severe newborn primary hydronephrosis.

A New Grading System for the Management of Antenatal Hydronephrosis

“…Our proposed grading system demonstrates for the first time, to our knowledge, that moderate APD values ($6-9 mm and $9-15mm) in combination with diffuse caliectasis are associated with subsequent surgical intervention. Consistent with our results, two previous studies have proposed the association of different APD ranges with aspects of the renal parenchyma, including caliectasis and parenchymal thinning, as a potentially more accurate diagnostic tool for postnatal assessment of ANH (13,14). In the first study, Grignon et al (13) applied such a grading system to the analysis of 92 hydronephrotic kidneys in utero.…”

“…We divided APD into quartiles generating four groups according to the measurement of the renal pelvis: (APD,6 mm, APD$6-9 mm, APD$9-15 mm, and APD.15 mm), similar to cut points reported in previous clinical studies (1,7,13,14). A combined grading system including each of the four APD groups plus the presence or absence of diffuse caliectasis was created.…”

“…As a result, current practice is far from uniform, often on the basis of physician or institutional individual practices. Previous studies have suggested that caliectasis may be associated with worse postnatal outcomes than pelviectasis without calyceal dilation (13)(14)(15). These studies proposed that the combination of APD grading and assessment of the renal parenchyma, including caliectasis and parenchymal thinning, could be a more predictive diagnostic tool for postnatal hydronephrosis.…”

Fetal hydronephrosis: postnatal management and follow up

“…A obstrução de junção pielo-ureteral é a uropatia mais freqüente em todas séries 15,16 . O segundo achado mais freqüente em nossa série foi de hidronefrose não obstrutiva.…”

Hidronefrosis perinatal: enfoque diagnostico

“…Por otro lado, no toda dilatacion de la via urinaria tiene, necesariamente, significado pato!6gico 5 . Cuando se clasifica adecuadamente la severidad de la hidronefrosis neonatal* basdndose en caracteristicas ecograTicas, radioI6gicas y cintigra~ficas, es posible pronosticar con bastante exactitud la evoluci6n de las alteraciones renales, reconocie"ndose en una serie a cerca de 30% de ninos cuya hidronefrosis fue no obstructiva sino mas bien mayoritariamente "transitoria", resolviendose al cabo de un corto periodo de seguimiento 17 . En el estudio mencionado, y otros tambien recientes 18 , el porcentaje de recien nacidos que finalmente requiri6 cirugia uro!6gica para descomprimir una uropatia obstructiva bordeaba en 10% del total de las hidronefrosis reconocidas antes de nacer, y correspondian principalmente a estenosis ureteropelvicas severas.…”