Current management of infants with fetal renal pelvis dilation: a survey by French-speaking pediatric nephrologists and urologists

Abstract

To analyze the current management recommendations among French-speaking physicians treating infants with antenatal renal pelvis dilatation, we surveyed 83 pediatric nephrologists and 68 pediatric urologists by questionnaire. A total of 45 (54%) pediatric nephrologists and 38 (56%) pediatric urologists responded. The threshold for the diagnosis of abnormal fetal renal pelvis dilatation was significantly higher among pediatric urologists than nephrologists. All responders perform renal ultrasound examinations after birth. Postnatal renal pelvis dilatation was considered abnormal if the anteroposterior diameter was >/=11+/-1.9 mm by the pediatric urologists and >/=9+/-2.9 mm by the pediatric nephrologists ( P=0.003). Pediatric urologists were more likely than nephrologists to recommend routine voiding cystourethrography [41% versus 20% ( P=0.04)]. Mercaptoacetyl-triglycine renography was the most routinely used tool to achieve functional evaluation during follow-up among the responders. Pediatric urologists were more likely to recommend surgical treatment in dilated kidneys with initial function <40%. In conclusion, pediatric urologists had significantly higher thresholds for the detection of prenatal and neonatal renal pelvis dilatation. They also more frequently recommended routine voiding cystourethrography and surgical therapy of dilated kidneys with low function than pediatric nephrologists. The variability in attitudes is most probably due to the absence of clear guidelines based on prospective and controlled trials.

Outcome of Antenatal Hydronephrosis

“…Graziela et al determined the incidence of significant uropathy as 40.6% during the follow-up of 192 cases [16]. The incidence of significant uropathy varied from 30% to 40% in other studies conducted, which is in concordance with our results [10,17].…”

“…Renal scarring was defined as the image showing the distortion of renal contour, or a complete loss of radioactivity localization monitored on two Tc-99 DMSA scans performed at an interval of at least six months [10].…”

“…It is obvious that not all dilatations have the same clinical relevance; moreover, their antenatal and postnatal evolution varies [9]. Therefore, there has been controversy in the literature over the best work-up and follow-up after birth [10,11]. A recent meta-analysis concluded that children with mild antenatal hydronephrosis may have a risk of postnatal anomaly, however; further prospective studies are required to determine the optimal management of these children [4].…”

Clinical Course of 822 Children with Prenatally Detected Nephrouropathies

“…Therefore, there are still many controversies regarding the clinical significance of mild isolated ANH. Consequently, there has been an abundant and somewhat controversial literature about the best work-up and follow-up for these patients (29,30). A recent consensus statement from the Society for Fetal Urology recommends at least 1 year of follow-up for mild dilatation (31).…”

Natural history of bilateral mild isolated antenatal hydronephrosis conservatively managed

“…It is being diagnosed with increasing frequency due to the routine use of ultrasonography (US) in pregnancy and the improving resolution of US equipment [1][2][3][4]. Various criteria are used to define hydronephrosis, and the cut-off limits for defining mild hydronephrosis are also different [1,[5][6][7].…”