Fetal hydronephrosis: is there hope for consensus?

Toiviainen-Salo, Sanna; Garel, Laurent; Grignon, Andrée; Dubois, Josée; Rypens, Françoise; Boisvert, Jonathan; Perreault, Gilles; Décarie, Jean Claude; Filiatrault, D; Lapierre, Chantale; Miron, Marie-Claude; Bechard, Nancy

doi:10.1007/s00247-004-1185-9

Cited by 48 publications

(41 citation statements)

References 58 publications

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“…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).…”

Section: Discussionmentioning

confidence: 99%

Clinical Course of 822 Children with Prenatally Detected Nephrouropathies

Quirino

Diniz

Bouzada

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives With the advent of fetal screening ultrasonography, the detection of congenital anomalies of the kidney and urinary tract (CAKUT) in utero has permitted early management of these conditions. This study aims to describe the clinical course of a large cohort of patients with prenatally detected nephrouropathies.Design, setting, participants, & measurements In this retrospective cohort study, 822 patients were prenatally diagnosed with CAKUT and systematically followed up at a tertiary Renal Unit for a median time of 43 months. Variables included in the analysis were sex, laterality, fetal ultrasonography (isolated versus associated hydronephrosis), and presence/absence of nephrouropathies. The events of interest were urinary tract infection, surgical interventions, hypertension, CKD, and death. Survival analyses were performed to evaluate time until occurrence of the events of interest.Results Urinary tract infection occurred in 245 (29.8%) children, with higher risk in females (hazard ratio=1.30, 95% confidence interval=1.02-1.70, P=0.05); 22 patients (2.7%) had hypertension, and 49 (6%) patients developed CKD. The risk of CKD was greater in patients with associated hydronephrosis (hazard ratio=5.20, 95% confidence interval=2.90-9.30, P,0.001). Twelve patients (1.5%) died during follow-up. Death was significantly associated with being born during the first period of the study (hazard ratio=6.00, 95% confidence interval=1.60-22.50, P,0.001), associated hydronephrosis (hazard ratio=9.30, 95% confidence interval=2.90-29.30, P,0.001), and CKD (hazard ratio=170.00, 95% confidence interval=41.00-228.00, P,0.001).Conclusions In our series, the clinical course of prenatally detected CAKUT was heterogeneous, and those infants with associated hydronephrosis at baseline were identified as a high-risk subgroup.

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Section: Discussionmentioning

confidence: 99%

Clinical Course of 822 Children with Prenatally Detected Nephrouropathies

Quirino

Diniz

Bouzada

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…2,[13][14][15] The data presented here showed that in our perinatal region, fetal surveillance for ANH is available and accessible to all patients. Additionally, our data showed that the early recognition of conditions not compatible with survival and identification of cases whose ANH resolved before delivery was possible and that the antenatal diagnoses were accurate.…”

Section: Discussionmentioning

confidence: 66%

“…Many investigators, however, have not mentioned any loss of patients in their ANH programs. [4][5]7,10,14,[19][20] In one-fourth of cases, our MFM specialists recommended follow-up after birth with their pediatrician. As suggested by our data, half of these infants were deemed to be healthy and no postnatal renal US or other consultations were done.…”

Section: Discussionmentioning

confidence: 99%

Postnatal follow-up of antenatal hydronephrosis: a health-care challenge

et al. 2009

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Objective: To examine our experience with ANH and to determine the success of our postnatal follow-up program.Study Design: Charts of mothers and infants seen (2004 to 2008) at our Regional Perinatal Center were reviewed retrospectively. ANH was defined during the third trimester by anterior pelvic diameters as follows: mild 7 to 9, moderate 10 to 14 or severe X15 mm. Fetuses with multicystic dysplastic kidney (MCDK) were included. Result:Screening of approximately 15 000 ultrasound (US) reports identified 268 fetuses with ANH. After prenatal US surveillance, 88 (33%) fetuses had resolved, while 180 (67%) required postnatal follow-up. These 180 fetuses were diagnosed with mild 38 (21%), moderate 83 (46%) and severe 19 (11%) ANH, uni or bilateral hydroureters 12 (7%), MCDK 19 (10%) and miscellaneous 9 (5%). Postnatal follow-up was successfully established for 75% of infants with hydroureters, 68% for those with MCDK and for 37% of infants with mild, 53% with moderate and 58% with severe ANH. Factors commonly known to influence compliance were not found more frequently among the 91 infants who were lost to follow-up. The only positive predictor for postnatal follow-up was a prenatal consultation with the pediatric urologist. 1-4 The majority of these fetuses recover spontaneously but approximately 40% require postnatal follow-up, and in half of these cases, medical or surgical intervention was needed to prevent significant renal damage. The spectrum of genitourinary abnormalities detected antenatally is varied but the majority of patients have ANH.5 It is commonly accepted that no specific etiology can be identified in 48% of ANH cases.1-5 Physiologic changes are seen in 15%, ureteropelvic and ureterovesical junction obstructions account for 11% of the cases, 9% have vesicoureteral reflux, 4% have unilateral or bilateral megaloureters, 2% of all cases have multicystic dysplastic kidney (MCDK) and 1% have ureterocele. 1,3,6 Regardless of the cause, it is expected that about half of the ANH cases will resolve before delivery or during the first year of life. 2,6 For the other half there will be a need for postnatal follow-up as persistent uropathy is expected to occur in 12% of mild, 45% of moderate and 88% of severe ANH cases.

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“…With the increasing use of ultrasound in the prenatal evaluation from the mid 80's, hydronephrosis began to be diagnosed in intrauterine life [9][10][11] .…”

Section: Discussionmentioning

confidence: 99%

Postnatal evaluation of intrauterine hydronephrosis due to ureteropelvic junction obstruction

et al. 2013

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PURPOSE:Fetal hydronephrosis is a frequent finding due to advances in prenatal ultrasonography. The definition of fetal and neonatal urinary tract obstruction is a very difficult task requiring confirmation of reduced renal function and hydronephrosis. In this study we followed a series of consecutive patients with intrauterine hydronephrosis that persisted during post-natal life. METHODS:116 newborns with antenatal hydronephrosis diagnosed by ultrasound and submitted to a specific post-natal evaluative protocol with a follow-up period of 6 years. RESULTS:In 45 (38.8%) of 116 patients, ureteropelvic junction (UPJ) obstruction was confirmed and surgical correction of the UPJ obstruction was done in 19 patients. From 26 children who were initially submitted to non-surgical treatment, only 6 (23%) needed a surgical approach during follow up. Overall analysis showed that surgery was performed in 25 patients with UPJ obstruction, and the others 20 patients were kept under clinical observation, since normal renal function was confirmed by scintigraphy scans. CONCLUSION:Fetal hydronephrosis due to UPJ obstruction deserves careful postnatal evaluation. UPJ obstruction is the most frequent anomaly and its surgical treatment has very precise indications. The evaluative protocol was useful in identify patients that could be followed-up with a non-surgical approach.Key words: Hydronephrosis. Prenatal Diagnosis. Radionuclide Imaging. RESUMO OBJETIVO:Com a ampla utilização dos exames ultrassonográficos na avaliação pré-natal, é frequente o diagnóstico da hidronefrose fetal. A definição de obstrução do trato urinário no periodo pós-natal necessita da confirmação de redução da função renal além da hidronefrose. Neste estudo, acompanhamos uma série de pacientes consecutivos com hidronefrose intra-útero que persistiu no periodo pós-natal. MÉTODOS:116 recém-nascidos com hidronefrose pré-natal diagnosticada pela ultrassonografia foram submetidos a protocolo específico de avaliação e companhados pelo periodo de 06 anos. inicialmente para observação clínica, apenas 6 (23%) necessitaram cirurgia durante o seguimento ambulatorial. Na análise geral, o procedimento cirúrgico para correção da estenose da JUP foi indicado em 25 pacientes. Nas outras 20 crianças não houve necessidade da realização da cirurgia. RESULTADOS:CONCLUSÃO: a hidronefrose fetal requer cuidadosa avaliação pós-natal. A estenose da junção pielo-ureteral é a anomalia mais frequente como causa da hidronefrose, e sua correção cirúrgica tem indicações precisas. O protocolo aplicado foi útil em diferenciar pacientes que não necessitaram cirurgia para tratamento da estenose da JUP. Descritores:Hidronefrose. Diagnóstico Pré-natal. Cintilografia.

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Fetal hydronephrosis: is there hope for consensus?

Cited by 48 publications

References 58 publications

Clinical Course of 822 Children with Prenatally Detected Nephrouropathies

Clinical Course of 822 Children with Prenatally Detected Nephrouropathies

Postnatal follow-up of antenatal hydronephrosis: a health-care challenge

Postnatal evaluation of intrauterine hydronephrosis due to ureteropelvic junction obstruction

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