Natural history of bilateral mild isolated antenatal hydronephrosis conservatively managed

Alconcher, Laura; Tombesi, María Marcela

doi:10.1007/s00467-012-2113-0

Cited by 42 publications

(44 citation statements)

References 35 publications

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“…Alconcher et al [12] reported that 80% of units resolved within the first 12 months of life. Others have reported intervals to resolution of 13.4 months–17 months [2,3].…”

Section: Discussionmentioning

confidence: 99%

Resolution rate of isolated low-grade hydronephrosis diagnosed within the first year of life

Madden‐Fuentes¹,

McNamara²,

Nseyo³

et al. 2014

Journal of Pediatric Urology

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Objective Diagnosis of low-grade hydronephrosis often occurs prenatally, during evaluation after urinary tract infection (UTI), or imaging for non-urologic reasons within the first year of life. Its significance in terms of resolution, need for antibiotic prophylaxis, or progression to surgery remains uncertain. We hypothesized that isolated low-grade hydronephrosis in this population frequently resolves, UTIs are infrequent, and progression to surgical intervention is minimal. Patients and methods Children <12 months old diagnosed hydronephrosis (Society for Fetal Urology [SFU] grade 1 or 2) between January 2004 and December 2009 were identified by ICD9 code. Patients with other urological abnormalities were excluded. Stability of hydronephrosis, UTI (≥100,000 CFU/mL bacterial growth) or need for surgical intervention was noted. Results Of 1496 infants with hydronephrosis, 416 (623 renal units) met inclusion criteria. Of 398 renal units with grade 1 hydronephrosis, 385 (96.7%) resolved or remained stable. Only 13 (3.3%) worsened, of which one underwent ureteroneocystostomy. Of 225 renal units with grade 2 hydro-nephrosis, 222 (98.7%) resolved, improved or remained stable, three (1.3%) worsened, of which one required pyeloplasty. Only 0.7% of patients in the ambulatory setting had a febrile UTI. Conclusions Low-grade hydronephrosis diagnosed within the first year of life remains stable or improves in 97.4% of renal units. Given the low rate of recurrent UTI in the ambulatory setting, antibiotic prophylaxis has a limited role in management.

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“…Alconcher et al [12] reported that 80% of units resolved within the first 12 months of life. Others have reported intervals to resolution of 13.4 months–17 months [2,3].…”

Section: Discussionmentioning

confidence: 99%

Resolution rate of isolated low-grade hydronephrosis diagnosed within the first year of life

Madden‐Fuentes¹,

McNamara²,

Nseyo³

et al. 2014

Journal of Pediatric Urology

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“…Several authors support initial conservative treatment of bilateral UPJO when it is diagnosed prenatally [8, 9]. A previous study showed that spontaneous improvement can be expected in most bilateral cases [9]. However, no clear protocol was established in that study.…”

Section: Introductionmentioning

confidence: 77%

“…Therefore, the natural history and appropriate management of contralateral hydronephrosis has received little attention. Several authors support initial conservative treatment of bilateral UPJO when it is diagnosed prenatally [8, 9]. A previous study showed that spontaneous improvement can be expected in most bilateral cases [9].…”

Section: Introductionmentioning

confidence: 99%

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Predictive Factors of Contralateral Operation after Initial Pyeloplasty in Children with Antenatally Detected Bilateral Hydronephrosis Due to Ureteropelvic Junction Obstruction

Jiang¹,

Chen²,

Lin³

et al. 2018

Urol Int

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Objectives: This study was performed to analyze the predictive factors of a contralateral operation after initial pyeloplasty in patients with antenatally detected bilateral ureteropelvic junction obstruction. Methods: Patients with prenatally diagnosed bilateral ureteropelvic junction obstruction who underwent initial pyeloplasty (aged <12 months at initial pyeloplasty) were offered to participate in the study. Patients were recruited from January 2012 to December 2015. The anteroposterior renal pelvic diameter, parenchymal thickness, and calyceal dilatation were evaluated. Predictive factors of contralateral pyeloplasty after initial unilateral pyeloplasty were also examined. Results: In total, 82 patients were included in the study (mean age, 2.8 months). Among all patients who underwent initial pyeloplasty, additional contralateral pyeloplasty was required in 11 patients (13.4%). The outcome of contralateral hydronephrosis was assessed as resolution, persistence, or surgery. The median anteroposterior renal pelvic diameter and calyceal dilatation were significantly different among the groups (p < 0.001). Calyceal dilatation of ≥10 mm and a calyceal dilatation/parenchymal thickness ratio of ≥5 strongly suggested the likelihood of a contralateral operation. Conclusions: In most patients with bilateral ureteropelvic junction obstruction, improvement or resolution of contralateral hydronephrosis following initial unilateral pyeloplasty can be expected. Patients with contralateral calyceal dilatation >10 mm and the calyceal dilatation/parenchymal thickness ratio >5 are at higher risk of surgery.

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“…Se ha identificado que el riesgo de infección urinaria está presente aún hasta en el 9% de casos con hidronefrosis bilateral leve, además de no variar la presencia de reflujo vesicoureteral cuando la hidronefrosis es leve bilateral o unilateral 32 . Son diversos los resultados según el grupo estudiado, ya que mientras en algunos grupos hasta el 80% de los casos de hidronefrosis resuelven de forma espontánea, en otros se encuentran frecuentes complicaciones asociadas.…”

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Anomalías congénitas de los riñones y de las vías urinarias, una revisión de la literatura*

et al. 2017

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Proporcionar a los profesionales de la salud, conocimientos básicos en la detección, abordaje y seguimiento de las anomalías congénitas del riñón y de la vía urinaria. Materiales y métodos: Revisión no sistemática de la literatura, se accedió a las bases de datos PubMed, LILACS, Science Direct, Tripdatabase, Cochrane Library, Biblioteca Virtual en Salud y revistas de nefrología pediá- trica. Se incluyeron publicaciones de los últimos 25 años. Se utilizaron los términos MeSH “Congenital Anomalies of the Kidney and Urinary Tract, Hydronephrosis, risk factors, prenatal diagnosis, congenital abnormalities”. Resultados: Se han identificado dos importantes factores de riesgo para desarrollar estas patologías, el primero la Diabetes pregestacional, es decir“, aquella diabetes conocida previamente a la gestación, bien diabetes mellitus tipo 1 (DM1), diabetes mellitus tipo 2 (DM2) o intolerancia a los carbohidratos”, en segundo lugar el bajo o tardío consumo de micronutrientes de la gestación. Conclusiones: La diabetes mellitus pregestacional y el bajo consumo de micronutrientes antes o durante la gestación, se ven relacionado con el desarrollo de las anomalías renales y de la vía urinaria en el feto, aunque no las explican en la mayoría de casos.

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Natural history of bilateral mild isolated antenatal hydronephrosis conservatively managed

Abstract: Antibiotic prophylaxis and VCUG are not mandatory in newborns with bilateral mild isolated antenatal hydronephrosis, but clinical and ultrasound follow-up are recommended during the first year of life.

Cited by 42 publications

References 35 publications

Resolution rate of isolated low-grade hydronephrosis diagnosed within the first year of life

Resolution rate of isolated low-grade hydronephrosis diagnosed within the first year of life

Predictive Factors of Contralateral Operation after Initial Pyeloplasty in Children with Antenatally Detected Bilateral Hydronephrosis Due to Ureteropelvic Junction Obstruction

Anomalías congénitas de los riñones y de las vías urinarias, una revisión de la literatura*

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