Revised guidelines on management of antenatal hydronephrosis

Abstract

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. Infants with vesicoureteric reflux 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.

The Rate Of Development Postnatal Obstructive Uropathy In Fetal Hydronephrosis

“…Birçok çalışmada US'nin birinci hafta ve birinci ayda tekrarı önerilmek-tedir (5,7,9,10). Genel yaklaşım çift taraflı olmayan üriner sistem dilatasyonlarında 3-10 gün arasında ilk US'yi yapmak şeklindedir (11,12).…”

Assessing Outcome of Antenatal Hydronephrosis- An Integrated Clinical Approach

“…[6] The severity of ANH was further graded into mild, moderate and severe based on 32 week foetal pelvic APD measured by fetal ultrasound ( Fig. 1) and as given in Table I.…”

Role of fetal renal pelvic dilatation - as a predictor of neonatal urological outcome

“…2 The collected data was entered in the Microsoft Excel sheet and analysed using proportions and suitable statistical test. Table 1 shows the distribution of the study subjects according to the sex of the baby.…”