Symptomatic Physiologic Hydronephrosis in Pregnancy

Puškar, Damir; Balagović, Ivica; Filipović, Amila; Knezović, Nikša; Kopjar, Miroslav; Huis, Marjan; Gilja, Ivan

doi:10.1159/000052449

Cited by 53 publications

(9 citation statements)

References 18 publications

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“…One such difference is the protocol used when both kidneys are being transplanted by the same center, for example Johnson et al 15 In addition to the difficulties posed by the short right renal vein, right kidneys themselves are shorter, 55 the parenchymal volume of the right kidney has been found to be significantly smaller than that of the left kidney 56 and right kidneys have been found to be more at risk of pregnancy related hydronephrosis and infection can lead to deterioration in function. 57 Any of these factors may negatively impact kidney function pre and post transplantation.…”

Section: Discussionmentioning

confidence: 99%

Comparing outcomes in right versus left kidney transplantation: A systematic review and meta‐analysis

Carolan

Tingle

Thompson

et al. 2021

Clinical Transplantation

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Introduction: Transplantation of right kidneys can pose technical challenges due to the short right renal vein. Whether this results in inferior outcomes remains controversial.Method: Healthcare Database Advanced Search (HDAS) was used to identify relevant studies. Two authors independently reviewed each study. Statistical analyses were performed using random effects models and results expressed as HR or relative risk (RR) with 95% confidence intervals. Subgroup analyses were performed in kidneys from deceased donors (DD) and living donors (LD).Results: A total of 35 studies (257,429 participants) were identified. Both deceased and living donor right kidneys were at increased risk of delayed graft function (DGF; RR = 1.12[1.06-1.18] and RR = 1.33[1.21-1.46] respectively; both p < .0001). In absolute terms, for each 100 kidney pairs of DD kidneys transplanted there are 2.72 (1.67-3.78, p < .00001) excess episodes of DGF in right kidneys. Graft thromboses and graft loss due to technical failure was also significantly more likely in right kidneys, in both DD and LD settings. There was no evidence that laterality alters long term graft survival in LD or DD. Conclusion:Right kidneys have inferior early outcomes, with higher rates of DGF, technical failure and graft thrombosis. However, these differences are small in absolute terms, and long-term graft survival is equivalent.

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Section: Discussionmentioning

confidence: 99%

Comparing outcomes in right versus left kidney transplantation: A systematic review and meta‐analysis

Carolan

Tingle

Thompson

et al. 2021

Clinical Transplantation

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“…Asymptomatic bacteriuria during pregnancy can lead to symptomatic UTI and have serious consequences both for the pregnant woman and her child (8,11,20) .…”

Section: Discussionmentioning

confidence: 99%

“…The higher propensity towards right kidney retention is due to the more superficial course of the right ureter and compression of a twisted uterus to the right as well as the protective effect of the sigmoid colon on the left ureter. Pyelectasis resolves up to a few weeks after delivery (8–12) .…”

Section: Introductionmentioning

confidence: 99%

Ultrasound screening for pyelectasis in pregnant women. Clinical necessity or “art for art’s sake”?

Szkodziak

2018

J Ultrason

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Renal pelvicalyceal dilatation is caused by urine retention in the upper urinary tract. It is referred to as pyelectasis in medical literature. This term does not indicate the cause that leads to the dilatation of and urine retention in the renal pelvicalyceal system. Mild pelvicalyceal dilatation during pregnancy is usually considered to be physiological in nature – it can occur in up to 90% of pregnant women. Retention is more common in the right kidney, in primigravidae, in the second half of pregnancy and in multiple pregnancies. Pyelectasis during pregnancy rarely causes clinical symptoms and often does not require treatment. Nevertheless, urine retention in the renal pelvicalyceal system is conducive to the development of asymptomatic bacteriuria and may be a risk factor for recurrent urinary tract infections, pyelonephritis and acute kidney failure; it may also cause renal colic. In consequence, this condition can lead to intrauterine infection and premature labor in the pregnant woman and to prematurity, anemia, congenital pneumonia or sepsis in the child. In a study conducted at the 3 rd Department of Gynecology of the Medical University of Lublin it was concluded that unilateral pyelectasis of more than 20 cm 3 is associated with a significant increase in the risk of asymptomatic bacteriuria. This volume corresponds to grade 3 and/or 4 pelvicalyceal dilatation according to the Society for Fetal Urology/European Federation of Societies for Ultrasound in Medicine and Biology classification. The pyelectasis volume measuring method using three-dimensional ultrasound scanning included in the criteria for the assessment of asymptomatic bacteriuria was assessed as sensitive and specific. The ultrasound-based evaluation of the kidneys for the presence of pyelectasis and its grade in pregnant women has some clinical implications. It allows for identifying cases with an increased risk of asymptomatic bacteriuria, which requires treatment in pregnant women. Screening during pregnancy for pyelectasis seems to be important in preventing asymptomatic bacteriuria from progressing to symptomatic urinary tract infection.

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“…Urosepsis due to obstructive uropathy is a rare complication of pregnancy [ 1 ], occasionally requiring placement of a percutaneous nephrostomy. Fluoroscopic antegrade pyelography may be indicated to determine the level and cause obstruction.…”

Section: Introductionmentioning

confidence: 99%

Water-enhanced antegrade MR pyelography in pregnancy: a novel radiation-free approach

et al. 2017

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Our aim was to determine if water-enhanced antegrade magnetic resonance (MR) pyelography can be an alternative to conventional antegrade pyelography in pregnant patients who require percutaneous nephrostomy placement for urosepsis and/or obstructive uropathy. The pregnant patient was placed supine in a 1.5-T MRI scanner seven days after percutaneous nephrostomy placement using ultrasound. Serial axial and coronal T2-weighted echo-planar fast spin-echo sequences were performed before and after injection of the catheter. The right nephrostomy catheter hub was sterilised using chlorhexidine. Sixty millilitres of sterile water were slowly injected. No Gd-based contrast agent was utilised due to safety concerns for the foetus. MR antegrade pyelography demonstrated the level of ureteric obstruction and the absence of renal calculi using sterile water as a contrast medium injected through a percutaneous nephrostomy followed by T2-weighted imaging. Air bubbles in the injected solution were differentiated from calculi due to their mobility on serial scans and their anti-dependent position. Water-enhanced antegrade MR pyelography was a safe and effective method of imaging the pregnant patient. It served as an alternative to conventional antegrade pyelography and minimised potential risks to the foetus.

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Symptomatic Physiologic Hydronephrosis in Pregnancy

Cited by 53 publications

References 18 publications

Comparing outcomes in right versus left kidney transplantation: A systematic review and meta‐analysis

Comparing outcomes in right versus left kidney transplantation: A systematic review and meta‐analysis

Ultrasound screening for pyelectasis in pregnant women. Clinical necessity or “art for art’s sake”?

Water-enhanced antegrade MR pyelography in pregnancy: a novel radiation-free approach

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