Vesicoureteric reflux in the newborn: relationship to fetal renal pelvic diameter

Anderson, Nigel G.; Abbott, G. D.; Mogridge, N; Allan, Richard B.; Maling, T.M.J.; Wells, J. Elisabeth

doi:10.1007/s004670050348

Cited by 56 publications

(36 citation statements)

References 26 publications

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“…We undertook a systematic review and metaregression analysis of cohort studies that reported outcomes of fetal RPD, for fetuses with an RPD of Յ15 mm. The primary analyses were based on fetuses identified by routine fetal ultrasound screening (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Secondary analyses evaluated studies that included pregnancies referred for specialist obstetric/fetal medicine reasons (29 -34).…”

Section: To Screen or Not To Screen That Is The Question: Whether 'mentioning

confidence: 99%

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Mild Fetal Renal Pelvis Dilatation—Much Ado About Nothing?

Hothi¹,

Wade²,

Gilbert³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background: Renal pelvis dilatation (RPD) occurs in 1% of fetuses. Severe RPD (>15 mm) is frequently associated with urinary tract pathology. For the majority with mild (5 to 9 mm) to moderate (10 to 15 mm) RPD, however, there is uncertainty about the risk of abnormalities and how much postnatal investigation is required.Study design: Systematic review of cohort studies of fetuses with RPD < 15 mm and metaregression to estimate risks of postnatal RPD, obstruction, and VUR.Results: Of 506 potentially relevant papers, 18 met the inclusion criteria. Risk of postnatal RPD increased with fetal RP size and earlier gestation. Odds ratios for postnatal RPD doubled per millimeter increase in fetal RP size: At 20 wk gestation, for example, 18% of fetuses with mean RP of 6 mm were estimated to have persistent postnatal RPD, compared with 95% of fetuses with 12 mm RPD, but risks were decreased by 16% to 18% per week of presentation gestation. Estimated risks of obstruction and VUR were substantially lower, particularly in the mild group such as the 6 mm example above: obstruction 2%, VUR 4%.Conclusions: Our novel risk estimates are useful for antenatal counseling at presentation. The low frequency of obstruction/ VUR in mild RPD raises questions over the most appropriate investigation of these cases but further data are required before establishing definitive postnatal management pathways. We suggest the need for a large prospective multicenter study to collect individual patient parameters/results and search for additional prognostic indicators.

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Section: To Screen or Not To Screen That Is The Question: Whether 'mentioning

confidence: 99%

“…Five hundred and six potentially relevant studies were identified, of which 18 met the inclusion criteria (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). Two studies reported overlapping patient cohorts but different outcomes (27,28).…”

Section: Study Characteristicsmentioning

confidence: 99%

Mild Fetal Renal Pelvis Dilatation—Much Ado About Nothing?

Hothi¹,

Wade²,

Gilbert³

et al. 2009

Clinical Journal of the American Society of Nephrology

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“…Previous retrospective studies, all of which had incomplete follow-up or postnatal investigation, or included children with additional renal abnormalities, have demonstrated a poor correlation between VUR and the degree of pelviectasis on postnatal US [10,11,12,13,14].A more-recent prospective study, with VCUG performed in all children, suggested that two separate normal US scans in the first 6 weeks postnatally were sufficient to exclude VUR in 93% of cases [15]. However, this study included children with additional renal abnormalities, so that the true prevalence of primary VUR in infants with isolated ANH remains unknown.…”

Section: Introductionmentioning

confidence: 98%

Vesicoureteral reflux in infants with isolated antenatal hydronephrosis

Phan

Traubici

Hershenfield

et al. 2003

Pediatric Nephrology

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Standardized evaluation of all newborns with antenatally recognized hydronephrosis (ANH) at The Hospital for Sick Children (HSC) has included voiding cystourethrography (VCUG). This paper reviews this protocol to determine: (1) the prevalence of vesicoureteral reflux (VUR) in isolated ANH and (2) the value of performing VCUG in cases of mild hydronephrosis, defined as renal pelvis dilatation <10 mm on postnatal ultrasonography (US). A retrospective chart review was performed on infants referred with ANH. The inclusion criterion was isolated ANH. Exclusion criteria were (1) presence of additional genitourinary abnormalities and (2) no VCUG. Pelviectasis was categorized according to the anteroposterior diameter of the renal pelvis. There were 111 infants with isolated ANH. All except 3 underwent VCUG. There were 68 children (63%) with normal postnatal US or mild pelviectasis (<10 mm). VUR was detected in 16 patients, of whom 10 had mild or absent pelvic dilatation. There was no correlation between the degree of pelviectasis on postnatal US and the presence or severity of VUR ( P=0.567 and P=0.802). VUR was detected in 15% of children with isolated ANH, many of whom had normal postnatal US or mild postnatal pelviectasis. VCUG is the only reliable test for detecting postnatal VUR.

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“…Fetal renal pelvis dilatation on obstetric sonography is a common finding, seen in up to 3% of obstetric sonograms [1]. The relative prevalence of vesicoureteral reflux (VUR) or obstructive uropathy in infants investigated postnatally seems to depend on the postnatal investigative protocol.…”

Section: Introductionmentioning

confidence: 99%

Fluctuating fetal or neonatal renal pelvis: marker of high-grade vesicoureteral reflux

Anderson¹,

Allan

Abbott³

2004

Pediatric Nephrology

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Fetal renal pelvic dilatation is a predictor of vesicoureteral reflux (VUR), but has low specificity. The aim of this study was to determine the clinical significance of fluctuating size of the renal pelvis on sonography, particularly in relationship to VUR. We prospectively recorded fetal renal pelvic diameter >/=4 mm in 1,092 fetuses (692 boys), from May 1989 to December 1995, with a minimum follow-up of 7 years. Fluctuation, defined as size of renal pelvis changing by more than 4 mm during the course of obstetric (23), postnatal (128), and both pre- and postnatal (7) renal sonograms, was recorded prospectively in 159 (117 boys). Of the 1,092, 849 (593 boys) had a voiding cystourethrogram at a mean age of 7 weeks (range 3-20 weeks). Of the 31 (16 girls) with high-grade VUR, fluctuation was observed in 20 (9 girls). Fluctuation was strongly associated with high-grade VUR (odds ratio 11.1, P=0.0000003) and with renal damage (sensitivity 61%, positive predictive value 31%). Primary high-grade VUR was persistent, seen equally in boys and girls, and required surgery in the majority. Fluctuation was associated with renal duplication anomalies ( P=0.00009) and megaureter ( P<0.00000001). Fluctuation of the renal pelvis on sonography is a marker for persistent high-grade VUR and renal damage in girls and boys.

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Vesicoureteric reflux in the newborn: relationship to fetal renal pelvic diameter

Cited by 56 publications

References 26 publications

Mild Fetal Renal Pelvis Dilatation—Much Ado About Nothing?

Mild Fetal Renal Pelvis Dilatation—Much Ado About Nothing?

Vesicoureteral reflux in infants with isolated antenatal hydronephrosis

Fluctuating fetal or neonatal renal pelvis: marker of high-grade vesicoureteral reflux

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