Antenatal hydronephrosis: role of different sonographic approaches in predicting prognosis

Abstract

Background: Antenatal hydronephrosis (AH) is a common finding in prenatal assessment. We assessed and compared society of fetal urology ( SFU) ,anteroposterior pelvic diameter ( APD) and, urinary tract dilation ( UTD) classification criteria in predicting prognosis . Material and methods: We retrospectively analyzed neonates with a history of antenal hydronephrosis.We analyzed relation between each of three classification ways with etiologic diagnosis and prognosis of AH. Prognosis was classified as four grades, from transient hydronephrosis ( Grade 1) Grade 4 as severe kidney involvemevt or any need to surgery. Results : We enroled 290 neonates with a mean age of 16.4 ±9.0 days, 33% were female , One third had severe VUR , severe obstruction observed in 19 (22%) patients, 40% had transient hydronephrosis, 26 (9%) need to surgery. Only antenatal SFU grading showed significant relation with severe obstruction and only Postnatal SFU grading was related to severity of VUR. The highest sensitivity was ; prenatal SFU-1 (100%) , postnatal SFU-1 (98%) for VUR presence ; prenatal and postnatal SFU-1 (100%) for surgery. The highest specificity was ; prenatal SFU-4 (96%) , postnatal UTD-P3 (73%) for VUR presence; prenatal SFU-4(99%) and postnatal SFU-4 (94%) for surgery . Conclusion: There are no reliable prenatal sonographic finding to predict VUR or severe UPJO , SFU grading in postnatal period can predict VUR with a low sensitivity and specificity. All three classification systems have good ability to evaluate prognostic items such as need to surgery.