Antenatally detected urinary tract abnormalities: changing incidence and management

James, C. A.; Watson, Alan R.; Twining, P.; Rance, C. H.

doi:10.1007/s004310050865

Cited by 56 publications

(25 citation statements)

References 24 publications

(23 reference statements)

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“…In particular, the management of those found to have isolated antenatal hydronephrosis is still a source of controversy. The criteria used in various studies to classify significant antenatal hydronephrosis are often different [4][5][6][7][8][9][10][11][12][13][14][15], and there is a lack of conformity in terms of postnatal management, with some centres advocating detailed investigations, including a micturating cystourethrogram (MCUG) in all groups [6,11,[16][17][18][19], and others adopting a less intensive approach [4,5,13]. The clinician is faced with the dilemma of either subjecting a large number of normal infants to investigations that are significantly invasive [20][21][22][23][24] or arranging fewer investigations and running the risk of missing significant pathology.…”

Section: Introductionmentioning

confidence: 99%

Antenatally detected urinary tract abnormalities: more detection but less action

2008

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We present the findings of a prospective cohort study of babies born with antenatally detected urinary tract abnormalities (AUTAs) between 1999-2003 and compare the outcomes with those of an earlier cohort born between 1989 and 1993. All infants with a fetal anteroposterior renal pelvic diameter (APRPD) > or =7 mm in the third trimester or other urinary tract abnormality underwent a detailed postnatal ultrasound scan and other investigations as indicated. The incidence of AUTAs was significantly greater in the more recent cohort (7.6/1000 vs. 3/1000 live births; p<0.05). Of the 350 infants on which we had data, 48.6% (170/350) were in the non-specific dilatation (NSD) category, and vesicoureteric reflux (VUR) was detected in 12%. Restricting investigations to those who had an APRPD > or =10 mm at >30 weeks of gestation could have reduced the number with NSD in the more recent cohort (26/115; 25%), but 25% of those with pelviureteric junction hold-up and 50% with VUR would have been missed. Significantly fewer patients in the more recent cohort underwent surgery (7 vs. 21%; p<0.001). There is a trend towards larger APRPDs on third trimester scans being associated with more significant pathology, but there is a lot of clinical overlap. The study highlights the need for cautious antenatal counselling combined with an assurance to prospective parents that postnatal investigations will be performed in a stepwise manner based on the initial postnatal ultrasound scan and clinical findings.

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Section: Introductionmentioning

confidence: 99%

Antenatally detected urinary tract abnormalities: more detection but less action

2008

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“…The incidence varies, depending on the study and country, but ranges from 1 in 3,640 and 1 in 4,300 live births [1,2]. Renal dysplasia is characterized by structural disorganization of the renal tissue, involving undifferentiated epithelium and primitive ducts surrounded by fibromuscular connective tissue.…”

Section: Introductionmentioning

confidence: 99%

Management and etiology of the unilateral multicystic dysplastic kidney: a review

et al. 2009

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In children, unilateral multicystic dysplastic kidney (MCDK) is one of the most frequently identified urinary tract abnormalities. A variety of proposed etiologies has been associated with the underlying pathogenesis of MCDK. These include genetic disturbances, teratogens, in utero infections, and urinary outflow tract obstruction. From 5-43% of the time, MCDK has associated genito-urinary anomalies, both structural and functional in nature. A review of the literature reveals that involution rates are reported to be 19-73%, compensatory hypertrophy of the contralateral kidney occurs from 24-81% of the time, and estimated glomerular filtration rates (GFRs) (by the Schwartz formula) range from 86-122 ml/min per 1.73 m(2) body surface area. Most authors suggest serial ultrasonography to monitor contralateral growth, routine blood pressure monitoring, and a serum creatinine monitoring algorithm. The risk of hypertension in those with MCDKs does not appear to be greater than that of the general population, and the rates of malignant transformation of MCDK are small, if at all increased, in comparison with those in the general population. If the patient develops a urinary tract infection or has abnormalities of the contralateral kidney, shown on ultrasound, a voiding cystourethrogram is recommended. Finally, the body of literature does not support the routine surgical removal of MCDKs.

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“…Moreover, a better understanding of the natural history of renal disorders has allowed a more conservative approach to many of these conditions [1]. Before the widespread use of antenatal ultrasonography, an abdominal mass in the flank of an otherwise healthy newborn was the most common presentation of a unilateral multicystic dysplastic kidney (MCDK) [2].…”

Section: Introductionmentioning

confidence: 99%

Natural history of multicystic kidney conservatively managed: a prospective study

et al. 2004

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We report the long-term clinical results of conservative management of children with unilateral multicystic dysplastic kidneys (MCDK). Between 1989 and 2002, 43 children with MCDK detected by prenatal ultrasonography were prospectively followed. At birth, ultrasonography confirmed the prenatal findings in all cases. Patients underwent a radioisotope scan and micturating cystogram in order to confirm the diagnosis and to exclude other uropathies. Follow-up ultrasound (US) examinations were performed at 6-month intervals during the first 2 years of life and yearly thereafter. The mean follow-up time was 42 months (range 12-156 months). Two children developed hypertension during follow-up. In total 257 US scans were performed. The mean number of US scans per patient was 6 (range 3-10). US scans demonstrated partial involution of the MCDK in 30 (70%) cases and complete involution in 8 (19%). The absolute MCDK length remained almost unchanged in 5 children (11%). The estimated median time of complete involution of the MCDK was 122 months [95% confidence interval (CI)=86-158 months]. A total of 33 (76.7%) contralateral kidneys underwent compensatory hypertrophy, reaching a renal length above the 95th percentile during follow-up. The estimated median time for the occurrence of compensatory hypertrophy was 30 months (95% CI=15-45 months). In conclusion, the natural history of MCDK is usually benign but patients must have long-term follow-up with US scans and blood pressure measurements.

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Antenatally detected urinary tract abnormalities: changing incidence and management

Cited by 56 publications

References 24 publications

Antenatally detected urinary tract abnormalities: more detection but less action

Antenatally detected urinary tract abnormalities: more detection but less action

Management and etiology of the unilateral multicystic dysplastic kidney: a review

Natural history of multicystic kidney conservatively managed: a prospective study

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