Antenatally detected urinary tract dilatation: a 12–15-year follow-up

Abstract

Background Antenatally diagnosed urinary tract dilatation (UTD) still burdens healthcare providers and parents. This study was conducted to establish long-term outcome in an unselected group of children with antenatally detected UTD. Methods Seventy-one out of 103 children born in 2003–2005 and diagnosed with antenatal UTD agreed to participate in a 12–15-year follow-up including blood and urine samples, a kidney ultrasound exam, and kidney scintigraphy. The records were searched for previous urinary tract infections. Results Among children with an anteroposterior diameter (APD) ≤ 7 mm and no calyceal, kidney, ureteral, or bladder pathology in the early postnatal period, no one tested had reduced estimated glomerular filtration rate (eGFR), albuminuria, or UTD at the follow-up at a mean age of 13.6 years. One child had kidney damage not affecting kidney function. Among children with postnatal APD > 7 mm and/or kidney, calyceal, ureteral, or bladder pathology, 15% had persistent UTD and 32–39% (depending on the method used) had kidney damage. Major postnatal urinary tract ultrasound abnormalities and a congenital anomalies of the kidney and urinary tract (CAKUT) diagnosis were factors associated with an increased risk for permanent kidney damage (odds ratios 8.9, p = 0.016; and 14.0, p = 0.002, respectively). No one had reduced eGFR. One child (1/71, 1%) had a febrile urinary tract infection after the age of 2. Conclusions We conclude that in children with postnatal APD ≤ 7 mm, no calyceal dilatation, normal bladder, ureters, and kidney parenchyma, the outcome is excellent. There is no need for long-term follow-up in these patients.

Risk Factors Associated With Renal and Urinary Tract Anomalies Delineated by an Ultrasound Screening Program in Infants

“…The advancing technology in medical equipment improves the detection of kidney and urinary tract anomalies in utero by prenatal ultrasonography. However, prenatal ultrasonographic diagnosis may fail to detect these congenital anomalies in oligoamnios and other rare situations ( 4 ). Lots of attempts have been made for CAKUT screening during the early postnatal period ( 5 – 8 ).…”

Conversations for the future in the follow-up of antenatally diagnosed renal pelvicalyceal dilatation

“…This index study argues indirectly perhaps for a structured surveillance of the other arm (group B) mentioning a higher risk of kidney damage albeit with no reported CKD. [4] In the study, 36% cases (approximately 20% of total) in group B (>7mm RPD) had progression/new evidence of kidney damage. This is a significant finding of this study.…”

“…The study from China appears to exclude group A patients (≤7mm RPD) and has a median follow-up of 142 months [2]. Nevertheless, they have almost a 25% incidence of PUJO in the included cohort, which is similar to group B in the index study (>7mm RPD) [4], and suggests a much higher kidney damage percentage extrapolated from the split kidney function data. They did not report data on creatinine, proteinuria and hypertension.…”

“…Antenatally detected renal pelvic dilatation and/or antenatally detected hydronephrosis is associated with a definite health burden [1]. This brief editorial, which is drafted in response to the study by Herthelius et al, looks at the results of the reported long-term follow-ups [2][3][4][5], compares between similar studies and discusses the direct and indirect future implications of such precious data on healthcare.…”

“…The authors of this index study have reported a longterm follow-up of a cohort of children diagnosed with antenatal renal pelvic dilation [4]. The median/mean follow-up is 13.5 years approximately.…”