Clinical Characteristics and Outcome of Hydronephrosis Detected by Prenatal Ultrasonography

Lim, Do Young; Park, Jae Young; Kim, Jeong Hyun; Paick, Sung Hyun; Oh, Seung June; Choi, Hwang

doi:10.3346/jkms.2003.18.6.859

Cited by 44 publications

(31 citation statements)

References 21 publications

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“…It has been reported that most mild hydronephroses resolve spontaneously and renal function then recovers to the level of the normal kidney [31,32,33,34]. Koff [31] reported that 85% of patients in whom prenatal hydronephrosis was detected proved to have transient, physiological dilation of the renal pelvis, and these hydronephroses resolved spontaneously without surgical intervention.…”

Section: Discussionmentioning

confidence: 96%

Postnatal management of infants with antenatally detected hydronephrosis

et al. 2005

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With the increasing use of antenatal sonography, fetal hydronephrosis has been reported more frequently. Because of the lack of consensus regarding treatment of these infants, the postnatal approach toward fetal renal pelvis enlargement remains controversial. The aim of this prospective study is to demonstrate the postnatal investigation, treatment, and outcome of infants with prenatally diagnosed hydronephrosis. Infants whose antenatal ultrasound scan showed a fetal renal pelvis of 5 mm or greater were investigated postnatally using ultrasound (US) and voiding cystourethrography. When indicated, isotope studies and intravenous urograms were also performed. We followed prospectively neonates with antenatally diagnosed hydronephrosis and recommended management guidelines on the basis of our findings. In 156 neonates (193 kidney units) that were found to have hydronephrosis, the average gestational age at which the diagnosis was made was 32.94+/-5.10 weeks. The mean duration of postnatal follow-up was 26.3+/-13.56 months (range 3-60 months). The mean APPD of the fetal renal pelvis was 10.35+/-3.24 mm (5-9 mm in 84 kidneys, 10-14 mm in 96 kidneys and > or =15 mm in 13 kidneys). Of the 193 kidney units, 145 units were found to be pathological. The most common detected underlying abnormalities were ureteropelvic junction obstruction (in 91 kidneys; 62.7%) and vesicoureteral reflux (in 24 kidneys; 16.6%). Postnatally, 23 (45%) of 51 patients whose first US was normal were diagnosed postnatally as having urinary tract abnormality. There was a negative correlation between APPD and the rate of spontaneous resolution and positive correlation between APPD and the rate of surgery (P<0.01). In conclusion, because it is not possible to determine an upper limit of normal for the antenatal renal pelvis, any baby with AH should not be considered clinically insignificant. Infants with antenatal renal pelvis measurements > or =5 mm should be investigated postnatally. A normal postnatal ultrasound scan does not preclude the presence of urinary tract abnormality.

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Section: Discussionmentioning

confidence: 96%

Postnatal management of infants with antenatally detected hydronephrosis

et al. 2005

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“…Doğum öncesinde ultrasonografinin (US) yaygın kullanımıyla birlikte fetal hidronefroz giderek artan sıklıkta tanımlanmaya başla-mıştır. Doğum öncesindeki US'ların 1/100-500'ünde hidronefroz saptanmaktadır (3). Doğum öncesinde saptanan hidronefrozun önemli bir nedenini ise obstrüktif üropatiler oluşturmaktadır.…”

Section: Introductionunclassified

The Rate Of Development Postnatal Obstructive Uropathy In Fetal Hydronephrosis

Yavaşcan¹,

Akbay²,

Özalkak³

et al. 2013

Tepecik Dergisi

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ÖZETAmaç: Gebelikte ultrasonografinin yaygın kullanımı ve doğum öncesi hidronefrozun artan sıklıkta tanımlanmasıyla, bu hastaların doğum sonrasında izlemin önemi giderek artmaktadır. Bu çalışmada doğmalık üriner sistem malformasyonlarının önemli bir bölümünü oluşturan obstrüktif üropatilerin tedavisinde erken tanının ve obstrüktif üropatili çocukların tanısal sü-recinde kullanılan radyolojik ve sintigrafik tetkiklerin önemini araştırmayı amaçladık.Gereç ve Yöntem: Doğum öncesinde yapılan ultrasonografi ile fetal renal pelvis çapı 5 mm ve üstünde olan bebekler doğum sonrasında ultrasonografi (7-10 gün, 1. ay) ve miksiyosistoüreterografi yöntemleriyle araştırıldı. Vezikoüreteral reflü tanısı alanlar çıkarıldıktan sonra 169 (222 böbrek birimi) hasta çalışmaya alındı. Obstrüktif üropati saptanan ve saptanmayan tüm hastalar ile obstrüksiyon saptanan hastalardan opere olanlar ve olmayanlar idrar yolu infeksiyonu sayısı, ultrasonografide ön arka pelvis çapı, Teknesyum 99m dimerkaptosüksinik asit(Tc-99) sintigrafisinde skar durumu, Tc-99 sintigrafisinde diferansiyel işlev açısından değerlendirildi. İstatistiksel değerlendirmede ki-kare ve student's t-testleri kullanıldı.Bulgular: Çalışmamızda, 54 bebekte (71 böbrek birimi) obstrüktif üropati saptandı. Bu bebeklerin ortanca doğum sonrası izlem süresi 40 ay (12-106 ay) olarak belirlendi. Üreteropelvik bileşke darlığı en sık saptanan anomali olarak tespit edildi (39 böbrek birimi). Yıllık idrar yolu infeksiyonu sıklığı obstrüktif üropati saptanan olgularda (0.95±0.92/yıl), saptanmayan olgulardan (0.41±0.42/yıl) yüksek bulundu (p<0.01). Son değerlendirmedeki böbrek pelvis ön arka çapları obstrüktif üropati saptanan (14.8±7.8 mm) olgularda saptanmayanlara (8.5±1.6 mm) ve opere olan hastalarda (19±7.7 mm), olmayanlara (11.7±5.7 mm) göre yüksek bulundu (p<0.01). Tc-99 sintigrafisinde skar saptanma oranı obstrüktif üropatili olgularda (ilk değerlendir-me % 45, son değerlendirme % 47), saptanmayan olgulara (ilk ve son değerlendirme % 1.3) göre yüksek bulundu (p<0.01).Sonuç: Doğum öncesinde hidronefroz saptanan bebeklerin doğum sonrasında yaşamlarının ilk haftasından itibaren seri ultrasonografi ve sintigrafik görüntüleme yöntemleri ile değerlendirilmesi ve aynı şekilde izlenmeye devam edilmesi üriner sistemde var olan obstrüktif patolojinin erken dönemde tanınmasını ve opere edilmesi gereken olguların belirlenmesinde kolaylık sağlayacaktır.Anahtar Sözcükler: Doğum öncesi hidronefroz,, Doğum sonrası ultrasonografi ,Fetal hidronefroz,Yenidoğan obstrüktif üropatisi

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“…Furthermore, the threshold value of the renal pelvis diameter on US to warrant VCUG remains debatable [11,12]. It is well known that prenatal hydronephrosis may represent a transient condition that frequently resolves spontaneously with tubular function maturation, the increasing reabsorption ability, and the ureteropelvic junction maturational process [18,22,24,25,[37][38][39][40]. It has been reported that many children with mild hydronephrosis did not have VUR [6].…”

Section: Discussionmentioning

confidence: 97%

“…Most of them constitute an isolated finding, disappearing spontaneously without renal function deterioration. Hence, it has been termed "physiologic hydronephrosis" [24,25,32].…”

Section: Discussionmentioning

confidence: 99%

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Mild hydronephrosis in newborns and infants: can ultrasound predict the presence of vesicoureteral reflux

et al. 2007

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The objective of our study was to determine the significance of mild hydronephrosis in newborns and infants as an indicator of vesicoureteral reflux (VUR). The voiding cystourethrography (VCUG) of 573 patients aged 0-18 months with mild, sonographically detected hydronephrosis were reviewed for VUR. Patients with secondary reflux or anomalies making an exact reflux grading impossible were excluded. Normal kidneys, contralateral to hydronephrotic ones, were included. Each kidney was considered separately, forming a total of 1,146 renal units. Mild hydronephrosis was defined as an anteroposterior diameter of the renal pelvis of 0.5-1.5 cm without caliectasis. The International Grading System was used to grade VUR. Seven hundred and thirty-six kidneys had mild hydronephrosis. VUR occurred in 189 out of 736 (25.7%) of these kidneys, and in 108 out of 410 (26.3%) non-distended kidneys, contralateral to hydronephrotic ones (p=0.806). No statistical differences in the frequency of VUR and dilatation were found between the subgroups of patients with and without infection, except for a higher grade of reflux in the group with infection. The frequency of VUR in mildly dilated kidneys was not significantly different from that in non-distended ones. There was a poor correlation between VUR and mild hydronephrosis. The latter should not be considered in itself an indication for VCUG in asymptomatic neonates and infants.

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Clinical Characteristics and Outcome of Hydronephrosis Detected by Prenatal Ultrasonography

Cited by 44 publications

References 21 publications

Postnatal management of infants with antenatally detected hydronephrosis

Postnatal management of infants with antenatally detected hydronephrosis

The Rate Of Development Postnatal Obstructive Uropathy In Fetal Hydronephrosis

Mild hydronephrosis in newborns and infants: can ultrasound predict the presence of vesicoureteral reflux

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