Investigation and management of antenatally detected hydronephrosis

Psooy, Karen; Pike, John

doi:10.5489/cuaj.1027

Cited by 36 publications

(15 citation statements)

References 9 publications

(20 reference statements)

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“…The base case consisted of an infant with Society of Fetal Urology (SFU) Grade III or IV HN, without VUR and with an anterior posterior diameter (APD) of the renal pelvis !15 mm. The analysis was performed from a third party payer perspective with a time horizon of 2 years, as this is the current recommendation for CAP duration in this patient population [11]. This study used discounting e the process of adjusting the value of future costs and benefits to allow for their comparison with present day data [12].…”

Section: Methodsmentioning

confidence: 99%

Economic analysis of continuous antibiotic prophylaxis for prevention of urinary tract infections in infants with high-grade hydronephrosis

Pemberton

Lorenzo

et al. 2015

Journal of Pediatric Urology

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Section: Methodsmentioning

confidence: 99%

Economic analysis of continuous antibiotic prophylaxis for prevention of urinary tract infections in infants with high-grade hydronephrosis

Pemberton

Lorenzo

et al. 2015

Journal of Pediatric Urology

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“…However, the American Urological Association (AUA), the Society for Fetal Urology (SFU), and the Canadian Urological Association (CUA) all acknowledge that use of CAP for UTI prevention in infants with prenatal HN has been based on low levels of evidence. 1,11 Not surprisingly, the lack of high-quality evidence has resulted in guidelines with varying criteria for prescribing CAP. In 2009, the CUA guidelines on prenatal HN provided Grade D recommendation for CAP use in children with this condition.…”

Section: Antibiotic Prophylaxismentioning

confidence: 99%

“…In 2009, the CUA guidelines on prenatal HN provided Grade D recommendation for CAP use in children with this condition. 11 In 2010, the SFU consensus statement on HN recommended CAP only for infants with high-grade HN and those with VUR. 12 On the other hand, the AUA guidelines suggested the use of CAP for children with asymptomatic VUR (i.e., without previous history of UTI) to be optional.…”

Section: Antibiotic Prophylaxismentioning

confidence: 99%

Continuous antibiotic prophylaxis in the setting of prenatal hydronephrosis and vesicoureteral reflux

Wong

Koyle

Braga

2017

CUAJ

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Continuous antibiotic prophylaxis (CAP) has traditionally been offered for children with recurrent urinary tract infections (UTIs) or those at risk, including children diagnosed with prenatal hydronephrosis (HN) and vesicoureteral reflux (VUR). However, indications for antibiotic prophylaxis are controversial, data on who should benefit from this therapy is conflicting and, thus, guidelines are unable to provide conclusive recommendations. In the setting of prenatal HN, although randomized trials are currently underway, most evidence is derived from low-to moderate-quality observational studies. Although there is no benefit in those with low-grade HN, a systematic review of the available studies showed that highgrade HN patients on prophylaxis experienced fewer infections with an estimated number needed to treat of 7. On the other hand, there are eight randomized trials that have investigated the use of antibiotic prophylaxis in the setting of VUR. Although four of the studies have demonstrated some value of prophylaxis and the other four have not, meta-analysis has shown an overall benefit of antibiotic prophylaxis in preventing infections. The observed differences are likely due to different inclusion criteria and study heterogeneity. Although generalizing results of meta-analyses to all children is tempting, an individualized approach, by determining which patients best behave like those of the included studies, is recommended.

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“…Recommendations from other expert groups, including the Society for Fetal Urology (SFU) have been published. [1015] This document revises the ISPN guidelines and has been simultaneously published in the February 2013 issue of the Indian Pediatrics.…”

Section: Introductionmentioning

confidence: 99%

Revised guidelines on management of antenatal hydronephrosis

Sinha

Bagga

Krishna³

et al. 2013

Indian J Nephrol

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Widespread antenatal screening has resulted in increased detection of anomalies of the kidneys and urinary tract. The present guidelines update the recommendations published in 2000. Antenatal hydronephrosis (ANH) is transient and resolves by the third trimester in almost one-half cases. The presence of oligohydramnios and additional renal or extrarenal anomalies suggests significant pathology. All patients with ANH should undergo postnatal ultrasonography; the intensity of subsequent evaluation depends on anteroposterior diameter (APD) of the renal pelvis and/or Society for Fetal Urology (SFU) grading. Patients with postnatal APD exceeding 10 mm and/or SFU grade 3-4 should be screened for upper or lower urinary tract obstruction and vesicoureteric reflux (VUR). Infants with VUR should receive antibiotic prophylaxis through the first year of life, and their parents counseled regarding the risk of urinary tract infections. The management of patients with pelviureteric junction or vesicoureteric junction obstruction depends on clinical features and results of sequential ultrasonography and radionuclide renography. Surgery is considered in patients with increasing renal pelvic APD and/or an obstructed renogram with differential renal function <35-40% or its subsequent decline. Further studies are necessary to clarify the role of prenatal intervention, frequency of follow-up investigations and indications for surgery in these patients.

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Investigation and management of antenatally detected hydronephrosis

Cited by 36 publications

References 9 publications

Economic analysis of continuous antibiotic prophylaxis for prevention of urinary tract infections in infants with high-grade hydronephrosis

Economic analysis of continuous antibiotic prophylaxis for prevention of urinary tract infections in infants with high-grade hydronephrosis

Continuous antibiotic prophylaxis in the setting of prenatal hydronephrosis and vesicoureteral reflux

Revised guidelines on management of antenatal hydronephrosis

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