Management in children of mild postnatal renal dilatation but without vesicoureteral reflux

Abstract

Infants with mild postnatal renal dilatation but without vesicoureteral reflux pose a challenge. For how long and in what way should they be followed? From May 1989 to December 2006, we prospectively followed 1,795 pregnancies in which the foetal renal pelvis measured 4 mm or greater. Voiding cystourethrography (VCUG) and renal ultrasound were performed on 1,315 infants at 6 weeks of age. Our study group comprised 208 (167 male) infants with normal VCUG findings who had a renal pelvis of 6-11 mm. We followed them for 1-17 years (mean 11 years). Medical and radiological records were reviewed to determine any urinary symptoms and final outcome. They underwent, on average, four further imaging tests. The renal dilatation had resolved by 24 months in approximately 70%. Urinary tract infection (UTI) developed in 16 (8%). Calyceal dilatation was more likely in those developing UTI (P=0.02). Twenty-two (10.6%) had a radiologically demonstrated urinary tract abnormality. Of the five who had renal scarring or severe obstruction, four became symptomatic. Most infants with mild postnatal renal dilatation can be investigated with only one further sonogram at 24 months of age. Mild postnatal renal dilatation is associated with subsequent UTI or renal tract abnormality in 18%. Severe renal abnormality occurred in 2.4%.

Short-term outcome of mild isolated antenatal hydronephrosis conservatively managed

“…It is true that no statistically significant relationship has been found between the degree of HN and the presence of VUR, confirming the poor predictive value of US for diagnosing VUR [16,20,26]. In series that performed VCUG for all NB with antenatal HN, the prevalence of VUR was between 12% and 33% [2,17,27]. We admit that when VCUG is omitted VUR may be missed.…”

Early risk factors for neonatal mortality in CAKUT: analysis of 524 affected newborns

“…Congenital abnormalities of the kidney and urinary tract comprises a broad spectrum of anatomical defects that range from asymptomatic abnormalities to lethal conditions [26][27][28][29]. It has been estimated that CAKUT occurs at a frequency of 1 in 500 live births [7,30].…”

Urinary levels of TGF β-1 and of cytokines in patients with prenatally detected nephrouropathies

“…Renal pelvic dilation (RPD) is the most common organspecific fetal condition detected during the antenatal period and one of the most difficult diagnostic challenges [1][2][3][4][5]. An increasing number of renal anomalies are identified prenatally in otherwise uncomplicated pregnancies.…”