Natural history of fetal hydronephrosis diagnosed on mid‐trimester ultrasound

Sairam, Shanthi; Al-Habib, Abdul-Karim; Sasson, S; Thilaganathan, B.

doi:10.1046/j.1469-0705.2001.00333.x

Cited by 198 publications

(147 citation statements)

References 18 publications

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“…Alternatively, urinary tract dilatation might occur normally during urinary tract development, perhaps due to the occurrence of VUR before the formation of a competent flap-valve mechanism. In reviewing the long-term follow-up of antenatal urinary tract dilatation, there are always some cases where previously observed abnormalities are no longer detected in the postnatal period (14,25). Our data suggest that in wild-type mice, VUR resolves in the newborn period because the flap-valve mechanism has now become competent.…”

Section: Discussionmentioning

confidence: 81%

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Overexpression of RET leads to vesicoureteric reflux in mice

Murawski

Myburgh

et al. 2004

American Journal of Physiology-Renal Physiology

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, a tyrosine kinase receptor essential for kidney development, has recently been shown to be important for the formation of the urinary tract. When RET is overexpressed in the HoxB7/Ret transgenic mouse, kidneys are small and cystic, and in some of the mice, the ureters are grossly dilated. Here, we report that the observed ureteral dilatation is associated with the urinary tract abnormality vesicoureteric reflux (VUR), in which urine flows retrogradely from the bladder to the ureter. Reflux was determined in vitro by injecting methylene blue into the bladders of HoxB7/Ret and wild-type mice. At postnatal day 1, 30% of HoxB7/Ret mice had VUR compared with 4% of wild-type mice (P Ͻ 0.05). The length of the intravesical ureteral tunnel was shorter in HoxB7/Ret mice compared with wild-type mice, on both the right and the left sides (P Ͻ 0.05), suggesting a basis for the higher incidence of VUR in these mutants. At embryonic day 11, the ureteric bud was found to exit more caudally from the mesonephric duct in HoxB7/Ret mice, and this may predispose them to VUR (P Ͻ 0.05). Wild-type and HoxB7/Ret mice were tested for reflux at embryonic day 17, and both showed a high frequency of VUR (59 and 75%, respectively). These results suggest that VUR may occur transiently during normal urinary tract development before the ureter has completed its insertion into the bladder. In the HoxB7/Ret mouse, overexpression of RET appears to delay the maturation of the distal ureter, resulting in postnatal VUR. The HoxB7/Ret mouse is thus an important model in which to examine how vesicoureteric reflux arises during urinary tract development. kidney defect; urinary tract defect; ureteric bud PRIMARY VESICOURETERIC REFLUX (VUR) is a urinary tract abnormality in which urine flows retrogradely from the bladder to the ureters because of an anatomic defect at the junction of the ureter and the bladder. It affects 1-2% of children and predisposes them to recurrent urinary tract infections and in some cases, end-stage renal disease (7, 33). The condition is hereditary: it frequently affects multiple family members, and several genetic loci have been identified from linkage studies of affected families (5, 6).VUR is normally prevented by a functional valve, the flap-valve mechanism, that forms at the site of the ureteral insertion into the bladder. The flap-valve is dependent on 1) the tunnel in which the ureter enters into the bladder, 2) the presence of a muscular layer within the bladder and the ureter, and 3) the position of the ureteral orifice in the muscular layer within the bladder (the trigone). When the bladder is distended with urine, the tunnel is compressed, and this prevents the retrograde passage of urine from the bladder to the kidneys.The length of the intravesical ureteral tunnel is critical for the flap-valve mechanism: shorter tunnels have been identified in patients with VUR (17, 32). Other anatomic findings that have been associated with VUR include a lack of musculature within the ureter and its tunnel (30) and a ureteral ...

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Section: Discussionmentioning

confidence: 81%

“…Urinary tract dilatation discovered on antenatal ultrasounds is not always detected on postnatal imaging (14,25). This raises many questions regarding its natural history, including the possibility that dilatation can occur as a transient finding during normal human embryogenesis (20).…”

Section: Hoxb7/ret Mice Have a High Incidence Of Vur Hoxb7/retmentioning

confidence: 99%

Overexpression of RET leads to vesicoureteric reflux in mice

Murawski

Myburgh

et al. 2004

American Journal of Physiology-Renal Physiology

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“…Five hundred and six potentially relevant studies were identified, of which 18 met the inclusion criteria (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). Two studies reported overlapping patient cohorts but different outcomes (27,28).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…We undertook a systematic review and metaregression analysis of cohort studies that reported outcomes of fetal RPD, for fetuses with an RPD of Յ15 mm. The primary analyses were based on fetuses identified by routine fetal ultrasound screening (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Secondary analyses evaluated studies that included pregnancies referred for specialist obstetric/fetal medicine reasons (29 -34).…”

Section: To Screen or Not To Screen That Is The Question: Whether 'mentioning

confidence: 99%

Mild Fetal Renal Pelvis Dilatation—Much Ado About Nothing?

Hothi¹,

Wade²,

Gilbert³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background: Renal pelvis dilatation (RPD) occurs in 1% of fetuses. Severe RPD (>15 mm) is frequently associated with urinary tract pathology. For the majority with mild (5 to 9 mm) to moderate (10 to 15 mm) RPD, however, there is uncertainty about the risk of abnormalities and how much postnatal investigation is required.Study design: Systematic review of cohort studies of fetuses with RPD < 15 mm and metaregression to estimate risks of postnatal RPD, obstruction, and VUR.Results: Of 506 potentially relevant papers, 18 met the inclusion criteria. Risk of postnatal RPD increased with fetal RP size and earlier gestation. Odds ratios for postnatal RPD doubled per millimeter increase in fetal RP size: At 20 wk gestation, for example, 18% of fetuses with mean RP of 6 mm were estimated to have persistent postnatal RPD, compared with 95% of fetuses with 12 mm RPD, but risks were decreased by 16% to 18% per week of presentation gestation. Estimated risks of obstruction and VUR were substantially lower, particularly in the mild group such as the 6 mm example above: obstruction 2%, VUR 4%.Conclusions: Our novel risk estimates are useful for antenatal counseling at presentation. The low frequency of obstruction/ VUR in mild RPD raises questions over the most appropriate investigation of these cases but further data are required before establishing definitive postnatal management pathways. We suggest the need for a large prospective multicenter study to collect individual patient parameters/results and search for additional prognostic indicators.

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“…The estimated incidence of antenatal hydronephrosis is 1-5% and this is one of the most common antenatally detected ultrasound anomalies. [1][2][3][4] Though majority of the cases of antenatally detected hydronephrosis resolves spontaneously, some may be a marker of serious underlying urinary tract abnormalities such as pelviureteric junction obstruction (PUJO), vesicoureteralreflux (VUR), urethral obstruction, megaureters, posterior urethral valve etc. Hence strict postnatal followup becomes a necessity to prevent the subsequent morbidity and mortality due to chronic kidney diseases.…”

Section: Introductionmentioning

confidence: 99%

A study on postnatal evaluation and follow-up of infants with antenatally detected hydronephrosis

Balasankar

Balasubramanian

2017

Int J Contemp Pediatr

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Background: Antenatal hydronephrosis(ANH) has now become a frequent diagnosis with the increasing use of antenatal ultrasonography. Objective of present study was to evaluate and follow up infants with antenatally detected hydronephrosis and to determine whether there is significant correlation between anteroposterior renal pelvic diameter detected in antenatal USG and urinary tract anomalies detected postnatally.Methods: After obtaining an informed consent, all neonates with antenatal ultrasound showing hydronephrosis (n=80) were enrolled in the study. Postnatal ultrasound was done at 3 days ,1 month and 6 months of postnatal life. Atleast 6 months followup was done to look for spontaneous resolution or other significant pathology. Micturating cystourethrography/radionuclide scan done in selected cases.Results: Out of 80 cases ,43 had mild,24 had moderate and 13 had severe degrees of hydronephrosis.31 of them (9 mild,10 moderate and 12 with severe hydronephrosis) had postnatal anomaly detected.14 of them (1 mild, 4 moderate and 9 with severe hydronephrosis) underwent surgery. As the grade of antenatal hydronephrosis increases from mild, moderate to severe, the relative risk of postnatal anomaly and requirement of surgical intervention also increased (p value<0.0001).Conclusions: Antenatal hydronephrosis may be associated with significant postnatal urinary tract anomaly with risk quantified by the measurement of anteroposterior renal pelvic diameter(APPD).

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Natural history of fetal hydronephrosis diagnosed on mid‐trimester ultrasound

Cited by 198 publications

References 18 publications

Overexpression of RET leads to vesicoureteric reflux in mice

Overexpression of RET leads to vesicoureteric reflux in mice

Mild Fetal Renal Pelvis Dilatation—Much Ado About Nothing?

A study on postnatal evaluation and follow-up of infants with antenatally detected hydronephrosis

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