Outcome and management of isolated moderate renal pelvis dilatation detected at postnatal screening

Abstract

The aim of this study was to evaluate the incidence and outcome of isolated moderate renal pelvis dilatation (RPD) [anterior-posterior diameter (APD) 10-15 mm] in an unselected population of 2-month-old infants prospectively followed for up to 12-14 months of life. Isolated moderate renal pelvis dilatation was detected in 282 of the 11,801 (2.4%), infants screened; 240 infants with normal renal ultrasound were enrolled as the control group. Resolution of RPD was considered when an APD <or= 5 mm was found on two consecutive sonograms. Urological investigations were initiated if the RPD persisted or if urinary tract infection (UTI) occurred during follow-up, and antibiotic therapy was administered only when UTI occurred. The events of interest were resolution of the RPD, presence of uropathy and UTI. At follow-up, RPD persisted only in 18 infants; of these, four infants were diagnosed with vesicoureteral reflux (grade 1-3) and 14 with ureteropelvic junction obstruction. Of the 223 infants with RPD and 230 control infants who completed follow-up, UTI occurred in 3.6 and 2.5%, respectively. The incidence rate of UTI per 1000 person-months was 5.98 episodes in the patient group and 5.22 episodes in the control group. The rate ratio was 1.146 (95% confidence interval 0.389-3.54, p = 0.8). Our data suggest that isolated moderate RPD is essentially a self-limiting condition and that antibiotic prophylaxis for the prevention of UTI should not be performed. A non-invasive ultrasound scan performed during the follow-up is sufficient to diagnose a potentially dangerous and persistent RPD.

Which Patients Should be Administrated Prophylactic Antibacterial Agents? A Study of Bacteriuria or Funguria by Urine Culture Taken From the Renal Pelvis in Children with Ureteropelvic Junction Obstruction

“…Our study found that there was no significant relationship between age or gender and bacteriuria or funguria, perhaps because boys were more likely develop UPJO, [5,6] whereas girls were much more likely to develop a UTI after 1 year [9]. Increasingly, UPJO is discovered by prenatal ultrasound [6], but being diagnosed by prenatal ultrasound was not a risk factor to develop bacteriuria or funguria.…”

“…UPJO is common in children, for which Anderson-Hynes pyeloplasty is the classic surgical treatment [5,6] < B1 B2 > < /C< B3 B4 > <, and there have been some reports concerning about UTI in patients with UPJO [1,2]. Unlike previous studies, in the present study, urine taken directly from the renal pelvis was cultured.…”

“…Increasingly, UPJO is discovered by prenatal ultrasound [6], but being diagnosed by prenatal ultrasound was not a risk factor to develop bacteriuria or funguria. In addition, hydronephrosis [5], abdominal pain, hematuria, and mass were not risk factors.…”

“…No previous study has reported a relationship between parenchymal thickness and bacteriuria or funguria. We found that parenchymal thickness was not a risk factor, although, deterioration in renal function was associated with exacerbation of hydronephrosis and decrease in parenchymal thickness in some patients [5,6]. Prophylactic antibacterial agents were probably necessary in those patients who had signs of urinary tract infection (UTI), or history of nephrostomy or pyeloplasty.…”

Natural history of bilateral mild isolated antenatal hydronephrosis conservatively managed

“…In recent years, the number of papers analyzing the significance of mild isolated antenatal hydronephrosis has been increasing. Even though almost all authors agree that unilateral mild isolated hydronephrosis is a benign condition [1,2,8,9], there have been a few studies reporting on the clinical significance and the outcome of newborns (NBs) with bilateral mild isolated hydronephrosis [9][10][11]. NBs with bilateral hydronephrosis, especially male NBs, are considered to be a group with a higher risk of having a significant abnormality and/or impairment of postnatal renal function [12].…”