Postnatal longitudinal evaluation of children diagnosed with prenatal hydronephrosis: insights in natural history and referral pattern

Abstract

Despite prenatal resolution totalizing 25%, pelvic dilatation persisted on first postnatal imaging in most cases, thus justifying postnatal ultrasound evaluation. Whereas most mild cases resolved spontaneously, a quarter of moderate and more than half of severe cases required surgery. Patients with postnatal imaging and referral had more severe PNH, which could result in overestimation of pathology.

Resolution rate of isolated low-grade hydronephrosis diagnosed within the first year of life

“…However, there is currently no established algorithm in terms of surveillance and use of antibiotic prophylaxis for isolated low-grade (Society for Fetal Urology [SFU] grades 1 and 2) hydronephrosis. Currently, the literature suggests that resolution is common, with resolution rates ranging from 46% to 80% [2,3]. UTIs are also reportedly infrequent with an incidence of 1.3–12% [3–5].…”

“…Studies evaluating outcomes in patients with hydro-nephrosis do not uniformly describe hydronephrosis and the definition may incorporate either the SFU grading criteria or the anterior–posterior diameter measurement [2,9]. The heterogeneity of diagnosis criteria coupled with variation in surveillance methods has interfered with the development of standard guidelines [8].…”

Prenatally detected, unilateral, high-grade hydronephrosis: Can we predict the natural history?

“…4 On the other hand, low-grade HN is usually benign in nature and about 50% of fetuses and infants diagnosed with this entity might show complete resolution on follow-up. 5 In our study, we tried to study the natural history of isolated high-grade antenatal HN. Our aim was to assign criteria for possible differentiations between cases that deserve observation and those which might necessitate surgical intervention in the hope of aiding the physician in parental counseling and risk stratification.…”

Occult Congenital Ureteropelvic Junction Obstruction in Two Adults Presenting with Collecting System Rupture After Blunt Renal Trauma: A Case Report Series

“…As one of the most frequent fetal abnormalities, the significance of such prenatal hydronephrosis has been a topic of much research, 8 with 25% of cases resolving spontaneously and a small percentage of persistent cases requiring surgical intervention. 9 Consequently, hydronephrosis detected in utero is typically followed to ensure proper management and preservation of kidney function. 10 The present cases are striking in the occult nature of the UPJ obstruction and its presentation.…”