Prenatal sonographic evaluation and postnatal outcome of renal anomalies

Kumar, Manisha; Gupta, Usha; Thakur, Seema; Aggrawal, Shilpi; Meena, Jyoti; Sharma, Sumedha; Trivedi, Shubha Sagar

doi:10.4103/0971-6866.96656

Cited by 6 publications

(7 citation statements)

References 14 publications

(16 reference statements)

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“…UPJO is the most common cause of hydronephrosis detected antenatally. [ 1 2 3 4 5 6 7 8 14 ] There are very few reports on the optimal mode of treatment of antenatally detected bilateral UPJO with regard to the timing of pyeloplasty. [ 9 10 11 12 ] Irrespective of the initial DRF, early pyeloplasty in prenatally diagnosed unilateral SFU Grade 3–4 UPJO has been shown to result in a significant improvement of DRF, while delayed pyeloplasty is reported to result in a marginal but significant loss.…”

Section: Discussionmentioning

confidence: 99%

“…With the advent of routine antenatal ultrasonography, the incidence of fetal hydronephrosis has increased many folds. [ 1 2 3 ] While a majority of these are transient, uretero pelvic junction obstruction (UPJO) is a common cause in those with persistent hydronephrosis,. [ 3 4 ] In the vast majority of the patients with unilateral UPJO, the initial management is conservative with the surgical intervention being reserved for those with a significant deterioration in the differential renal function (DRF) on the follow-up.…”

Section: Introductionmentioning

confidence: 99%

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Postnatal management of bilateral Grade 3–4 ureteropelvic junction obstruction

et al. 2020

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Introduction: Bilateral hydronephrosis on prenatal ultrasound can be managed expectantly or with surgical intervention. The treatment strategies and outcomes are not clearly defined. Methods: We conducted a retrospectively audit of outcomes of management of prenatally detected severe bilateral ureteropelvic junction obstruction (UPJO) in our institution.Patients with bilateral Grade 3–4 hydronephrosis were included. Those with complications like rupture, underwent bilateral intervention within 4 weeks; in the remaining, unilateral pyeloplasty was performed at 4–12 weeks. The contralateral renal unit was re-evaluated at a later date for further improvement or deterioration. All the patients were followed up with ultrasonography and renogram at 3 months, 6 months, and 1-year post operatively. The case records were analyzed for the resolution of antero-posterior diameter (APD) or the improvement in single-kidney glomerular filtration rate (s-GFR) in the operated units. Results: Over 15 years, 28 patients (56 renal units) had bilateral UPJO (male-to-female ratio = 13:1). Twelve units underwent neonatal intervention to tackle the complications (6 bilateral pyeloplasty), 17 units underwent early pyeloplasty, and 15 underwent late pyeloplasty. Twelve of the twenty-two (54%) contralateral units, which were stented/observed, resolved spontaneously. Receiver operating characteristics analysis revealed that those with initial APD <25 mm and initial s-GFR >35 ml/m were more likely to improve during the observation. Ten of the forty-four operated units (22%) failed to show an improvement. Units with initial s-GFR <10 ml/m had poor chance of postoperative functional recovery. Conclusions: In neonates with bilateral UPJO, the worse affected kidney is operated first, as it still has the potential to recover. The contralateral milder UPJO unit is known to recover spontaneously following unilateral pyeloplasty. In those with bilateral Grade 4 UPJO and mass, bilateral pyeloplasty is feasible. Alternatively, unilateral pyeloplasty + contralateral cystoscopic retrograde stenting may prevent rupture or functional deterioration in the opposite kidney.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Postnatal management of bilateral Grade 3–4 ureteropelvic junction obstruction

et al. 2020

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“…El 40,3% de los niños que presentaba hidronefrosis severa posnatal (UTD P2oP3), tuvieron también alteraciones en el renograma. Estos datos reafirman el peor pronóstico de las hidronefrosis graves y concuerdan con lo publicado por autores como Ismaili (15) y Kumar (21) . Coincidimos con Perlman (22) en el hecho de que el pronóstico renal fue peor en aquellos casos en los que la HNF se asoció con otras anomalías congénitas del riñón.…”

Section: Discussionunclassified

Correlación entre el diagnóstico ecográfico prenatal y posnatal en casos de hidronefrosis fetal

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Pueyo

et al. 2019

Rev peru ginecol obstet.

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Introducción. La ecografía prenatal permite detectar una anomalía significativa en 1% de los embarazos; de ellos, 20 a 30% son genitourinarias y 50% de estas son hidronefrosis fetales (HNF). Objetivo. Establecer una correlación entre el grado de hidronefrosis prenatal y posnatal, así como analizar las implicaciones pronósticas. Diseño, pacientes, intervenciones y variables principales. Estudio observacional retrospectivo realizado por la Unidad de Diagnóstico Prenatal del hospital Parc Taulí de Sabadell, que incluyó un total de 177 gestantes con diagnóstico ecográfico de HNF entre enero de 2011 y diciembre de 2016. Se realizó un análisis descriptivo de las variables ecográficas y perinatales más importantes. La principal variable de estudio fue el grado de dilatación de la HNF. Resultados. La prevalencia de HNF fue 1,17%. El 82,8% de los casos fue diagnosticado en la ecografía del 2º trimestre. En 42,9%, la afectación fue bilateral, y en 95,6% la malformación renal fue aislada. La cardiopatía fue la anomalía congénita asociada con más frecuencia (3,3%). De las 93 hidronefrosis de riesgo bajo diagnosticadas en el 2º trimestre, 53,8% se normalizaron en el 3er trimestre, 30,1% permanecieron estables y 16,1% progresaron. De los 32 casos de HNF moderadas-severas diagnosticadas en el 2º trimestre, solo 9,4% se normalizaron en el 3er trimestre. El 46,9% de los neonatos precisó exploraciones complementarias y 14,1% intervención quirúrgica. Conclusiones. Existe buena correlación de la HNF prenatal y posnatal. La HNF leve presenta buen pronóstico, mientras que la moderada-severa suele persistir posnatalmente.

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“…When renal function is abnormal, there is oligohydramnios and the bladder is small or absent. [4] Kumar M et al .,[5] in a prospective study over a 3-year period from Jan 2008-Dec 2010, found 422 cases (1.8%) with gross congenital anomaly out of 24,160 deliveries studied. Out of the 422 cases, there were only 63 cases with renal anomaly (14.9%).…”

Section: Discussionmentioning

confidence: 99%

Autosomal Recessive Polycystic Kidney Disease: Antenatal Diagnosis and Histopathological Correlation

et al. 2013

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Autosomal recessive polycystic kidney disease (ARPKD) is one of the most common inheritable disease manifesting in infancy and childhood with a frequency of 1:6,000 to 1:55,000 births. The patient in her second trimester presented with a history of amenorrhea. Ultrasound examination revealed bilateral, enlarged, hyperechogenic kidneys, placentomegaly, and severe oligohydramnios. The pregnancy was terminated. An autopsy was performed on the fetus. Both the kidneys were found to be enlarged and the cut surface showed numerous cysts. The liver sections showed changes due to fibrosis. The final diagnosis of autosomal recessive polycystic kidney disease was made based on these findings. In this article, we correlate the ante-natal ultrasound and histopathological findings in autosomal recessive polycystic kidney disease.

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Prenatal sonographic evaluation and postnatal outcome of renal anomalies

Cited by 6 publications

References 14 publications

Postnatal management of bilateral Grade 3–4 ureteropelvic junction obstruction

Postnatal management of bilateral Grade 3–4 ureteropelvic junction obstruction

Correlación entre el diagnóstico ecográfico prenatal y posnatal en casos de hidronefrosis fetal

Autosomal Recessive Polycystic Kidney Disease: Antenatal Diagnosis and Histopathological Correlation

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