Prospective study of outcome in antenatally diagnosed renal pelvis dilatation

Jaswon, Mervyn; Dibble, Laraine; Puri, S.; Davis, Jacky; Young, Jane; Dave, Raj; Morgan, Herbert R.

doi:10.1136/fn.80.2.f135

Cited by 133 publications

(98 citation statements)

References 17 publications

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“…The earliest reported fetal ultrasound was at 14 wk of gestation (21). Most studies reported that postnatal scans were not performed within 2 d after birth (17,20,22,23,(27)(28)(29)(30)(31), which may be important because newborns are initially oliguric and false-negative results are common at this time: 4 studies did not specify the earliest age at postnatal ultrasound assessment (18,29,30,33).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…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%

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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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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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

confidence: 99%

See 1 more Smart Citation

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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“…For those patients of more advanced gestation who were referred for prenatal urology consultation, compliance was nearly universal. An observation similar to that was made by Jaswon et al, 12 who surmised that more detailed information provided to patients by the pediatric urologist was the key to better compliance. To refer all ANH cases for prenatal urology consultation is not feasible.…”

Section: Discussionmentioning

confidence: 64%

“…16 Three small prospective studies recognized that 10 to 30% of their ANH infants were lost to follow-up. 2,12,[17][18] More recently Lee et al, 3 in a meta-analysis (using a criteria similar to ours) noted that 246 (15%) of 1678 patients with ANH were lost to follow-up. Many investigators, however, have not mentioned any loss of patients in their ANH programs.…”

Section: Discussionmentioning

confidence: 99%

Postnatal follow-up of antenatal hydronephrosis: a health-care challenge

et al. 2009

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Objective: To examine our experience with ANH and to determine the success of our postnatal follow-up program.Study Design: Charts of mothers and infants seen (2004 to 2008) at our Regional Perinatal Center were reviewed retrospectively. ANH was defined during the third trimester by anterior pelvic diameters as follows: mild 7 to 9, moderate 10 to 14 or severe X15 mm. Fetuses with multicystic dysplastic kidney (MCDK) were included. Result:Screening of approximately 15 000 ultrasound (US) reports identified 268 fetuses with ANH. After prenatal US surveillance, 88 (33%) fetuses had resolved, while 180 (67%) required postnatal follow-up. These 180 fetuses were diagnosed with mild 38 (21%), moderate 83 (46%) and severe 19 (11%) ANH, uni or bilateral hydroureters 12 (7%), MCDK 19 (10%) and miscellaneous 9 (5%). Postnatal follow-up was successfully established for 75% of infants with hydroureters, 68% for those with MCDK and for 37% of infants with mild, 53% with moderate and 58% with severe ANH. Factors commonly known to influence compliance were not found more frequently among the 91 infants who were lost to follow-up. The only positive predictor for postnatal follow-up was a prenatal consultation with the pediatric urologist. 1-4 The majority of these fetuses recover spontaneously but approximately 40% require postnatal follow-up, and in half of these cases, medical or surgical intervention was needed to prevent significant renal damage. The spectrum of genitourinary abnormalities detected antenatally is varied but the majority of patients have ANH.5 It is commonly accepted that no specific etiology can be identified in 48% of ANH cases.1-5 Physiologic changes are seen in 15%, ureteropelvic and ureterovesical junction obstructions account for 11% of the cases, 9% have vesicoureteral reflux, 4% have unilateral or bilateral megaloureters, 2% of all cases have multicystic dysplastic kidney (MCDK) and 1% have ureterocele. 1,3,6 Regardless of the cause, it is expected that about half of the ANH cases will resolve before delivery or during the first year of life. 2,6 For the other half there will be a need for postnatal follow-up as persistent uropathy is expected to occur in 12% of mild, 45% of moderate and 88% of severe ANH cases.

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