The Natural History of Neonatal Vesicoureteral Reflux Associated With Antenatal Hydronephrosis

Farhat, Walid A.; McLorie, Gordon A.; Geary, Denis F.; Capolicchio, Gianpaolo; B??GLI, DARIUS; Merguerian, Paul A.; Khoury, Antoine E.

doi:10.1097/00005392-200009020-00033

Cited by 40 publications

(41 citation statements)

References 24 publications

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“…Resolution of VUR without significant damage has often been observed [10,25,26]. However, severe VUR defined, as grade !III, detected after a UTI, has been associated with a threefold increased risk of renal scarring compared with children with lesssevere VUR [27].…”

Section: Discussionmentioning

confidence: 99%

Vesicoureteral reflux in infants with isolated antenatal hydronephrosis

Phan

Traubici

Hershenfield

et al. 2003

Pediatric Nephrology

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Standardized evaluation of all newborns with antenatally recognized hydronephrosis (ANH) at The Hospital for Sick Children (HSC) has included voiding cystourethrography (VCUG). This paper reviews this protocol to determine: (1) the prevalence of vesicoureteral reflux (VUR) in isolated ANH and (2) the value of performing VCUG in cases of mild hydronephrosis, defined as renal pelvis dilatation <10 mm on postnatal ultrasonography (US). A retrospective chart review was performed on infants referred with ANH. The inclusion criterion was isolated ANH. Exclusion criteria were (1) presence of additional genitourinary abnormalities and (2) no VCUG. Pelviectasis was categorized according to the anteroposterior diameter of the renal pelvis. There were 111 infants with isolated ANH. All except 3 underwent VCUG. There were 68 children (63%) with normal postnatal US or mild pelviectasis (<10 mm). VUR was detected in 16 patients, of whom 10 had mild or absent pelvic dilatation. There was no correlation between the degree of pelviectasis on postnatal US and the presence or severity of VUR ( P=0.567 and P=0.802). VUR was detected in 15% of children with isolated ANH, many of whom had normal postnatal US or mild postnatal pelviectasis. VCUG is the only reliable test for detecting postnatal VUR.

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Section: Discussionmentioning

confidence: 99%

Vesicoureteral reflux in infants with isolated antenatal hydronephrosis

Phan

Traubici

Hershenfield

et al. 2003

Pediatric Nephrology

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“…Spontaneous resolution of moderate VUR has been observed in 60-85% of children after a few years' follow-up [23].…”

Section: The Occurrence Of Vesicoureteral Refluxmentioning

confidence: 99%

Vesicoureteral reflux, a benign condition

Venhola

Uhari

2009

Pediatr Nephrol

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The combination of urinary tract infection (UTI) and vesicoureteral reflux (VUR) is commonly thought to predispose the child to pyelonephritis, renal scarring and, later in life, to hypertension or end-stage renal disease (ESRD). This paradigm has led to the active search, follow-up and treatment of VUR, and also prevention of recurrent UTI in children. The causality of VUR and ESRD is controversial, however. According to recent meta-analyses it is uncertain whether we can prevent renal scarring or ESRD by treating VUR. Studies on VUR are abundant, but the findings and conclusions are confounding. Because of the lack of evidence of the role of VUR, reasonable doubt has recently been presented on the rationale of imaging all children with UTI and treating the children with VUR. The overall importance of VUR is confounded because of the natural tendency of VUR to resolve spontaneously, its dynamic nature, and its different grades in children. The historical studies showing that VUR is much more common, even among healthy children, than usually claimed, have been forgotten. Since it seems that we are referring too many healthy children to unpleasant and possibly unnecessary imaging tests for VUR, we are uncertain when and what kind of VUR-if any-we should treat, and whether our present rationale of addressing VUR truly makes any difference to renal scarring or ESRD in children, we should critically revisit the subject of VUR.

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“…This finding provides another useful parameter for choosing which patients may not need to undergo VCUG. In spite of this information, many physicians still perform VCUG in all cases of prenatal hydronephrosis [37][38][39][40]; however, a more selective approach now seems reasonable.…”

Section: Postnatal Managementmentioning

confidence: 99%

Management of fetal hydronephrosis

Yiee

Wilcox

2007

Pediatr Nephrol

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Prenatally detected hydronephrosis has become a common diagnosis for both pediatric nephrologists and urologists. Hydronephrosis is most commonly assessed by the Society for Fetal Urology grading system or anterior-posterior diameter of the renal pelvis in the transverse plane. Some cases of bilateral obstruction, most commonly from posterior urethral valves, can be life-threatening and require close monitoring or, occasionally, fetal intervention. The majority are unilateral and of no threat to the growing fetus. The crux of postnatal management is the separation of the minority of patients whose renal function is at risk from the majority who will suffer no renal consequences. This management involves a regimen of ultrasounds, voiding cystourethrograms, and nuclear renograms for diagnosis and surveillance. Recent literature has been aimed at the timing and necessity of these studies in order to minimize extraneous studies without compromising renal function.

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The Natural History of Neonatal Vesicoureteral Reflux Associated With Antenatal Hydronephrosis

Cited by 40 publications

References 24 publications

Vesicoureteral reflux in infants with isolated antenatal hydronephrosis

Vesicoureteral reflux in infants with isolated antenatal hydronephrosis

Vesicoureteral reflux, a benign condition

Management of fetal hydronephrosis

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