Revised guidelines on management of antenatal hydronephrosis
Open Access
- 1 January 2013
- journal article
- review article
- Published by Medknow in Indian Journal of Nephrology
- Vol. 23 (2), 83-97
- https://doi.org/10.4103/0971-4065.109403
Abstract
Widespread antenatal screening has resulted in increased detection of anomalies of the kidneys and urinary tract. The present guidelines update the recommendations published in 2000. Antenatal hydronephrosis (ANH) is transient and resolves by the third trimester in almost one-half cases. The presence of oligohydramnios and additional renal or extrarenal anomalies suggests significant pathology. All patients with ANH should undergo postnatal ultrasonography; the intensity of subsequent evaluation depends on anteroposterior diameter (APD) of the renal pelvis and/or Society for Fetal Urology (SFU) grading. Patients with postnatal APD exceeding 10 mm and/or SFU grade 3-4 should be screened for upper or lower urinary tract obstruction and vesicoureteric reflux (VUR). Infants with VUR should receive antibiotic prophylaxis through the first year of life, and their parents counseled regarding the risk of urinary tract infections. The management of patients with pelviureteric junction or vesicoureteric junction obstruction depends on clinical features and results of sequential ultrasonography and radionuclide renography. Surgery is considered in patients with increasing renal pelvic APD and/or an obstructed renogram with differential renal function < 35-40% or its subsequent decline. Further studies are necessary to clarify the role of prenatal intervention, frequency of follow-up investigations and indications for surgery in these patients.Keywords
This publication has 106 references indexed in Scilit:
- Applying the ALARA concept to the evaluation of vesicoureteric refluxPediatric Radiology, 2006
- Patient dose reduction during voiding cystourethrographyPediatric Radiology, 2006
- Postnatal management of infants with antenatally detected hydronephrosisPediatric Nephrology, 2005
- Should determination of the karyotype be systematic for all malformations detected by obstetrical ultrasound?Prenatal Diagnosis, 2005
- Current management of infants with fetal renal pelvis dilation: a survey by French-speaking pediatric nephrologists and urologistsPediatric Nephrology, 2004
- Vesicoureteral reflux in infants with isolated antenatal hydronephrosisPediatric Nephrology, 2003
- Prognostic factors in fetal hydronephrosis: a multivariate analysisPediatric Nephrology, 1999
- In Utero Progression of Isolated Renal Pelvis DilationAmerican Journal of Perinatology, 1997
- Prognostic significance of antenatally detected fetal pyelectasisUltrasound in Obstetrics & Gynecology, 1996
- Ultrasound grading of hydronephrosis: Introduction to the system used by the society for fetal urologyPediatric Radiology, 1993