DOI: http://dx.doi.org/10.18203/2349-2902.isj20200536

A prospective study antenatally detected hydronephrosis and their postnatal evaluation and management

Karpaga Vinayagam, C. Saravanan

Abstract


Background: Detection of urologic anomalies prenatally permits fetal interventions that avoid complications in rare cases of bladder outlet obstruction with oligohydramnios even though their final benefits still remain controversial. To analyse the incidence of ureteropelvic junction (UPJ) obstruction in antenatally detected hydronephrosis cases.

Methods: This prospective study was conducted February 2019 to August 2019 at the Institute of Child Health and Hospital for Children Egmore, Chennai. All the cases of hydronephrosis which were detected antenatally and those children presented with hydronephrosis in the neonatal period were taken for this study. Totally 58 cases were analyzed in the study, among that 32 cases detected antenatally with UPJ obstruction. Their epidemiology and their immediate postnatal findings (USG abdomen by 3-7 days, IVP and DTPA by 4-6 weeks) were recorded and the percentage of cases in which pelvic-ureteric junction obstruction was significant.

Results: Among the cases that were diagnosed to have hydronephrosis antenatally (46), 69% (32/46) had UPJ obstruction, 21% (10/46) had bilateral hydronephrosis, 6.5% (3/46) had vesicoureteric reflux and rest had other anomalies (1/46).

Conclusions: Antenatal hydronephrosis (ANH), one of the most common abnormal findings on the antenatal ultrasound (US), continues to increase as the standard of care includes the 2nd trimester US. US is the mainstay of the postnatal evaluation and voiding cystourethrogram may be safely reserved for high-grade ANH or dilated distal ureter. New urinary biomarkers may offer promising potential for more accurate risk stratification in the near future.


Keywords


Child, Diagnostic imaging, Hydronephrosis, Prenatal diagnosis

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References


Anderson JC, Hynes W. Retrocaval ureter: A Case diagnosed pre‐operatively and treated successfully by a Plastic Operation. Bri J Urol. 1949;21(3):209-14.

Brooks JD, Kavoussi LR, Preminger GM, Schuessler WW, Moore RG. Comparison of open and endourologic approaches to the obstructed ureteropelvic junction. Urology. 1995;46(6):791-5.

Connor J, Buttyan R, Olsson CA, D'Agati V, Toole KO, Sawczuk IS. SGP-2 expression as a genetic marker of progressive cellular pathology in experimental hydronephrosis. Kidney Inter. 1991;39(6):1098-103.

Djurhuus JC, Jørgensen TM, Nørgaard JP, Nerstrøm B, Hvid-Hansen H. Constant perfusion provocation in idiopathic hydronephrosis. Urology. 1982;19(6):611-6.

Elder JS. Experimental studies of partial ureteral obstruction. Dial Ped Urol. 1991;14:2.

Felsen D, Loo MH, Marion DN, Vaughan ED. Involvement of platelet activating factor and thromboxane A2 in the renal response to unilateral ureteral obstruction. J Urol. 1990;144(1):141-5.

Fung LC, Atala A. Constant elevation in renal pelvic pressure induces an increase in urinary N-acetyl-beta-D-glucosaminidase in a nonobstructive porcine model. J Urol. 1998;159(1):212-6.

Glick PL, Harrison MR, Noall RA, Villa RL. Correction of congenital hydronephrosis in utero III. Early mid-trimester ureteral obstruction produces renal dysplasia. J Pediatr Surg. 1983;18(6):681-7.

Gobe GC, Axelsen RA. Genesis of renal tubular atrophy in experimental hydronephrosis in the rat. Role of apoptosis. Lab Invest; J Tech Meth Pathol. 1987;56(3):273-81.

Grignon A, Filion R, Filiatrault D, Robitaille P, Homsy Y, Boutin H, et al. Urinary tract dilatation in utero: classification and clinical applications. Radiology. 1986;160(3):645-7.

Haralambous-Gasser A, Chan D, Walker RG, Powell HR, Becker GJ, Jones CL. Collagen studies in newborn rat kidneys with incomplete ureteric obstruction. Kidney Inter. 1993;44(3):593-605.

Hawthorne NJ, Zincke H, Kelalis PP. Ureterocalicostomy: an alternative to nephrectomy. J Urol. 1976;115(5):583-6.

Johnston JH, Evans JP, Glassberg KI, Shapiro SR. Pelvic hydronephrosis in children: a review of 219 personal cases. J Urol. 1977;117(1):97-101.

Johnston JH, Evans JP, Glassberg KI, Shapiro SR. Pelvic hydronephrosis in children: a review of 219 personal cases. J Urol. 1977;117(1):97-101.

Josephson S. Experimental obstructive hydronephrosis in newborn rats: III. Long-term effects on renal function. J Urol. 1983;129(2):396-400.

Kass EJ, Fink-Bennett D. Contemporary techniques for the radioisotopic evaluation of the dilated urinary tract. Urologic Clin North Am. 1990;17(2):273-89.

Keller MS. Resistive index ratios in the US diffierentiation of unilateral obstructive vs. nonobstructive hydronephrosis in children. Pediatr. Tadiol. 1991;21:462.

Koff SA. Pathophysiology of ureteropelvic junction obstruction. Clinical and experimental observations. Urol Clin North Am. 1990;17(2):263-72.

Mesrobian HG, Kelalis PP. Ureterocalicostomy: indications and results in 21 patients. J Urol. 1989;142(5):1285-7.

Mollard P, Braun P. Primary ureterocalycostomy for severe hydronephrosis in children. J Pediatr Surg. 1980;15(1):87-91.