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Pediatric Urology, Marburg 1, North Wolfe St., Baltimore, MD This review will encompass the identification of antenatal hydronephrosis as. Department of Pediatric Nephrology. Ankara- Antenatal hydronephrosis is present if. APD ≥4 mm in . Sinha A. Indian Pediatrics Neonates with normal. Hydronephrosis. Antenatal hydronephrosis (ANH) is one of the most common abnormal findings Department of Pediatrics, CHA. Bundang.

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Society of Fetal Urology.

If there is no increasing hydronephrosis on serial ultrasounds then also the child needs to be followed up till the age of 6 years. Prenatal puncture of a unilateral hydronephrosis leading to fetal urinoma and postnatal nephrectomy.

The diagnosis of fetal pelvis dilatation and hydroneprosis natural history postnatally is best understood if we understand that the definition of hydronephrosis has undergone a sea change. The antenatal ultrasound screening is most commonly performed at wk of gestation. In cases of posterior urethral valves the level of amniotic fluid is a significant predictor of renal function and clinical outcome[ 21 ].

At present fetal intervention is indicated in cases where the life of the fetus is at risk, typically a second trimester fetus with significant oligohydramnios, suspected good inian function and absence of other life threatening anomalies[ 21 ]. Current management of infants with fetal renal pelvis dilation: The available literature is conflicting.

WB Saunders Company; ; J Korean Med Sci. The exceptions antenaatal this caveat are: However this grading system is not universally followed and due to the ambiguity in inter and intra observer agreement especially in grade 3 and grade 4 hydronephrosis, modifications have been proposed[ 1718 ].

Revised guidelines on management of antenatal hydronephrosis.

This probably explains the disappearing fetal hydronephrosis postnatally when the physiological function of the urinary tract becomes more mature. Clinical characteristics and outcome of hydronephrosis detected by prenatal ultrasonography. British Association of Paediatric Urologists consensus statement on the management of the primary obstructive megaureter.


This needs to be diagnosed as early as possible so that intervention can be done before renal damage occurs. But chemoprophylaxis is indicated in those with moderate or severe degree of hydronephrosis till VCUG is done. Functional outcome after pyeloplasty in children: Antibiotics or surgery for vesicoureteric reflux in children. Percutaneous fetal cystoscopy and endoscopic fulguration of anetnatal urethral valves. Pediatr Clin North Am. Antenatal hydronephrosis current evaluation and management.

A systematic review and meta-analysis.

These factors were taken into account by the Society of Fetal Urology and a grading system for hydronephrosis was proposed[ 3 ]. Voiding cysto urethrogram; USG: Long-term outcomes in children treated by prenatal vesicoamniotic shunting for lower urinary tract obstruction. Mild to moderate postnatal hydronephrosis–grading systems and management. A detailed review of the current literature on this topic is provided.

Intrauterine diagnosis of renal anomalies by ultrasonography. However the agreement ends here. Surgery versus observation for managing obstructive grade 3 to 4 unilateral hydronephrosis: Also once the bladder is empty, the effect of a distended bladder on the filling and emptying of the collecting system resulting in fallacious diagnosis of pyelectasis is avoided. The hydronephrosis index is defined by the APD of the fetal kidney divided by the urinary bladder volume.

Till an answer to this dilemma is obtained, there is much parental anxiety, as the need for surgery hangs like a sword of Damocles on the head of the patient. Investigators have studied whether ultrasonography can be used to predict the need for surgery. Though there are defined criteria of intervention, it is still not clear as to who will benefit.


The sonologist should be vigilant in the antenatal period to differentiate a dilated collecting system from the hypoechoic sonolucent pyramids which may mimic hydronephrosis. Even these modifications have not gained universal acceptance. Two modalities have been extensively studied to provide an answer to this vexing question-Ultrasonography and Radionuclide studies. Article-Type of This Article.

Insights into the pathogenesis and natural history of fetuses with renal pelvis dilatation. The landmark study by Dhillon et al[ 58 ] inproposed the measurement of APD of the renal pelvis as a means of judging the severity of hydronephrosis and predicting the need for surgery.

Postnatal management of antenatally detected hydronephrosis

Wang F S- Editor: Related articles Ultrasound hydronephrosis antenatal. This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers.

Normally the renal pelvis and calyces are not seen, if seen then it indicates hydronephrosis. Ultrasound findings in these clinical scenarios have an important bearing on the decision making in deciding the obstetric course of the patient.

Anomalies of the upper tract. Although SFU is a useful system, two alternative grading systems have been proposed. However, all these three terms are used interchangeably and are used to describe a dilated pelvicalyceal system regardless of its etiology[ 8 ].

Open-Access Policy of This Article. Cochrane Database Syst Rev A delay in this suggests obstruction. Vesicoureteral reflux and clinical outcomes in infants with prenatally detected hydronephrosis.

If the function has been compromised then the diagnosis of obstruction is beyond doubt.