Fetal hydronephrosis: natural history and risk factors for postnatal surgery
-
Cristina Plevani
,
Anna Locatelli
Abstract
Background: The objective of this study was to assess the ability of prenatal ultrasound to predict an unfavorable outcome and the need for postnatal surgery in cases of fetal hydronephrosis (HY).
Methods: Antenatal HY was classified according to the renal pelvis anteroposterior (AP) diameter in the third trimester. Postnatal outcome was considered favorable in the presence of spontaneous resolution or postnatal diagnosis of HY <20 mm, and unfavorable in the presence of postnatal diagnosis of >20 mm HY or urinary tract pathologies.
Results: Prenatal diagnosis of HY was made in 120 fetuses (for a total of 161 abnormal renal units). The rates of postnatal urinary tract pathology were 14, 27 and 53% for antenatal HY of ≤7, 8–15 and >15 mm, respectively. An AP diameter ≥7 mm in the third trimester had a sensitivity of 100% and a specificity of 23% to predict unfavorable outcome. A formula inclusive of AP diameter and presence or absence of urinary tract anomalies can predict the need for postnatal surgery.
Conclusions: The majority of infants with congenital HY have a favorable postnatal outcome. Risk of unfavorable outcome increases with the degree of dilatation of the renal pelvis and the presence of urinary tract anomalies. An AP diameter ≥7 mm in the third trimester warrants postnatal follow-up.
References
[1] Arger PH, Coleman BG, Mintz MC, Snyder HP, Camardese T, Arenson RL, et al. Routine fetal genitourinary tract screening. Radiology. 1985;156:485–9.10.1148/radiology.156.2.3892578Search in Google Scholar
[2] Aviram R, Pomeranz A, Sharony R, Beyth Y, Rathaus V, Tepper R. The increase of renal pelvis dilatation in the fetus and its significance. Ultrasound Obstet Gynecol. 2000;16:60–2.10.1046/j.1469-0705.2000.00164.xSearch in Google Scholar
[3] Babu R, Sai V. Postnatal outcome of fetal hydronephrosis: implications for prenatal counseling. Indian J Urol. 2010;26:60–2.10.4103/0970-1591.60446Search in Google Scholar
[4] Blyth B, Snyder HM, Duckett JW. Antenatal diagnosis and subsequent management of hydronephrosis. J Urol. 1993;149:693–8.10.1016/S0022-5347(17)36185-2Search in Google Scholar
[5] Broadley P, Mchugo J, Morgan I, Whittke MJ, Kilby MD. The 4 years outcome following the demonstration of bilateral renal pelvic dilatation on pre-natal renal ultrasound. Br J Radiol. 1999;72:265–70.10.1259/bjr.72.855.10396216Search in Google Scholar
[6] Corteville JE, Gray DL, Crane JP. Congenital hydronephrosis: correlation of fetal ultrasonographic finding with infant outcome. Am J Obstet Gynecol. 1991;165:384–8.10.1016/0002-9378(91)90099-DSearch in Google Scholar
[7] Fleischer AC, Romero R, Manning FA, Jeanty P, James AE. The principles and practice of ultrasonography in obstetrics and gynecology. Norfolk, CT: Appleton and Lange; 2007:251–306.Search in Google Scholar
[8] Gramellini D, Fieni S, Caforio E, Benassi G, Bedocchi L, Beseghi U, et al. Diagnostic accuracy of fetal renal pelvis anteroposterior diameter as a predictor of significant postnatal nephrouropathy: second versus third trimester of pregnancy. Am J Obstet Gynecol. 2006;194:167–73.10.1016/j.ajog.2005.06.071Search in Google Scholar
[9] Grandjean H, Larroque D, Levi S, Eurofetus Study Group. The performance of routine ultrasonographic screening of pregnancies in the Eurofetus Study. Am J Obstet Gynecol. 1999;181:446–54.10.1016/S0002-9378(99)70577-6Search in Google Scholar
[10] Grignon A, Filion R, Filiatrault D, Robitaille P, Homsy Y, Boutin H, et al. Urinary dilatation in utero: classification and clinical applications. Radiology. 1986;160:645–7.10.1148/radiology.160.3.3526402Search in Google Scholar
[11] Gunn TR, Mora JD, Pease P. Antenatal diagnosis of urinary tract abnormalities by ultrasonography after 28 weeks’ gestation: incidence and outcome. Am J Obstet Gynecol. 1995;172:479–86.10.1016/0002-9378(95)90560-XSearch in Google Scholar
[12] Ismaili K, Avni FE, Piepsz A, Wissing KM, Cochat P, Aubert D, et al. Current management of infants with fetal renal pelvis dilation: a survey by French-speaking pediatric nephrologists and urologists. Pediatr Nephrol. 2004;19: 966–71.10.1007/s00467-004-1506-0Search in Google Scholar PubMed
[13] Ismaili K, Avni FE, Wissing K, Hall M, Brussels Free University Perinatal Nephrology Study Group. Long-term clinical outcome of infants with mild and moderate fetal pyelectasis: validation of neonatal ultrasound as a screening tool to detect significant nephrouropathies. J Pediatr. 2004;144:759–65.Search in Google Scholar
[14] Kim HJ, Jung HJ, Lee HY, Lee YS, Im YJ, Hong CH, et al. Diagnostic value of anteroposterior diameter of fetal renal pelvis during second and third trimesters in predicting postnatal surgery among Korean population: useful information for antenatal counselling. Urology. 2012;79:1132–7.10.1016/j.urology.2012.01.007Search in Google Scholar PubMed
[15] Lee RS, Cendron M, Kinnamon DD, Nguyen HT. Antenatal hydronephrosis as a predictor of postnatal outcome: a meta-analysis. Pediatrics. 2006;118:586–93.10.1542/peds.2006-0120Search in Google Scholar PubMed
[16] Sairam S, Al-Habib A, Sasson S, Thilaganathan B. Natural history of fetal hydronephrosis diagnosed on mid-trimester ultrasound. Ultrasound Obstet Gynecol. 2001;17:191–6.10.1046/j.1469-0705.2001.00333.xSearch in Google Scholar PubMed
[17] Shamshirsaz AA, Ravangard SF, Egan JF, Prabulos AM, Shamshirsaz AA, Ferrer FA, et al. Fetal hydronephrosis as a predictor of neonatal urologic outcomes. J Ultrasound Med. 2012;31:947–54.10.7863/jum.2012.31.6.947Search in Google Scholar PubMed
[18] Signorelli M, Cerri V, Taddei F, Grolli C, Bianchi UA. Prenatal diagnosis and management of mild fetal pyelectasis: implications of neonatal outcome and follow-up. Eur J Obstet Gynecol Reprod Biol. 2005;118:154–9.10.1016/j.ejogrb.2004.04.023Search in Google Scholar PubMed
[19] Stedman T. Stedman’s medical dictionary, 26th edition. Baltimore: Williams & Wilkins Lippincott; 1995.Search in Google Scholar
[20] Stocks A, Richards D, Frentzen B, Richard G. Correlation of prenatal renal pelvic anteroposterior diameter with outcome in infancy. J Urol. 1996;165:1050–2.10.1097/00005392-199603000-00076Search in Google Scholar
[21] Sverker EK, Lidefeldt KJ, Varricio L. Fetal hydronephrosis; prevalence, natural history and postnatal consequences in an unselected population. Acta Obstet Gynecol Scand. 2007;86:1463–6.10.1080/00016340701714802Search in Google Scholar PubMed
[22] Wiesel A, Queisser-Luft A, Clementi M, Bianca S, Stoll C. Euroscan Study Group. Prenatal detection of congenital renal malformations by fetal ultrasonographic examination: analysis of 709,030 births in 12 European Countries. Eur J Med Genet. 2005;48:131–44.10.1016/j.ejmg.2005.02.003Search in Google Scholar PubMed
[23] Wollenberg A, NeuHaus TJ, Willi UV, Wisser J. Outcome of fetal renal pelvic dilatation diagnosed during the third trimester. Ultrasound Obstet Gynecol. 2005;25:483–8.10.1002/uog.1879Search in Google Scholar PubMed
[24] Woodward M, Frank D. Postnatal management of antenatal hydronephrosis. BJU Int. 2002;89:149–56.10.1046/j.1464-4096.2001.woodward.2578.xSearch in Google Scholar PubMed
The authors stated that there are no conflicts of interest regarding the publication of this article.
©2014 by Walter de Gruyter Berlin Boston
Articles in the same Issue
- Frontmatter
- Editorial
- Academy’s Corner – a new section at JPM
- Academy’s Corner
- Global education in perinatal medicine: will the bureaucracy or smartocracy prevail?
- Review articles
- Placental chorioangioma: literature review
- Sonographic measurement of cervical length as a predictor of preterm delivery: a systematic review
- Original articles – Obstetrics
- Peripartum anesthetic management of patients with Factor XI deficiency
- Risk of inferior vena cava compression syndrome during fetal MRI in the supine position – a retrospective analysis
- Fetal behavioral states are stable over daytime – evidence by longitudinal and cross-sectional fetal biomagnetic recordings
- Diet or medically treated gestational diabetes: is there any difference for obstetrical and neonatal complications? A French cohort study
- Cerebroplacental Doppler ratio and placental histopathological features in pregnancies complicated by fetal growth restriction
- Placental syndecan-1 and sulphated glycosaminoglycans are decreased in preeclampsia
- Pharmacological anti-thrombotic prophylaxis after elective caesarean delivery in thrombophilia unscreened women: should maternal age have a role in decision making?
- Values of T/QRS ratios measured during normal and post-term pregnancies
- The factors associated with the failure of transcatheter pelvic arterial embolization for intractable postpartum hemorrhage
- Hysteroscopic and laparoscopic management of uterine defects on previous cesarean delivery scars
- Chemerin concentrations in maternal and fetal compartments: implications for metabolic adaptations to normal human pregnancy
- Repetitive administration of acetylcholine receptor agonist rescues brain inflammation and brain damage after hypoxia-ischemia in newborn rat
- Original article – Fetus
- Fetal hydronephrosis: natural history and risk factors for postnatal surgery
- Original article – Newborn
- Cytomegalovirus infection among infants in California neonatal intensive care units, 2005–2010
- Letter to the Editors
- Origin of the long-term variability and acceleration of FHR studied for the prevention of cerebral palsy in fetal hypoxia and general insults
- Neonatal phototherapy, fluids, and photorelaxation
- Congress Calendar
- Congress Calendar
Articles in the same Issue
- Frontmatter
- Editorial
- Academy’s Corner – a new section at JPM
- Academy’s Corner
- Global education in perinatal medicine: will the bureaucracy or smartocracy prevail?
- Review articles
- Placental chorioangioma: literature review
- Sonographic measurement of cervical length as a predictor of preterm delivery: a systematic review
- Original articles – Obstetrics
- Peripartum anesthetic management of patients with Factor XI deficiency
- Risk of inferior vena cava compression syndrome during fetal MRI in the supine position – a retrospective analysis
- Fetal behavioral states are stable over daytime – evidence by longitudinal and cross-sectional fetal biomagnetic recordings
- Diet or medically treated gestational diabetes: is there any difference for obstetrical and neonatal complications? A French cohort study
- Cerebroplacental Doppler ratio and placental histopathological features in pregnancies complicated by fetal growth restriction
- Placental syndecan-1 and sulphated glycosaminoglycans are decreased in preeclampsia
- Pharmacological anti-thrombotic prophylaxis after elective caesarean delivery in thrombophilia unscreened women: should maternal age have a role in decision making?
- Values of T/QRS ratios measured during normal and post-term pregnancies
- The factors associated with the failure of transcatheter pelvic arterial embolization for intractable postpartum hemorrhage
- Hysteroscopic and laparoscopic management of uterine defects on previous cesarean delivery scars
- Chemerin concentrations in maternal and fetal compartments: implications for metabolic adaptations to normal human pregnancy
- Repetitive administration of acetylcholine receptor agonist rescues brain inflammation and brain damage after hypoxia-ischemia in newborn rat
- Original article – Fetus
- Fetal hydronephrosis: natural history and risk factors for postnatal surgery
- Original article – Newborn
- Cytomegalovirus infection among infants in California neonatal intensive care units, 2005–2010
- Letter to the Editors
- Origin of the long-term variability and acceleration of FHR studied for the prevention of cerebral palsy in fetal hypoxia and general insults
- Neonatal phototherapy, fluids, and photorelaxation
- Congress Calendar
- Congress Calendar
