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Neonatal hydronephrosis—the controversy and the management

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Abstract

Neonatal hydronephrosis is being detected with increasing frequency. The majority of these cases have a tendency to resolve during infancy. Hydronephrosis is an anatomical entity that is not synonymous with obstruction. Review of the pathoembryology, the pathophysiology, the diagnostic techniques currently used and the natural history of hydronephrosis is given. The management and the controversies involved are discussed.

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References

  1. 1.

    Homsy YL, Koff SA (1988) Problems in the diagnosis of obstruction in the neonate. In: King LR (ed) Urologic surgery in neonates and young infants. Saunders, Philadelphia, pp 77–94

  2. 2.

    Thomas DF (1990) Fetal uropathy. Br J Urol 66: 225–231

  3. 3.

    Livera LN, Brookfield DS, Egglinton JA, Hawnaur JM (1989) Antenatal ultrasonography to detect fetal renal abnormalities: a prospective screening programme. BMJ 298: 1421–1423

  4. 4.

    Helin I, Persson PH (1986) Prenatal diagnosis of urinary tract abnormalities by ultrasound. Pediatrics 78: 879–883

  5. 5.

    Grignon A, Filiatrault D, Homsy YL, Robitaille F, Filion R, Boutin H, Lebland R (1986) Urinary tract dilatation in utero: classification and clinical applications. Radiology 160: 645–647

  6. 6.

    Homsy YL, Saad F, Laberge I, Williot P, Pison C (1990) Transitional hydronephrosis of the newborn and infant. J Urol 144: 579–582

  7. 7.

    Klahr S (1991) New insights into the consequences and mechanisms of renal impairment in obstructive nephropathy. Am J Kidney Dis 18: 689–699

  8. 8.

    Klahr S, Purkerson ML (1994) The pathophysiology of obstructive nephropathy: the role of vasoactive compounds in the hemodynamic and structural abnormalities of the obstructed kidney. Am J Kidney Dis 23: 219–223

  9. 9.

    Passerini-Glazel G, Koff SA (1993) Hydronephrosis in the newborn: an experimental overview Dialogues Pediatr Urol 16: 1–8

  10. 10.

    Fichtner J, Boineau FG, Lewy JE, Sibley RK, Vari RC, Shortliffe LM (1994) Congenital unilateral hydronephrosis in a rat model: continuous renal pelvic and bladder pressures. J Urol 152: 652–657

  11. 11.

    Fitzpatrick JM, Ryan JPC, Geraghty JG, Lennon GM (1993) The effects of renal and ureteric function on partial ureteric obstruction. Dialogues Pediatr Urol 16: 4–6

  12. 12.

    Chevalier RL (1993) Renal hemodynamics and the renin angiotensin system in experimental ureteral obstruction. Dialogues Pediatr Urol 16: 6–8

  13. 13.

    Bogaert GA, Mevorach RA, Kogan BA (1994) Renal hemodynamic and functional effects of 10 days partial urinary obstructive in the fetal lamb. J Urol 152: 220–225

  14. 14.

    Lewy JE (1993) Congenital hydronephrosis in an animal model. Dialogues Pediatr Urol 16: 3–4

  15. 15.

    Bowie JD, Rosenberg ER, Andreotti RF, Fields SI (1983) The changing sonographic appearance of fetal kidneys during pregnacy. J Ultrasound Med 2: 505–507

  16. 16.

    Chwalla R (1927) Über die Entwicklung der Harnblase und der Primaren der Menschen mit besonderer Berücksichtigung der Art und Weise, in der sich die Uretern von der Urnierengangen trennen, nebst Bemerkungen über die Entwicklung der Müllerschen Gange und des Mastdarms. Z Anat Entw Gesch 83: 615

  17. 17.

    Ostling K (1942) The genesis of hydronephrosis particularly with regard to the changes at the ureteropelvic junction. Acta Chir Scand 86: 1

  18. 18.

    Ruano-Gil D, Coca-Payeras A, Tejedo-Mateu A (1975) Obstruction and normal recanalization of the ureter in the human embryo. Its relation to congenital ureteric obstruction. Eur Urol 1: 287–293

  19. 19.

    Allen TD (1970) Congenital ureteral strictures. J Urol 104: 196–204

  20. 20.

    Homsy YL, Williot P, Danais S (1985) Transitional hydronephrosis: fact or fantasy? J Urol 136: 339–341

  21. 21.

    Koff SA, Peller PA, Young DC, Pollifrone DL (1994) The assessment of obstruction in the newborn with unilateral hydronephrosis by measuring the size of the opposite kidney. J Urol 152: 596–599

  22. 22.

    Maizels M, Reisman ME, Flom LS, Nelson J, Fernbach S, Firlit CE, Conway JJ (1992) Grading nephroureteral dilatation detected in first year of life: correlation with obstruction. J Urol 148: 609–614

  23. 23.

    Platt JF, Rubin JM, Ellis JH, DiPietro MA (1989) Duplex dopplex US of the kidney: differentiation of obstructive from nonobstructive dilatation. Radiology 171: 515

  24. 24.

    Keller MS, Garcia CJ, Korsvik H, Weiss RM, Rosenfield NS (1991) Resistive index ratios in the US differentiation of unilateral obstructive vs. nonobstructive hydronephrosis in children (abstract). Pediatr Radiol 21: 462

  25. 25.

    Ordorica RI, Lindfors KK, Palmer JM (1993) Diuretic doppler sonography following successful repair of renal obstruction in children. J Urol 150: 774–777

  26. 26.

    Mandell J, Peters DA, Estroff JA, Alfred EN, Benacekaff BR (1993) Human fetal compensatory renal growth. J Urol 150: 790–792

  27. 27.

    Hollowell JG, Altman HG, Snyder HM, Duckett JW (1989) Coexisting ureteropelvic junction obstruction and vesicoureteral reflux: diagnostic and therapeutic implications. J Urol 142: 490

  28. 28.

    Weiss RM, Lytton B (1974) Vesicoureteral reflux and distal ureteral obstruction. J Urol 111: 245

  29. 29.

    Krueger RP, Ash JM, Silver MM, Kass EJ, Gilmour RF, Alton DJ, Gilday DL, Churchill BM (1980) Primary hydronephrosis: assessment of diuretic renography, pelvis perfusion pressure, operative findings, and renal and ureteral histology. Urol Clin North Am 7: 231–232

  30. 30.

    Eshima D, Taylor A (1992) Technetium-99m mercaptoacetyltriglycerine: update on the new 99mTc renal tubular function agent. Semin Nucl Med 22: 61–73

  31. 31.

    Lambert R, Turpin S, Taillefer R, Leveille J (1993) An easy technique for GFR determination in children using99mTc-DTPA, one plasma sample and external counting with a thyroid probe (abstract). J Nucl Med 34: 5

  32. 32.

    Homsy YL, Mehta P, Danais S (1988) Intermittent hydronephrosis: a diagnostic challenge. J Urol 140: 1222–1226

  33. 33.

    Kass EJ, Majd M (1985) Evaluation and management of upper urinary tract obstruction in infancy and childhood Urol. Clin. North Am 12: 133–141

  34. 34.

    Conway JJ (1992) Well tempered diuresis renography: its historical development, physiological and technical pitfalls and standardized technique protocol. Semin Nucl Med 22: 74–84

  35. 35.

    Conway JJ (1992) The “well-tempered” diuretic renogram: a standard method to examine the asymptomatic neonate with hydronephrosis or hydroureteronephrosis. A report from combined meeting of The Society for Fetal Urology and members of The Pediatric Nuclear Medicine Council—The Society of Nuclear Medicine. J Nucl Med 33: 2047–2051

  36. 36.

    Koff SA, Thrall JH, Keyes JW Jr (1979) Diuretic radionuclide urography: a non-invasive method for evaluation nephroureteral dilatation. J Urol 122: 451–454

  37. 37.

    Koff SA, McDowell GC, Byard M (1988) Diuretic radionuclide assessment of obstruction in the infant: guidelines for successful interpretation. J Urol 140: 1167–1168

  38. 38.

    Koff SA, Campbell KD (1994) Nonoperative management of unilateral neonatal hydronephrosis: natural history of poorty functioning kidneys. J Urol 152: 593–595

  39. 39.

    Ransley PG, Dhillon HK, Gordon I, Duffy PG, Dillon MJ, Barrat TM (1990) The postnatal management of hydronephrosis diagnosed by prenatal ultrasound. J Urol 144: 584–587

  40. 40.

    Cartwright PL, Duckett JW, Keating MA, Snyder HM, Escala J, Blyth B, Heyman S (1992) Managing apparent ureteropelvic junction obstruction in the newborn. J Urol 148: 1224–1228

  41. 41.

    Flashner SC, Mesrobian HJ, Flatt JA, Wilkinson RH, King RL (1993) Nonobstructive dilatation of upper urinary tract may later convert to obstruction. Urology 42: 569–573

  42. 42.

    Liu HY, Dhillon HK, Yeung CK, Diamond DA, Duggy PG, Ransley PG (1994) Clinical outcome and management of prenatally diagnosed primary megaureters. J Urol 152: 614–617

  43. 43.

    Duckett JW (1993) When to operate on neonatal hydronephrosis. Urology 42: 617–619

  44. 44.

    Blyth B, Snyder HM, Duckett JW (1993) Antenatal diagnosis and subsequent management of hydronephrosis. J Urol 149: 693–698

  45. 45.

    Kass EJ, Fink-Bennett D (1990) Contemporary techniques for the radioisotopic evaluation of the dilated urinary tract. Urol Clin North Am 17: 273–289

  46. 46.

    Maizels M, Mitchell B, Kass E, Fernbach SK, Conway JJ (1994) Outcome of non-specific hydronephrosis in the infant: a report from the registry of The Society for Fetal Urology. J Urol 152: 2324–2327

  47. 47.

    Mayor G, Genton N, Torrado A, Guignard JP (1975) Renal function in obstructive nephropathy: long-term effect of reconstructive surgery. Pediatrics 56: 740–747

  48. 48.

    Perez LM, Friedman RM, King LR (1991) The case for relief of ureteral pelvic junction obstruction in neonates and young children at time of diagnosis. Urology 38: 195

  49. 49.

    Thomas DM, Coles GA, Williams JD (1994) What does the renal reserve mean? Kidney Int 45: 411–416

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Correspondence to Yves L. Homsy.

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Tripp, B.M., Homsy, Y.L. Neonatal hydronephrosis—the controversy and the management. Pediatr Nephrol 9, 503–509 (1995). https://doi.org/10.1007/BF00866741

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Key words

  • Hydronephrosis
  • Kidney diseases
  • Prenatal diagnosis
  • Ultrasonography
  • Nuclear renography