Management in children of mild postnatal renal dilatation but without vesicoureteral reflux
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Infants with mild postnatal renal dilatation but without vesicoureteral reflux pose a challenge. For how long and in what way should they be followed? From May 1989 to December 2006, we prospectively followed 1,795 pregnancies in which the foetal renal pelvis measured 4 mm or greater. Voiding cystourethrography (VCUG) and renal ultrasound were performed on 1,315 infants at 6 weeks of age. Our study group comprised 208 (167 male) infants with normal VCUG findings who had a renal pelvis of 6–11 mm. We followed them for 1–17 years (mean 11 years). Medical and radiological records were reviewed to determine any urinary symptoms and final outcome. They underwent, on average, four further imaging tests. The renal dilatation had resolved by 24 months in approximately 70%. Urinary tract infection (UTI) developed in 16 (8%). Calyceal dilatation was more likely in those developing UTI (P = 0.02). Twenty-two (10.6%) had a radiologically demonstrated urinary tract abnormality. Of the five who had renal scarring or severe obstruction, four became symptomatic. Most infants with mild postnatal renal dilatation can be investigated with only one further sonogram at 24 months of age. Mild postnatal renal dilatation is associated with subsequent UTI or renal tract abnormality in 18%. Severe renal abnormality occurred in 2.4%.
KeywordsVesicoureteral reflux Ureteral obstruction Ultrasonography Prenatal Neonatal screening Neonatal hydronephrosis Mild postnatal renal dilatation Urinary tract infection
We are grateful to the sonographers over the years who have scanned these children, the paediatricians who have faced the difficulties in deciding how to treat the children, and, especially, the parents for their forbearance. We particularly acknowledge the work of Dr. George Abbott. We thank Judith Dawson for preparing the manuscript and Jim Stankovich for helping to prepare Fig. 2.
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