Advertisement

Pediatric Nephrology

, Volume 25, Issue 9, pp 1687–1692 | Cite as

Antenatal and postnatal ultrasound in the evaluation of the risk of vesicoureteral reflux

  • Serge Grazioli
  • Paloma Parvex
  • Laura Merlini
  • Christophe Combescure
  • Eric Girardin
Original Article

Abstract

Antenatal hydronephrosis (ANH) is a frequent anomaly detected on fetal ultrasound scans. There is no consensus recommendation for the postnatal follow-up and/or the necessity to perform a voiding cystourethrography (VCUG) to diagnose vesicoureteral reflux (VUR). We conducted a cohort/non-randomized trial of 121 patients with ANH, defined as an anterior posterior diameter (APD) ≥5 mm after the 20th week of gestation, to evaluate the ability of the antenatal and postnatal ultrasonography results to predict VUR. All infants had two successive ultrasounds at 5 days and 1 month, respectively, after birth. A VCUG was performed at 6 weeks in children with a persistent APD ≥5 mm and/or an ureteral dilatation observed on at least one of two postnatal ultrasounds. In total, 88 patients had VCUG and nine had VUR, with five having high-grade reflux (>grade II). The risk of VUR increased significantly with the degree of APD detected on the postnatal ultrasound scan (p = 0.03). The odds ratios were 5.0 [95% confidence interval (CI) 0.5–51.2] for APD = 7–9 mm and 9.1 (95% CI 1.0–80.9) for APD ≥10 mm. The results of this study show that among our patient cohort antenatal ultrasound was not predictive of reflux. There was, however, a relation between the importance of the postnatal renal pelvis diameter and the risk of VUR. A cut-off of 7 mm showed a fair ability of ultrasonography to predict VUR and a cut-off of 10 mm enabled all severe refluxes in the 88 patients who had a VCUG to be diagnosed.

Keywords

Hydronephrosis Nephrology Prenatal diagnosis Ultrasonography Vesicoureteral reflux 

Abbreviations

APD

anterior posterior diameter

RPD

renal pelvic dilatation

UTI

urinary tract infection

VCUG

voiding cystourethrography

VUR

vesicoureteral reflux

Notes

Acknowledgments

The authors acknowledge the contributions of Mrs. Cécile Delhumeau, who provided assistance with the statistical aspects of our study and Dr. Eric Antonelli who transmitted the antenatal data.

The authors have indicated they have no financial relationships or conflict of interest relevant to this article to disclose.

References

  1. 1.
    Roth JA, Diamond DA (2001) Prenatal hydronephrosis. Curr Opin Pediatr 13:138–141CrossRefPubMedGoogle Scholar
  2. 2.
    Sairam S, Al-Habib A, Sasson S, Thilaganathan B (2001) Natural history of fetal hydronephrosis diagnosed on mid-trimester ultrasound. Ultrasound Obstet Gynecol 17:191–196CrossRefPubMedGoogle Scholar
  3. 3.
    Grignon A, Filion R, Filiatrault D, Robitaille P, Homsy Y, Boutin H, Leblond R (1986) Urinary tract dilatation in utero: classification and clinical applications. Radiology 160:645–647PubMedGoogle Scholar
  4. 4.
    Corteville JE, Gray DL, Crane JP (1991) Congenital hydronephrosis: correlation of fetal ultrasonographic findings with infant outcome. Am J Obstet Gynecol 165:384–388PubMedGoogle Scholar
  5. 5.
    Lee RS, Cendron M, Kinnamon DD, Nguyen HT (2006) Antenatal hydronephrosis as a predictor of postnatal outcome: a meta-analysis. Pediatrics 118:586–593CrossRefPubMedGoogle Scholar
  6. 6.
    Upadhyay J, McLorie GA, Bolduc S, Bagli DJ, Khoury AE, Farhat W (2003) Natural history of neonatal reflux associated with prenatal hydronephrosis: long-term results of a prospective study. J Urol 169:1837–1841, discussion 1841; author reply 1841CrossRefPubMedGoogle Scholar
  7. 7.
    Farhat W, McLorie G, Geary D, Capolicchio G, Bagli D, Merguerian P, Khoury A (2000) The natural history of neonatal vesicoureteral reflux associated with antenatal hydronephrosis. J Urol 164:1057–1060CrossRefPubMedGoogle Scholar
  8. 8.
    Ismaili K, Avni FE, Wissing KM, Hall M (2004) 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 144:759–765PubMedGoogle Scholar
  9. 9.
    Ismaili K, Avni FE, Hall M (2002) Results of systematic voiding cystourethrography in infants with antenatally diagnosed renal pelvis dilation. J Pediatr 141:21–24CrossRefPubMedGoogle Scholar
  10. 10.
    Malone PS (1996) Antenatal diagnosis of renal tract anomalies: has it increased the sum of human happiness? J R Soc Med 89:155P–158PPubMedGoogle Scholar
  11. 11.
    Marra G, Oppezzo C, Ardissino G, Dacco V, Testa S, Avolio L, Taioli E, Sereni F (2004) Severe vesicoureteral reflux and chronic renal failure: a condition peculiar to male gender? Data from the ItalKid Project. J Pediatr 144:677–681CrossRefPubMedGoogle Scholar
  12. 12.
    Knudson MJ, Austin JC, McMillan ZM, Hawtrey CE, Cooper CS (2007) Predictive factors of early spontaneous resolution in children with primary vesicoureteral reflux. J Urol 178:1684–1688CrossRefPubMedGoogle Scholar
  13. 13.
    Penido Silva JM, Oliveira EA, Diniz JS, Bouzada MC, Vergara RM, Souza BC (2006) Clinical course of prenatally detected primary vesicoureteral reflux. Pediatr Nephrol 21:86–91CrossRefPubMedGoogle Scholar
  14. 14.
    Gonzalez E, Papazyan JP, Girardin E (2005) Impact of vesicoureteral reflux on the size of renal lesions after an episode of acute pyelonephritis. J Urol 173:571–574, discussion 574-575CrossRefPubMedGoogle Scholar
  15. 15.
    Coplen DE, Austin PF, Yan Y, Dicke JM (2008) Correlation of prenatal and postnatal ultrasound findings with the incidence of vesicoureteral reflux in children with fetal renal pelvic dilatation. J Urol 180:1631–1634, discussion 1634CrossRefPubMedGoogle Scholar
  16. 16.
    Wong DC, Anderson PA, Macken M, Jackson JR (1999) Congenital hydronephrosis who requires intervention? Can J Urol 6:812–818PubMedGoogle Scholar
  17. 17.
    Avni EF, Ayadi K, Rypens F, Hall M, Schulman CC (1997) Can careful ultrasound examination of the urinary tract exclude vesicoureteric reflux in the neonate? Br J Radiol 70:977–982PubMedGoogle Scholar
  18. 18.
    Lebowitz RL, Olbing H, Parkkulainen KV, Smellie JM, Tamminen-Mobius TE (1985) International system of radiographic grading of vesicoureteric reflux. International Reflux Study in Children. Pediatr Radiol 15:105–109CrossRefPubMedGoogle Scholar
  19. 19.
    Sargent MA (2000) What is the normal prevalence of vesicoureteral reflux? Pediatr Radiol 30:587–593CrossRefPubMedGoogle Scholar
  20. 20.
    Persutte WH, Koyle M, Lenke RR, Klas J, Ryan C, Hobbins JC (1997) Mild pyelectasis ascertained with prenatal ultrasonography is pediatrically significant. Ultrasound Obstet Gynecol 10:12–18CrossRefPubMedGoogle Scholar
  21. 21.
    Phan V, Traubici J, Hershenfield B, Stephens D, Rosenblum ND, Geary DF (2003) Vesicoureteral reflux in infants with isolated antenatal hydronephrosis. Pediatr Nephrol 18:1224–1228CrossRefPubMedGoogle Scholar
  22. 22.
    Estrada CR Jr (2008) Prenatal hydronephrosis: early evaluation. Curr Opin Urol 18:401–403CrossRefPubMedGoogle Scholar
  23. 23.
    Parvex P, Willi JP, Kossovsky MP, Girardin E (2008) Longitudinal analyses of renal lesions due to acute pyelonephritis in children and their impact on renal growth. J Urol 180:2602–2606, discussion 2606CrossRefPubMedGoogle Scholar
  24. 24.
    Kapadia H, Lidefelt KJ, Erasmie U, Pilo C (2004) Antenatal renal pelvis dilatation emphasizing vesicoureteric reflux: two-year follow-up of minor postnatal dilatation. Acta Paediatr 93:336–339CrossRefPubMedGoogle Scholar
  25. 25.
    Anderson NG, Wright S, Abbott GD, Wells JE, Mogridge N (2003) Fetal renal pelvic dilatation—poor predictor of familial vesicoureteral reflux. Pediatr Nephrol 18:902–905CrossRefPubMedGoogle Scholar
  26. 26.
    Walsh G, Dubbins PA (1996) Antenatal renal pelvis dilatation: a predictor of vesicoureteral reflux? AJR Am J Roentgenol 167:897–900PubMedGoogle Scholar
  27. 27.
    Persutte WH, Hussey M, Chyu J, Hobbins JC (2000) Striking findings concerning the variability in the measurement of the fetal renal collecting system. Ultrasound Obstet Gynecol 15:186–190CrossRefPubMedGoogle Scholar
  28. 28.
    Wiener JS, O'Hara SM (2002) Optimal timing of initial postnatal ultrasonography in newborns with prenatal hydronephrosis. J Urol 168:1826–1829CrossRefPubMedGoogle Scholar
  29. 29.
    Moorthy I, Joshi N, Cook JV, Warren M (2003) Antenatal hydronephrosis: negative predictive value of normal postnatal ultrasound—a 5-year study. Clin Radiol 58:964–970CrossRefPubMedGoogle Scholar
  30. 30.
    Lidefelt KJ, Herthelius M, Soeria-Atmadja S (2009) Antenatal renal pelvis dilatation: 2-year follow-up with DMSA scintigraphy. Pediatr Nephrol 24:533–536CrossRefPubMedGoogle Scholar

Copyright information

© IPNA 2010

Authors and Affiliations

  • Serge Grazioli
    • 1
  • Paloma Parvex
    • 1
  • Laura Merlini
    • 2
  • Christophe Combescure
    • 3
  • Eric Girardin
    • 1
  1. 1.Department of Pediatric, Pediatric Nephrology UnitUniversity Hospital of Geneva, University of GenevaGenevaSwitzerland
  2. 2.Department of Pediatric, Pediatric Radiology UnitUniversity Hospital of Geneva, University of GenevaGenevaSwitzerland
  3. 3.Division of Clinical EpidemiologyUniversity Hospital of Geneva, University of GenevaGenevaSwitzerland

Personalised recommendations