Skip to main content

Advertisement

SpringerLink
Log in

Outcome of isolated antenatal hydronephrosis: a prospective cohort study

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

The purpose of this study was to report the outcome of infants with antenatal hydronephrosis. Between May 1999 and June 2006, all patients diagnosed with isolated fetal renal pelvic dilatation (RPD) were prospectively followed. The events of interest were: presence of uropathy, need for surgical intervention, RPD resolution, urinary tract infection (UTI), and hypertension. RPD was classified as mild (5–9.9 mm), moderate (10–14.9 mm) or severe (≥15 mm). A total of 192 patients was included in the analysis; 114 were assigned to the group of non-significant findings (59.4%) and 78 to the group of significant uropathy (40.6%). Of 89 patients with mild dilatation, 16 (18%) presented uropathy. Median follow-up time was 24 months. Twenty-seven patients (15%) required surgical intervention. During follow-up, UTI occurred in 27 (14%) children. Of 89 patients with mild dilatation, seven (7.8%) presented UTI during follow-up. Renal function, blood pressure, and somatic growth were within normal range at last visit. The majority of patients with mild fetal RPD have no significant findings during infancy. Nevertheless, our prospective study has shown that 18% of these patients presented uropathy and 7.8% had UTI during a medium-term follow-up time. Our findings suggested that, in contrast to patients with moderate/severe RPD, infants with mild RPD do not require invasive diagnostic procedures but need strict clinical surveillance for UTI and progression of RPD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ismaili K, Hall M, Piepsz A, Alexander M, Schulman C, Avni FE (2005) Insights into the pathogenesis and natural history of fetuses with renal pelvis dilatation. Eur Urol 48:207–214

    Article  PubMed  Google Scholar 

  2. Becker A, Baum M (2006) Obstructive uropathy. Early Hum Dev 82:15–22

    Article  PubMed  Google Scholar 

  3. Belarmino JM, Kogan BA (2006) Management of neonatal hydronephrosis. Early Hum Dev 82:9–14

    Article  PubMed  Google Scholar 

  4. Avni FE, Cos T, Cassart M, Massez A, Donner C, Ismaili K, Hall M (2007) Evolution of fetal ultrasonography. Eur Radiol 17:419–431

    Article  CAS  PubMed  Google Scholar 

  5. Ismaili K, Avni FE, Piepsz A, Wissing KM, Cochat P, Aubert D, Hall M (2004) Current management of infants with fetal renal pelvis dilation: a survey by French-speaking pediatric nephrologists and urologists. Pediatr Nephrol 19:966–971

    Article  PubMed  Google Scholar 

  6. Toiviainen-Salo S, Garel L, Grignon A, Dubois J, Rypens F, Boisvert J, Perreault G, Decarie JC, Filiatrault D, Lapierre C, Miron MC, Bechard N (2004) Fetal hydronephrosis: is there hope for consensus? Pediatr Radiol 34:519–529

    Article  PubMed  Google Scholar 

  7. Lee RS, Cendron M, Kinnamon DD, Nguyen HT (2006) Antenatal hydronephrosis as a predictor of postnatal outcome: a meta-analysis. Pediatrics 118:586–593

    Article  PubMed  Google Scholar 

  8. Sidhu G, Beyene J, Rosenblum ND (2006) Outcome of isolated antenatal hydronephrosis: a systematic review and meta-analysis. Pediatr Nephrol 21:218–224

    Article  PubMed  Google Scholar 

  9. Bouzada MC, Oliveira EA, Pereira AK, Leite HV, Rodrigues AM, Fagundes LA, Goncalves RP, Parreiras RL (2004) Diagnostic accuracy of fetal renal pelvis anteroposterior diameter as a predictor of uropathy: a prospective study. Ultrasound Obstet Gynecol 24:745–749

    Article  CAS  PubMed  Google Scholar 

  10. Bouzada MC, Oliveira EA, Pereira AK, Leite HV, Rodrigues AM, Fagundes LA, Goncalves RP, Parreiras R (2004) Diagnostic accuracy of postnatal renal pelvic diameter as a predictor of uropathy: a prospective study. Pediatr Radiol 34:798–804

    Article  PubMed  Google Scholar 

  11. 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 15:105–109

    Article  CAS  PubMed  Google Scholar 

  12. Schwartz GJ, Brion LP, Spitzer A (1987) The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin North Am 34:571–590

    CAS  PubMed  Google Scholar 

  13. National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents (1996) Update on the 1987 task force report on high blood pressure in children and adolescents: a working group report from the National High Blood Pressure Education Program. Pediatrics 98:649–658

    Google Scholar 

  14. National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576

    Article  Google Scholar 

  15. 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 144:759–765

    PubMed  Google Scholar 

  16. Coplen DE, Austin PF, Yan Y, Blanco VM, Dicke JM (2006) The magnitude of fetal renal pelvic dilatation can identify obstructive postnatal hydronephrosis, and direct postnatal evaluation and management. J Urol 176:724–727

    Article  PubMed  Google Scholar 

  17. Gramellini D, Fieni S, Caforio E, Benassi G, Bedocchi L, Beseghi U, Benassi L (2006) 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 194:167–173

    Article  PubMed  Google Scholar 

  18. Wollenberg A, Neuhaus TJ, Willi UV, Wisser J (2005) Outcome of fetal renal pelvic dilatation diagnosed during the third trimester. Ultrasound Obstet Gynecol 25:483–488

    Article  CAS  PubMed  Google Scholar 

  19. Alconcher L, Tombesi M (2004) Mild antenatal hydronephrosis: management controversies. Pediatr Nephrol 19:819–820

    Article  PubMed  Google Scholar 

  20. Penido Silva JM, Oliveira EA, Diniz JS, Bouzada MC, Vergara RM, Souza BC (2006) Clinical course of prenatally detected primary vesicoureteral reflux. Pediatr Nephrol 21:86–91

    Article  PubMed  Google Scholar 

  21. Dacher JN, Mandell J, Lebowitz RL (1992) Urinary tract infection in infants in spite of prenatal diagnosis of hydronephrosis. Pediatr Radiol 22:401–404

    Article  CAS  PubMed  Google Scholar 

  22. Verrier Jones K (1996) Vesico-ureteric reflux: a medical perspective on management. Pediatr Nephrol 10:795–797

    Article  CAS  PubMed  Google Scholar 

  23. Cheng AM, Phan V, Geary DF, Rosenblum ND (2004) Outcome of isolated antenatal hydronephrosis. Arch Pediatr Adolesc Med 158:38–40

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was partially supported by CNPq (Brazilian National Research Council) and FAPEMIG (Fundação de Amparo a Pesquisa de Minas Gerais). B.F.F. and D.S.O. were recipients of CNPq fellowships and M.R.S.L. was recipient of a FAPEMIG (Fundação de Amparo a Pesquisa de Minas Gerais) fellowship.

Conflict of Interest Statement

None.

Author information

Authors and Affiliations

  1. Pediatric Nephrourology Unit, Department of Pediatrics, Hospital Das Clinicas, Federal University Of Minas Gerais, Belo Horizonte, MG, Brazil

    Graziela M. Coelho, Maria Candida F. Bouzada, Bruno F. Figueiredo, Maria Rafaela S. Leite, Danielly S. Oliveira & Eduardo A. Oliveira

  2. Fetal Medicine Division, Department of Pediatrics, Hospital Das Clinicas, Federal University Of Minas Gerais, Belo Horizonte, MG, Brazil

    Alamanda K. Pereira

  3. Rua Engenheiro Amaro Lanari 389/501, Belo Horizonte, 30.310.580, Minas Gerais, Brazil

    Eduardo A. Oliveira

Authors
  1. Graziela M. Coelho
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria Candida F. Bouzada
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alamanda K. Pereira
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bruno F. Figueiredo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maria Rafaela S. Leite
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Danielly S. Oliveira
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Eduardo A. Oliveira
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eduardo A. Oliveira.

Additional information

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Coelho, G.M., Bouzada, M.C.F., Pereira, A.K. et al. Outcome of isolated antenatal hydronephrosis: a prospective cohort study. Pediatr Nephrol 22, 1727–1734 (2007). https://doi.org/10.1007/s00467-007-0539-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-007-0539-6

Keywords

Search

Navigation