Skip to main content
SpringerLink
Log in

Vesicoureteral reflux in infants with isolated antenatal hydronephrosis

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

Abstract

Standardized evaluation of all newborns with antenatally recognized hydronephrosis (ANH) at The Hospital for Sick Children (HSC) has included voiding cystourethrography (VCUG). This paper reviews this protocol to determine: (1) the prevalence of vesicoureteral reflux (VUR) in isolated ANH and (2) the value of performing VCUG in cases of mild hydronephrosis, defined as renal pelvis dilatation <10 mm on postnatal ultrasonography (US). A retrospective chart review was performed on infants referred with ANH. The inclusion criterion was isolated ANH. Exclusion criteria were (1) presence of additional genitourinary abnormalities and (2) no VCUG. Pelviectasis was categorized according to the anteroposterior diameter of the renal pelvis. There were 111 infants with isolated ANH. All except 3 underwent VCUG. There were 68 children (63%) with normal postnatal US or mild pelviectasis (<10 mm). VUR was detected in 16 patients, of whom 10 had mild or absent pelvic dilatation. There was no correlation between the degree of pelviectasis on postnatal US and the presence or severity of VUR (P=0.567 and P=0.802). VUR was detected in 15% of children with isolated ANH, many of whom had normal postnatal US or mild postnatal pelviectasis. VCUG is the only reliable test for detecting postnatal VUR.

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. Manning F (1989) Common fetal urinary tract anomalies. Clin Diagn Ultrasound 25:139–161

    CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  3. Lam BC, Wong SN, Yeung CY, Tang MH, Ghosh A (1993) Outcome and management of babies with prenatal ultrasonographic renal abnormalities. Am J Perinatol 10:263–268

    CAS  PubMed  Google Scholar 

  4. Blachar A, Blachar Y, Livne PM, Zurkowski L, Pelet D, Mogilner B (1994) Clinical outcome and follow-up of prenatal hydronephrosis. Pediatr Nephrol 8:30–35

    CAS  PubMed  Google Scholar 

  5. Gunn TR, Mora JD, Pease P (1995) Antenatal diagnosis of urinary tract abnormalities by ultrasonography after 28 weeks’ gestation: incidence and outcome. Am J Obstet Gynecol 172:479–486

    CAS  PubMed  Google Scholar 

  6. Elder JS (1992) Commentary: importance of antenatal diagnosis of vesicoureteral reflux. J Urol 148:1750–1754

    CAS  PubMed  Google Scholar 

  7. Avner ED, Chavers B, Sullivan EK, Tejani A (1995) Renal transplantation and chronic dialysis in children and adolescents: the 1993 annual report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol 9:61–73

    CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  9. Elder JS (1997) Antenatal hydronephrosis. Fetal and neonatal management. Pediatr Clin North Am 44:1299–1321

    CAS  PubMed  Google Scholar 

  10. Zerin JM, Ritchey ML, Chang AC (1993) Incidental vesicoureteral reflux in neonates with antenatally detected hydronephrosis and other renal abnormalities. Radiology 187:157–160

    CAS  PubMed  Google Scholar 

  11. Tibballs JM, De Bruyn R (1996) Primary vesicoureteric reflux—how useful is postnatal ultrasound? Arch Dis Child 75:444–447

    PubMed  Google Scholar 

  12. Pal CR, Tuson JR, Lindsell DR, McHugh K, Hope PL, Ives K (1998) The role of micturating cystourethrography in antenatally detected mild hydronephrosis. Pediatr Radiol 28:152–155

    Article  CAS  PubMed  Google Scholar 

  13. Dudley JA, Haworth JM, McGraw ME, Frank JD, Tizard EJ (1997) Clinical relevance and implications of antenatal hydronephrosis. Arch Dis Child Fetal Neonatal Ed 76:F31–F34

    CAS  PubMed  Google Scholar 

  14. Anderson NG, Abbott GD, Mogridge N, Allan RB, Maling TM, Wells JE (1997) Vesicoureteric reflux in the newborn: relationship to fetal renal pelvic diameter. Pediatr Nephrol 11:610–616

    Google Scholar 

  15. Ismaili K, Avni FE, Hall M (2002) Results of systematic voiding cystourethrography in infants with antenatally diagnosed renal pelvis dilation. J Pediatr 141:21–24

    Article  PubMed  Google Scholar 

  16. Wong D, Anderson P (1999) Congenital hydronephrosis who requires intervention. Can J Urol 6:812–818

    PubMed  Google Scholar 

  17. 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

    CAS  PubMed  Google Scholar 

  18. Hanbury DC, Whitaker RH, Tudor J, Dixon AK, Wraight EP (1989) Maps for diagnosis and management of antenatal urinary tract dilatation. Br J Urol 64:221–226

    CAS  PubMed  Google Scholar 

  19. Fasolato V, Poloniato A, Bianchi C, Spagnolo D, Valsecchi L, Ferrari A, Paesano P, Del Maschio A (1998) Feto-neonatal ultrasonography to detect renal abnormalities: evaluation of 1-year screening program. Am J Perinatol 15:161–164

    CAS  PubMed  Google Scholar 

  20. Sargent MA (2000) What is the normal prevalence of vesicoureteral reflux. Pediatr Radiol 30:587–593

    Article  CAS  PubMed  Google Scholar 

  21. Lebowitz RL (1992) The detection and characterization of vesicoureteral reflux in the child. J Urol 148:1640–1642

    CAS  PubMed  Google Scholar 

  22. Marra G BG, Dell’ Agnola CA, Cacamo ML, Castellani MR, Assael BM (1994) Congenital renal damage associated with primary vesicouereteral reflux detected prenatally in male infants. J Pediatr 124:726–730

    CAS  PubMed  Google Scholar 

  23. Marra G, Barbieri G, Moioli C, Assael BM, Grumieri G, Caccamo ML (1994) Mild fetal hydronephrosis indicating vesicoureteric reflux. Arch Dis Child Fetal Neonatal Ed 70:F147–F149

    CAS  PubMed  Google Scholar 

  24. 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 160:645–647

    CAS  PubMed  Google Scholar 

  25. Scott JE (1993) Fetal ureteric reflux: a follow-up study. Br J Urol 71:481–483

    CAS  PubMed  Google Scholar 

  26. 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 164:1057–1060

    CAS  PubMed  Google Scholar 

  27. Arant BS Jr (1992) Medical management of mild and moderate vesicoureteral reflux: followup studies of infants and young children. A preliminary report of the Southwest Pediatric Nephrology Study Group. J Urol 148:1683–1687

    PubMed  Google Scholar 

  28. Dejter SW, Gibbons MD (1989) The fate of infant kidneys with fetal hydronephrosis but initially normal postnatal sonography. J Urol (1989) 142:661–662

    Google Scholar 

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

    PubMed  Google Scholar 

  30. Pylkkanen J, Vilska J, Koskimies O (1981) The value of level diagnosis of childhood urinary tract infection in predicting renal injury. Acta Paediatr Scand 70:879–883

    CAS  PubMed  Google Scholar 

  31. Smellie JM, Ransley PG, Normand IC, Prescod N, Edwards D (1985) Development of new renal scars: a collaborative study. BMJ 290:1957–1960

    CAS  PubMed  Google Scholar 

  32. Jakobsson B, Berg U, Svensson L (1994) Renal scarring after acute pyelonephritis. Arch Dis Child 70:111–115

    CAS  PubMed  Google Scholar 

  33. Hiraoka M, Hori C, Tsukahara H, Kasuga K, Ishihara Y, Sudo M (1997) Congenitally small kidneys with reflux as a common cause of nephropathy in boys. Kidney Int 52:811–816

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Nephrology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

    Véronique Phan & Norman D. Rosenblum

  2. Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

    Jeffrey Traubici

  3. Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

    Brian Hershenfield

  4. Department of Population Health Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

    Derek Stephens

  5. Division of Nephrology, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada

    Denis F. Geary

Authors
  1. Véronique Phan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeffrey Traubici
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brian Hershenfield
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Derek Stephens
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Norman D. Rosenblum
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Denis F. Geary
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Denis F. Geary.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Phan, V., Traubici, J., Hershenfield, B. et al. Vesicoureteral reflux in infants with isolated antenatal hydronephrosis. Pediatr Nephrol 18, 1224–1228 (2003). https://doi.org/10.1007/s00467-003-1287-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-003-1287-x

Keywords

Search

Navigation