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

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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.

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Fig. 1

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Abbreviations

APD:

anterior posterior diameter

RPD:

renal pelvic dilatation

UTI:

urinary tract infection

VCUG:

voiding cystourethrography

VUR:

vesicoureteral reflux

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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.

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Authors and Affiliations

  1. Department of Pediatric, Pediatric Nephrology Unit, University Hospital of Geneva, University of Geneva, 6 Willy-Donzé Street, 1211, Geneva, Switzerland

    Serge Grazioli, Paloma Parvex & Eric Girardin

  2. Department of Pediatric, Pediatric Radiology Unit, University Hospital of Geneva, University of Geneva, Geneva, Switzerland

    Laura Merlini

  3. Division of Clinical Epidemiology, University Hospital of Geneva, University of Geneva, Geneva, Switzerland

    Christophe Combescure

Authors
  1. Serge Grazioli
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  2. Paloma Parvex
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  3. Laura Merlini
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  4. Christophe Combescure
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  5. Eric Girardin
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Correspondence to Eric Girardin.

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Grazioli, S., Parvex, P., Merlini, L. et al. Antenatal and postnatal ultrasound in the evaluation of the risk of vesicoureteral reflux. Pediatr Nephrol 25, 1687–1692 (2010). https://doi.org/10.1007/s00467-010-1543-9

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  • DOI: https://doi.org/10.1007/s00467-010-1543-9

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