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Hydronephrosis: prenatal and postnatal evaluation and management.

Dennis B Liu1, William R Armstrong2, Max Maizels1

  • 1Ann and Robert H. Lurie Children's Hospital of Chicago, Department of Urology, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 24, Chicago, IL 60611, USA.

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Summary

Antenatal hydronephrosis (ANH) is common in pregnancies. Postnatal prognosis for ANH depends on dilation severity, with renal ultrasounds guiding further investigation.

Keywords:
Antenatal diagnosisHydronephrosisObstructive uropathyRadiologyUrinary tract infectionsVesicoureteral reflux

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Area of Science:

  • Perinatology
  • Pediatric Nephrology
  • Diagnostic Imaging

Background:

  • Antenatal hydronephrosis (ANH) is a frequent finding on prenatal ultrasounds, occurring in 1-4.5% of pregnancies.
  • Clinical significance and postnatal outcomes of ANH remain areas of uncertainty.
  • Prognosis is closely linked to the severity of fetal kidney dilation.

Purpose of the Study:

  • To clarify the clinical impact and prognostic factors of antenatal hydronephrosis after birth.
  • To emphasize the role of postnatal imaging in managing ANH.
  • To guide further investigations based on ultrasound findings.

Main Methods:

  • Review of antenatal hydronephrosis cases.
  • Correlation of prenatal ultrasound findings with postnatal diagnoses.
  • Utilizing renal and bladder ultrasound for follow-up.
  • Employing voiding cystourethrography and diuretic renography for further evaluation.

Main Results:

  • Ureteropelvic junction obstruction and vesicoureteral reflux are the most common postnatal diagnoses associated with ANH.
  • Renal and bladder ultrasound is crucial for assessing ANH severity and guiding management.
  • Expectant management is typical, with fetal intervention reserved for rare, severe cases.

Conclusions:

  • Postnatal management of ANH relies on imaging to determine prognosis and necessary interventions.
  • Early and appropriate follow-up imaging is essential for optimal patient outcomes.
  • Further investigations like VCUG and diuretic renography are vital for specific ANH cases.