Antenatally detected urinary tract dilatation: a 12-15-year follow-up

Area of Science:

• Pediatric Nephrology
• Urology
• Medical Imaging

Background:

• Antenatally diagnosed urinary tract dilatation (UTD) presents a significant challenge for healthcare systems and families.
• Establishing the long-term prognosis for children with antenatal UTD is crucial for guiding clinical management and parental reassurance.

Purpose of the Study:

• To determine the long-term outcomes in an unselected cohort of children diagnosed with UTD antenatally.
• To identify factors influencing kidney function and structural integrity in children with a history of antenatal UTD.

Main Methods:

• A 12-15 year follow-up study involving 71 children diagnosed with antenatal UTD.
• Assessments included blood and urine samples, kidney ultrasound, kidney scintigraphy, and review of past urinary tract infection (UTI) history.
• Children were stratified based on postnatal anteroposterior diameter (APD) and presence of urinary tract abnormalities.

Main Results:

• Children with postnatal APD ≤ 7 mm and no early calyceal, kidney, ureteral, or bladder pathology exhibited normal estimated glomerular filtration rate (eGFR), no albuminuria, and no UTD at follow-up.
• In contrast, children with postnatal APD > 7 mm and/or urinary tract abnormalities showed persistent UTD (15%) and kidney damage (32-39%).
• Major postnatal ultrasound abnormalities and congenital anomalies of the kidney and urinary tract (CAKUT) diagnosis were significant predictors of permanent kidney damage.

Conclusions:

• Excellent long-term outcomes are observed in children with mild antenatal UTD, specifically those with postnatal APD ≤ 7 mm and normal calyceal, bladder, ureteral, and kidney parenchyma.
• Routine long-term follow-up is unnecessary for this low-risk group, simplifying care pathways.
• Risk stratification based on early postnatal findings is essential for identifying children requiring ongoing monitoring for kidney damage.