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Published on: January 7, 2019
Long Term Follow-Up Of Patients With Nonrefluxing Hydronephrosis
Songül Yılmaz1, Zeynep Birsin Özçakar1, Nilgun Cakar1
1Pediatric Nephrology, Ankara University Faculty of Medicine, Ankara, Turkey.
Insights
Children with mild ureteropelvic junction obstruction-like hydronephrosis (UPJO-like HN) have an excellent prognosis. Close monitoring is recommended for severe UPJO-like HN cases due to potential complications like urinary tract infections (UTIs).
Area of Science:
- Pediatric Urology
- Nephrology
- Medical Prognosis
Background:
- Ureteropelvic junction obstruction-like hydronephrosis (UPJO-like HN) is a common condition in children.
- Understanding the long-term outcomes of UPJO-like HN is crucial for clinical management.
- Previous studies have focused on surgical interventions, with less emphasis on conservative management and natural prognosis.
Purpose of the Study:
- To evaluate the long-term prognosis of pediatric UPJO-like hydronephrosis (HN).
- To identify factors influencing the resolution, improvement, or worsening of HN.
- To assess the incidence of surgery and urinary tract infections (UTIs) in relation to HN severity.
Main Methods:
- Retrospective analysis of pediatric HN cases, excluding those with VUR or other genitourinary anomalies.
- Evaluation of HN final status, surgical necessity, and UTI frequency.
- Correlation of outcomes with kidney size and parenchymal thickness.
Main Results:
- Out of 302 renal units (RU) with HN, 40.2% resolved, 23.3% improved, and 35.5% remained unchanged.
- Higher surgery rates were observed in RUs with larger kidney size and parenchymal thinning.
- Severe HN, larger kidney size, and thin parenchyma were associated with less favorable recovery and improvement rates. UTI frequency was significantly higher in the severe HN group (30.6% vs 12.2%).
Conclusions:
- Mild UPJO-like HN in children generally has an excellent prognosis.
- While most high-grade HN cases also show a good prognosis, close follow-up is essential for severe cases, especially those with increased kidney size and parenchymal thinning.
- Clinicians must be vigilant about the increased risk of UTIs in children with severe HN.
Backgound:
The aim of this study is to examine the long-term prognosis of children with ureteropelvic junction obstruction-like hydronephrosis (UPJO-like HN).
Patients And Methods:
The files of children with hydronephrosis (HN) were analyzed retrospectively. Patients with vesicoureteral reflux (VUR) and other genitourinary anomalies were excluded. The final status of the HN, the need for surgery, and urinary tract infection (UTI) frequency were evaluated.
Results:
The study included 219 patients with 302 renal units (RU) with HN. Surgery rate was higher in RUs with larger kidney size and parenchymal thinning (p:<0.001 for both). Hydronephrosis resolved in 113 (40.2%) RUs, improved in 66 (23.3%), unchanged in 100 (35.5%) and worsened in 4 (1.4%). The frequency of recovery and improvement was found to be less in RUs with severe HN, large kidney size, and thin parenchyma. The UTI frequency was higher in severe HN group (12.2% vs 30.6% p:<0.001).
Conclusions:
Children with mild HN had an excellent prognosis. Although the majority of the patients with high-grade HN had also a good prognosis, it seems important to closely follow up patients with severe HN, increased kidney size, and accompanying parenchymal thinning. Clinicians should be aware of the increased frequency of UTIs in children with severe HN.
