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Optimizing postnatal management based on prenatal UTD grading: a 5-year follow-up study of fetal hydronephrosis in a

Zhiqiang Mo1,2, Weiping Zhang3, Xianghui Xie1

  • 1Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.

BMC Pediatrics
|November 22, 2025
PubMed

Insights

Most fetal hydronephrosis (FH) cases resolve spontaneously. The Urinary Tract Dilation (UTD) classification system effectively identifies high-risk infants, guiding management and reducing unnecessary interventions for low-risk cases.

Area of Science:

  • Pediatric Nephrology
  • Prenatal Diagnosis
  • Medical Imaging

Background:

  • Fetal hydronephrosis (FH) is a common prenatal finding requiring careful postnatal evaluation.
  • Predicting the natural history and identifying prognostic factors for FH is crucial for optimizing management.
  • The Urinary Tract Dilation (UTD) classification system aims to standardize risk stratification for FH.

Purpose of the Study:

  • To investigate the long-term natural history of fetal hydronephrosis in a Chinese population.
  • To identify key prognostic factors influencing FH outcomes.
  • To optimize postnatal management strategies using the UTD classification system.

Main Methods:

  • A hybrid retrospective-prospective cohort study of 49,097 pregnant women, with 2,263 fetuses diagnosed with FH, followed for 5 years.
  • Analysis of prenatal ultrasound parameters including anteroposterior renal pelvic diameter (APD) and A/R ratio.
  • Stratification of cases into UTD A1 (low-risk) and UTD A2-3 (high-risk) groups for comparative analysis.

Main Results:

  • The incidence of FH was 4.61%, with 97.39% resolving spontaneously by 5 years.
  • Only 0.75% of cases required surgery, all within the UTD A2-3 group.
  • Left renal APD and A/R ratio were independent predictors for surgery; UTD A2-3 group showed significantly higher risks of postnatal complications.

Conclusions:

  • The majority of fetal hydronephrosis cases resolve spontaneously, necessitating conservative management for low-risk infants.
  • The UTD classification system effectively stratifies postnatal risk, guiding clinical decisions.
  • APD and A/R ratio are critical imaging predictors for surgical intervention in FH.
Abstract

Keywords:
Fetal hydronephrosisLong-term outcomePostnatal managementSurgical predictorsUrinary tract dilation classification

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