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Mild fetal hydronephrosis indicating vesicoureteric reflux
G Marra1, G Barbieri, C Moioli
1Department of Paediatrics, University of Milan Medical School, Italy.
Summary
Mild antenatal hydronephrosis in newborns may indicate underlying vesicoureteric reflux (VUR). Careful follow-up is essential, as many cases resolve spontaneously, but some require intervention for urinary tract issues.
Area of Science:
- Pediatric Urology
- Neonatal Medicine
- Diagnostic Imaging
Background:
- Management of mild antenatal hydronephrosis in neonates remains controversial.
- Some infants with mild hydronephrosis have normal urinary tracts, while others have ureteropelvic junction obstruction or vesicoureteric reflux (VUR).
Purpose of the Study:
- To prospectively assess the frequency of VUR in neonates diagnosed with mild hydronephrosis antenatally.
- To evaluate the natural history and management outcomes of these cases.
Main Methods:
- Prospective study of 47 neonates (62 kidneys) with antenatal mild hydronephrosis.
- Voiding cystography performed in 14 patients (21 renal units).
- Follow-up included ultrasonography, repeat cystography, and surgical/medical management as indicated.
Main Results:
- Vesicoureteric reflux (VUR) was detected in 14 patients (21 renal units) via voiding cystography.
- Two patients with VUR underwent successful surgical correction.
- Twelve patients received medical management for VUR, with a high rate of spontaneous resolution observed by 12-18 months.
- Only one case showed hydronephrosis deterioration due to severe ureteropelvic junction obstruction.
Conclusions:
- Mild antenatal hydronephrosis can be a sign of significant underlying conditions like VUR.
- A thorough follow-up protocol is mandatory for neonates with mild antenatal hydronephrosis to detect and manage potential complications.