Revised guidelines on management of antenatal hydronephrosis

Widespread antenatal screening has resulted in increased detection of anomalies of the kidneys and urinary tract. The present guidelines update the recommendations published in 2000. Antenatal hydronephrosis (ANH) is transient and resolves by the third trimester in almost one-half cases. The presenc...

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Bibliographic Details
Published in:Indian pediatrics 2013-02, Vol.50 (2), p.215-231
Main Authors: Sinha, Aditi, Bagga, Arvind, Krishna, Anurag, Bajpai, Minu, Srinivas, M., Uppal, Rajesh, Agarwal, Indira
Format: Article
Language:English
Subjects:
Antibiotic Prophylaxis
Female
Humans
Hydronephrosis - diagnosis
Hydronephrosis - diagnostic imaging
Hydronephrosis - therapy
Maternal and Child Health
Medicine
Medicine & Public Health
Pediatric Surgery
Pediatrics
Pregnancy
Prenatal Diagnosis - methods
Prenatal Diagnosis - standards
Radioisotope Renography - standards
Recommendations
Ultrasonography, Prenatal
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Summary:Widespread antenatal screening has resulted in increased detection of anomalies of the kidneys and urinary tract. The present guidelines update the recommendations published in 2000. Antenatal hydronephrosis (ANH) is transient and resolves by the third trimester in almost one-half cases. The presence of oligohydramnios and additional renal or extrarenal anomalies suggests significant pathology. All patients with ANH should undergo postnatal ultrasonography; the intensity of subsequent evaluation depends on anteroposterior diameter (APD) of the renal pelvis and/or Society for Fetal Urology (SFU) grading. Patients with postnatal APD exceeding 10 mm and/or SFU grade 3–4 should be screened for upper or lower urinary tract obstruction and vesicoureteric reflux. Infants with vesicoureteric reflux should receive antibiotic prophylaxis through the first year of life, and their parents counseled regarding the risk of urinary tract infections. The management of patients with pelviureteric junction or vesicoureteric junction obstruction depends on clinical features and results of sequential ultrasonography and radionuclide renography. Surgery is considered in patients with increasing renal pelvic APD and/or an obstructed renogram with differential renal function
ISSN:0019-6061
0974-7559
DOI:10.1007/s13312-013-0064-6