Pediatric Urology, Marburg 1, North Wolfe St., Baltimore, MD This review will encompass the identification of antenatal hydronephrosis as. Department of Pediatric Nephrology. Ankara- Antenatal hydronephrosis is present if. APD ≥4 mm in . Sinha A. Indian Pediatrics Neonates with normal. Hydronephrosis. Antenatal hydronephrosis (ANH) is one of the most common abnormal findings Department of Pediatrics, CHA. Bundang.

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When the diagnosis of ANH is made the parents often have apprehension that the child will need surgery postnatally[ 25 ].

Outcome of fetal renal pelvic dilatation diagnosed during the third trimester. It is the passage of the tracer antenqtal the outer cortex to the inner structures i.

Analysis of trends on serial ultrasound for high grade neonatal hydronephrosis. Antero posterior diameter; SFU: The mechanism by which a full bladder causes dilatation of the renal pelvis and the maximal degree of normal dilatation is not known.

If the function has been compromised then the diagnosis of pedistrics is beyond doubt. These measurements of course would have to be done with an empty bladder as a full bladder interferes with the drainage form the pelvicalyceal system. Also a large prospective natenatal is needed to confirm that cortical transit time is the best predictor of which children should be operated upon[ 6768 ].

The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis.

Revised guidelines on management of antenatal hydronephrosis.

Current management of infants with fetal renal pelvis dilation: Am J Obstet Gynecol. Can Urol Assoc J. August 5, Accepted: While the APD measurement provides an objective means of predicting pathology, many felt that other features are also important in determining the severity hydrnoephrosis hydronephrosis.


All other patients can be followed with ultrasound as mentioned above, with a radionuclide study done when there are signs of increasing hydronephrosis. Principles and Practice of Pediatrics 2nd ed. The predictive value of the first postnatal ultrasound in children with antenatal hydronephrosis. So, should neonates and infants with ANH be put on antibiotic prophylaxis?

Postnatal management of antenatally detected hydronephrosis

Hence the first postnatal ultrasound is preferably done between d after birth[ 122627 ]. Mild to moderate postnatal hydronephrosis–grading systems and management. However given the subjective nature of sonography and the factors like maternal hydration affecting the measurements, this issue has not been resolved as of today and hence clinicians should follow a standard classification and grade the dilatation as mild, moderate and severe as suggested in Table 2.

Once the diagnosis is made then the next ultrasonography can be done in the third trimester between wk.

Diuretic renography in infants with prenatal unilateral hydronephrosis: Till a reliable method is described, which overcomes the variables of maternal hydration, bladder fullness of fetuses and the operator dependency, clinicians should mention the method used to diagnose antenatal hydronephrosis and grade its findings. Lessons Learned after 16 Years of Follow-Up. Accuracy of renal-bladder ultrasonography as a screening method to suggest posterior urethral valves.

Urinary tract dilatation in utero: Literature is sparse in providing guidelines to peciatrics this group of patients. Prenatal puncture of a unilateral hydronephrosis leading to fetal urinoma and postnatal nephrectomy.

Renal ultrasonography in newborns with prenatally detected hydronephrosis: Ultrasonography at d would show one of the following scenarios: If there is no increasing hydronephrosis on serial ultrasounds then also the child needs to be followed up till the age of 6 years.


This in turn would maintain the amniotic fluid levels to allow for normal lung development. Given these discrepancies, it is imperative pediatrlcs worldwide a uniform system of classifying and grading hydronephrosis should be followed. Postnatal management of prenatally detected hydronephrosis is a topic which has evoked widespread interest.

Revised guidelines on management of antenatal hydronephrosis.

Normally the renal pelvis and calyces are not seen, if seen then it indicates hydronephrosis. Diuretic renography in hydronephrosis: Recently cut off of 6 mm at 20 wk and 10 mm at 30 wk have been suggested for pyelectasis and an APD cut off of 10 mm at 20 wk and 12 mm at 30 wk for hydronephrosis[ 15 ]. Any immaturity of the pacemaker in the renal pelvis might lead to poor co-ordination of the peristaltic activity[ 40 – 42 ]. Antibiotic prophylaxis for urinary tract infections in antenatal hydronephrosis.

Ultrasound grading of hydronephrosis: Corresponding Author of This Article.

Am J Dis Child ; Antenatal hydronephrosis as a predictor of postnatal outcome: In contrast, if the APD does not change in prone position or increases in prone position then these cases needed surgical intervention as their differential function showed a substantial drop[ 78 ]. For these reasons interpretation of the wash out curves should be made in the light of differential renal function and the degree of renal pelvis dilatation. We propose the following algorithm to manage these patients with unilateral hydronephrosis Figure 1.