Abstract
BackgroundAntenatally diagnosed urinary tract dilatation (UTD) still burdens healthcare providers and parents. This study was conducted to establish long-term outcome in an unselected group of children with antenatally detected UTD.MethodsSeventy-one out of 103 children born in 2003–2005 and diagnosed with antenatal UTD agreed to participate in a 12–15-year follow-up including blood and urine samples, a kidney ultrasound exam, and kidney scintigraphy. The records were searched for previous urinary tract infections.ResultsAmong children with an anteroposterior diameter (APD) ≤ 7 mm and no calyceal, kidney, ureteral, or bladder pathology in the early postnatal period, no one tested had reduced estimated glomerular filtration rate (eGFR), albuminuria, or UTD at the follow-up at a mean age of 13.6 years. One child had kidney damage not affecting kidney function. Among children with postnatal APD > 7 mm and/or kidney, calyceal, ureteral, or bladder pathology, 15% had persistent UTD and 32–39% (depending on the method used) had kidney damage. Major postnatal urinary tract ultrasound abnormalities and a congenital anomalies of the kidney and urinary tract (CAKUT) diagnosis were factors associated with an increased risk for permanent kidney damage (odds ratios 8.9, p = 0.016; and 14.0, p = 0.002, respectively). No one had reduced eGFR. One child (1/71, 1%) had a febrile urinary tract infection after the age of 2.ConclusionsWe conclude that in children with postnatal APD ≤ 7 mm, no calyceal dilatation, normal bladder, ureters, and kidney parenchyma, the outcome is excellent. There is no need for long-term follow-up in these patients.
Highlights
The question of what is the optimal postnatal follow-up for antenatally detected urinary tract dilatation (UTD) in children is still being debated [1,2,3]
UTD is regarded as a transient and benign condition [4, 6], but uncertainty regarding the cause and prognosis may lead to concern among the parents
103 children were followed according to a standardized protocol including ultrasound at 5–7 days, 3 weeks, and 3, 6, and 12 months; a voiding cystourethrogram (VCUG) at 6–8 weeks; and a dimercaptosuccinic acid (DMSA) scintigraphy at 2 years of age
Summary
The question of what is the optimal postnatal follow-up for antenatally detected urinary tract dilatation (UTD) in children is still being debated [1,2,3]. Few studies have followed children with antenatally detected UTD for longer than a median of 2 years [5, 7, 8], and even fewer for longer than a median of 10 years [9, 10]. To meet the need for a study of an unselected cohort with a long follow-up [11], we conducted this 12–15-year re-evaluation of children antenatally diagnosed with UTD, born in 2003–2005, and followed according to a standardized protocol during the first 2 years of life [12,13,14]. This study was conducted to establish long-term outcome in an unselected group of children with antenatally detected UTD.
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