Neonatal Outcome of Antenatally Diagnosed Hydronephrosis at a Tertiary Care Centre, Telangana, India: A Prospective Study

Abstract

Introduction: Antenatal Hydronephrosis (ANH) is one of the most commonly detected congenital anomaly by antenatal sonogram. It requires periodic follow-up and in selected cases, early interventions are required in postnatal period. Aim: To study the relationship between Anteroposterior Diameter (APD) of foetal renal pelvis and postnatal outcome of hydronephrosis in neonates and to study the relation between APD of foetal renal pelvis and structural abnormalities of kidney. Materials and Methods: This prospective study included neonates whose antenatal scan showed hydronephrosis. The study was conducted during the period of November 2018 to November 2020, in Niloufer Hospital (Osmania Medical College), Hyderabad, Telangana, India. A total of 50 neonates were included. For all neonates postnatal monitoring with ultrasonography was done to detect structural anomalies and resolution of hydronephrosis. Micturating cystourethrogram was done in selected cases. The cases which needed surgery were treated accordingly. The Statistical Package for the Social Sciences (SPSS) version 24.0 was used for data analysis. Kruskal-Wallis Chi-square test was used to test the significance of difference between quantitative variables. The p-value less than 0.05 was taken as statistically significant. Results: Among 50 neonates enrolled in the study, 27 (54%) had transient hydronephrosis and 23 (46%) had urogenital structural abnormalities. Twenty-two cases (44%) required micturating cystourethrogram. Antenatal APD of 9.5 mm predicted the development of significant postnatal uropathy with a sensitivity of 74% and specificity of 89%. Antenatal APD of 9.5 mm had 100% sensitivity and 67% specificity in predicting the need for surgical intervention. Only 3 (6%) cases needed surgical intervention in neonatal period and all cases were kept under follow-up. Conclusion: All cases of ANH need postnatal evaluation and pertinent follow-up to detect significant uropathy for their proper management to prevent renal damage. Antenatal renal pelvic diameter has significant role in predicting the significant uropathy and surgical intervention.