Prenatal Diagnosis of Severe Fetal Hydronephrosis Due to Pyeloureteral Junction Syndrome with False Neonatal Resolution

Arianna Lesma,Audrey Serafini,Paolo Ivo Cavoretto,Pier Luigi Paesano,Gerarda Gaeta,Mirko Pozzoni,Massimo Candiani

doi:10.3390/reprodmed2040017

Arianna Lesma, Audrey Serafini + Show 5 more

Open Access

https://doi.org/10.3390/reprodmed2040017

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Journal: Reproductive Medicine	Publication Date: Nov 15, 2021
Citations: 1	License type: CC BY 4.0

Affiliation: San Raffaele University of Rome

Abstract

A case of severe fetal hydronephrosis due to isolated bilateral stenosis of the pyelo-ureteral junction was diagnosed at our centre. Surprisingly, a negative renal ultrasound scan was performed on the 3rd postnatal day. An ultrasound follow-up showed severe bilateral pyelectasis a few weeks later. The infant underwent bilateral pyeloplasty at six months of age with an excellent outcome. Such a neonatal picture may be due to the reduction of urinary output secondary to excessive postnatal weight loss and dehydration. In this case, prenatal ultrasound result was more reliable than postnatal ultrasound, emphasizing the importance of postnatal urologic follow-up after prenatal indication.

Highlights

Fetal hydronephrosis is a common, diagnosed finding on prenatal ultrasound examination occurring in 1 to 2% of pregnancies [1]
The goal of prenatal management is to detect those cases of antenatal hydronephrosis that will require postnatal evaluation, timely referral to a paediatric urologist, and possible intervention [7]
The Society of Fetal Urology (SFU) developed criteria for the diagnosis and grading of antenatal hydronephrosis based upon the degree of pelvic dilatation, number of calyces seen, and the presence and severity of parenchymal atrophy [10]

Summary

Introduction

Fetal hydronephrosis is a common, diagnosed finding on prenatal ultrasound examination occurring in 1 to 2% of pregnancies (twice as often in males than in females) [1]. It is bilateral in 20 to 40% of cases and can be detected as early as the 12 to. The goal of prenatal management is to detect those cases of antenatal hydronephrosis that will require postnatal evaluation, timely referral to a paediatric urologist, and possible intervention [7]. The Society of Fetal Urology (SFU) developed criteria for the diagnosis and grading of antenatal hydronephrosis based upon the degree of pelvic dilatation, number of calyces seen, and the presence and severity of parenchymal atrophy [10]. In a meta-analysis of 1308 subjects with varying degrees of antenatal hydronephrosis, the risk of a pathologic postnatal outcome was estimated to be 88.3%, 45.1%, and 11.9% for severe, moderate, and mild antenatal hydronephrosis, respectively [5]

Case Report

Review of the Literature

Findings

Discussion

Conclusions