Diagnosis Of Fetal Hydronephrosis Research Articles

Hydronephrosis Index as a New Method for the Evaluation and Follow-up of Fetal Hydronephrosis

Background: The present study was conducted to compare the efficiency of hydronephrosis index (HI) with those of pelvic anteroposterior (AP) diameter and parenchymal thickness in the diagnosis of fetal hydronephrosis in the prenatal period, as well as 1, 6, and 12 months after birth. Methods: This study was conducted on pregnant women with the pregnancy age of > 30 weeks whose fetus was suspected of hydronephrosis. The study participants were collected via the consecutive sampling method. The HI, pelvic AP diameter, and parenchymal thickness were measured at the baseline and 1, 6, and 12 months after delivery using ultrasound. According to the study design, the study participants were divided into three groups. Group A consisted of cases with decreased HI and higher hydronephrosis severity. Group B was composed of subjects with relatively constant HI, and group C entailed individuals with increased HI and lower hydronephrosis severity. All of the study measurements and analyses were performed on the three study groups. Results: The results revealed a negative association between HI and pelvic AP diameter but a positive association with parenchymal thickness. On the other hand, HI showed a significant correlation with parenchymal thickness in the diagnosis and prognostic assessment of fetal hydronephrosis. Conclusion: The HI correlated with parenchymal thickness and pelvic AP diameter scores in all follow-up stages. Accordingly, HI can be concluded to be a good alternative to parenchymal thickness or pelvic AP diameter as a grading factor for hydronephrosis. It is suggested to perform further studies to carefully assess the efficiency of HI in the diagnosis, prognosis, and clinical outcome of hydronephrosis.

Can maternal urinary and serum carbohydrate antigen 19-9 concentrations be utilized in the diagnosis of fetal hydronephrosis?

Objective:Fetal hydronephrosis (FH) is the most common fetal renal pathology encountered in daily obstetric practice. Urinary and serum carbohydrate antigen 19-9 (CA 19-9) concentrations are elevated in obstructive renal pathologies. Our aim was to assess maternal urinary and serum CA 19-9 concentrations in pregnancies with FH and compare results with controls.Material and Methods:Twenty pregnancies with severe FH, 20 pregnancies with mild-moderate FH, and 20 healthy singleton pregnancies were included in this descriptive, case-control study. The diagnosis and classification of FH was based on the anterioposterior diameter of fetal renal pelvis. Maternal urinary and serum CA 19-9 concentrations were measured and compared between groups.Results:Severe FH cases had significantly higher maternal urinary CA 19-9 concentrations compared to controls (median: 75 vs 24 U/mL; respectively; p=0.014). Concentrations of CA 19-9 did not differ between the mild-moderate FH group and control group. No statistically significant difference was found between the groups with respect to maternal serum CA 19-9 concentrations.Conclusion:Our results show that maternal urinary CA 19-9 concentration is significantly higher in pregnancies with severe FH. However, no difference was detected in serum CA 19-9 concentrations between pregnancies with severe FH, mild-moderate FH and controls. If the mechanisms of transplacental passage and maternal urinary excretion are clarified, maternal urinary CA 19-9 may be a potential marker for indicating fetal kidney damage.

Prenatal diagnosis and postnatal management of fetal hydronephrosis

Objective To investigate the prenatal diagnosis and postnatal management of fetal hydronephrosis. Methods One hundred and two cases (87 unilateral and 15 bilateral, with a total of 117 kidneys) of fetal hydronephrosis in singleton pregnancy were diagnosed by prenatal ultrasonography in Jinhua People's Hospital between January 2011 and December 2014. During pregnancy and postpartum, all cases were routinely examined by genitourinary ultrasound for the classification of severity of hydronephrosis. The age of gestation at diagnosis of fetal hydronephrosis, the classification of hydronephrosis and postnatal follow-up outcome were recorded and retrospectively analyzed by descriptive statistical analysis. Results Of the 102 pregnancies, the mean gravida age and gestational age at diagnosis of fetal hydronephrosis was (28.1±3.7) years (20-39 years) and (30.4±4.9) gestational weeks (16-40 gestational weeks), respectively. One hundred and two cases (35 right, 52 left and 15 bilateral) of fetal hydronephrosis were diagnosed by antenatal ultrasonography. In the second trimester, 59 cases (11 bilateral) of fetal hydronephrosis were diagnosed, including 28 mild (five bilateral), 24 moderate (three bilateral), four severe (one bilateral) and three terminated ones. In the third trimester, 43 cases (four bilateral) were diagnosed, including 22 mild (two bilateral), 17 moderate (one bilateral), two severe and two terminated ones. All these patients were re-examined by ultrasonography at 48 hours postpartum, and hydronephrosis was still present in 41 cases (five bilateral), including 19 grade 1 (two bilateral), 11 grade 2 (two bilateral), seven grade 3 and four grade 4 (one bilateral). From the second and third trimester to postnatal period, there were 18 (two bilateral) and 23 (three bilateral) cases of hydronephrosis, respectively. The regression rate of prenatal hydronephrosis was 53.8% (63/117), including 64.3% (45/70) in the second trimester and 38.3% (18/47) in the third trimester. During postnatal follow-up period, two cases (6.7%, 2/30, unilateral) of grade 2, four grade 3 (4/7, unilateral) and four grade 4 (one bilateral) underwent surgery. Eleven cases of grade 3-4 hydronephrosis (one bilateral) were followed up and nine kidneys were treated with surgery due to ureteropelvic junction obstruction (6/9), ureter stricture (1/9), vesicoureteral stricture (1/9) and posterior urethral valves (1/9). Conclusions Although the majority of cases of fetal hydronephrosis spontaneously regress, postnatal hydronephrosis should be monitored timely and continuously by ultrasound. In particular, grade 3-4 hydronephrosis should be followed up to evaluate renal functions. If hydronephrosis presents with symptoms, progressive aggravation, pathological obstruction, or differential renal function <40%, early surgical intervention should be provided to improve renal functions. Key words: Hydronephrosis; Ultrasonography, prenatal; Urologic surgical procedures

Analysis of postnatal outcomes of prenatally detected fetal hydronephrosis

Background: Prenatal hydronephrosis comprises 20% of the anomalies detected on ultrasound. Adequate information is required to counsel the parents regarding the diagnosis and possible need for further evaluation and postnatal therapy including surgery. The aim of the study is to analyse the postnatal outcomes of neonates with prenatal diagnosis of hydronephrosis. Material and Methods: Fetuses diagnosed with hydronephrosis from January 1, 2014 to May 31, 2015 were identified from the obstetric ultrasound database. 27 fetuses had a diagnosis of hydronephrosis and had complete postnatal follow-up. These were classified on the basis of the severity and bilaterality of hydronephrosis. Postnatal data and follow up was obtained from the hospital records and from the parents over phone when delivery had occurred at another institution. Results: Of 27 fetuses, 15 were diagnosed in second trimester and 13 in the third trimester due to late booking. No fetuses with a normal scan at second trimester subsequently developed hydronephrosis. Of 18 fetuses with mild hydronephrosis, 17 were seen to be normal at prenatal follow up or postnatally. Only one progressed and became severe requiring postnatal surgery. Of the nine fetuses classified as moderate or severe, seven neonates required surgery in the neonatal period. On comparing the two groups, this was found to be statistically significant. (p:0.005). The effect of bilateral hydronephrosis on outcomes could not be assessed due to the small numbers of fetuses in this category. Conclusion: Antenatal diagnosis of fetal hydronephrosis may progress and so parents need to be counselled regarding the need for a follow up scan which will then determine the need for post-natal follow up or treatment. Severity of the hydronephrosis seen antenatally influences the need for surgery in the neonate.

Vesicoureteral Reflux and Urinary Tract Infection in Children With a History of Prenatal Hydronephrosis—Should Voiding Cystourethrography be Performed in Cases of Postnatally Persistent Grade II Hydronephrosis?

The clinical relevance of prenatal hydronephrosis is not well-defined. We determined the risk of febrile urinary tract infection in the absence of screening for vesicoureteral reflux, and whether postnatal voiding cystourethrography should be performed in patients with a history of prenatal hydronephrosis and postnatally persistent Society for Fetal Urology grade II hydronephrosis. From a longitudinal database of patients with prenatal hydronephrosis maintained since 1998 we identified those with postnatally persistent grade II hydronephrosis. This cohort was divided into patients who were and were not screened with an initial voiding cystourethrogram. The rates of vesicoureteral reflux and development of febrile urinary tract infection were determined. Of 2,076 patients with prenatal hydronephrosis 1,514 had grade II hydronephrosis. Of the patients 76% underwent an initial voiding cystourethrogram and vesicoureteral reflux was found in 28%. There was no relation between laterality of hydronephrosis and incidence of vesicoureteral reflux. There was no difference between nonscreened and screened patients with respect to gender and laterality of hydronephrosis. Urinary tract infection developed in 1.3% of the patients who were screened and did not have vesicoureteral reflux and, therefore, were not receiving antibiotics. Of the screened patients with vesicoureteral reflux who were receiving prophylactic antibiotics urinary tract infection developed in 1.6% at a mean age of 9.4 months. In 363 patients who did not undergo an initial voiding cystourethrogram we estimated (based on the screened population) that 101 would have vesicoureteral reflux and 5 would have a urinary tract infection. However, a febrile urinary tract infection developed in 16 patients (4.4% overall, p <0.0001) at a mean age of 9.3 months. Voiding cystourethrogram performed in these 16 patients revealed vesicoureteral reflux in 12. Of all the patients with a urinary tract infection who were ultimately observed to have vesicoureteral reflux (including those initially screened and those discovered to have reflux after a urinary tract infection) the laterality of hydronephrosis, grade of reflux and laterality of reflux were comparable. In patients with a history of prenatal hydronephrosis who are observed to have postnatally persistent grade II hydronephrosis identification of vesicoureteral reflux and use of prophylactic antibiotics significantly reduce the risk of febrile urinary tract infection. Therefore, we recommend that patients with a history of prenatal hydronephrosis and postnatally persistent hydronephrosis be screened with voiding cystourethrography early in life, and be placed on prophylactic antibiotics until the screening results are known.

Ultrasound diagnosis of fetal hydronephrosis: Fetal renal pelvic size correlated to postnatal outcome

Ultrasound diagnosis of fetal hydronephrosis: Fetal renal pelvic size correlated to postnatal outcome

Nonobstructive Fetal Hydronephrosis

The postnatal outcome of nine patients with the prenatal diagnosis of fetal hydronephrosis is reported. In only three of the nine cases was true obstructive hydronephrosis demonstrated, and in only one of these cases (11%) the patient might have benefited from decompressive surgery at the time of diagnosis of the abnormality. Twenty-nine additional cases from the literature are reviewed. It is concluded that a major deterrent to early fetal surgery is that most of the cases of obstructive hydronephrosis are identified too late in gestation.

Diagnosis of fetal hydronephrosis in utero using ultrasound

Detection of fetal hydronephrosis in utero, subsequent investigation, and surgical treatment is described. With the increasing use of ultrasound for obstetrical problems and greater experience with fetal sonography, more urologic abnormalities will be diagnosed prenatally.

Ultrasonographic diagnosis of fetal hydronephrosis in utero

Ultrasonography offers a noninvasive method to visualize antenatal or neonatal anatomy which will lead to early detection and treatment of abnormalities. In these 2 cases, ultrasound allowed prompt diagnosis of hydronephrosis despite normal physical examination and laboratory values at birth.