Skip to main content
SpringerLink
Log in

Current management of antenatal hydronephrosis

  • Educational Review
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

The strategy for the management of children with urinary tract anomalies has changed considerably as a result of the development of ultrasound equipment and techniques that allow for detailed fetal evaluation. Hydronephrosis is the most common urogenital anomaly detected, suggesting that an obstructive process may be potentially present. The goal of postnatal management is to identify and treat those patients whose renal function is at risk, while leaving alone the high percentage of patients who are at no risk of renal damage. This management involves a spectrum of radiological, medical, and surgical interventions for diagnosis, surveillance, and treatment. In this article, we review our current understanding of the natural history of antenatal hydronephrosis and its management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Grisoni ER, Gauderer MW, Wolfson RN, Izant RJ Jr (1986) Antenatal ultrasonography: the experience in a high risk perinatal center. J Pediatr Surg 21:358–361

    Article  PubMed  CAS  Google Scholar 

  2. Woodward M, Frank D (2002) Postnatal management of antenatal hydronephrosis. BJU Int 89:149–156

    Article  PubMed  CAS  Google Scholar 

  3. Ismaili K, Hall M, Donner C, Thomas D, Vermeylen D, Avni FE (2003) Results of systematic screening for minor degrees of fetal renal pelvis dilatation in an unselected population. Am J Obstet Gynecol 188:242–246

    Article  PubMed  Google Scholar 

  4. Lee RS, Cendron M, Kinnamon DD, Nguyen HT (2006) Antenatal hydronephrosis as a predictor of postnatal outcome: a meta-analysis. Pediatrics 118:586–593

    Article  PubMed  Google Scholar 

  5. Ismaili K, Avni FE, Piepsz A, Wissing KM, Cochat P, Aubert D, Hall M (2004) Current management of infants with fetal renal pelvis dilation: a survey by French-speaking pediatric nephrologists and urologists. Pediatr Nephrol 19:966–971

    Article  PubMed  Google Scholar 

  6. Corteville JE, Gray DL, Crane JP (1991) Congenital hydronephrosis: correlation of fetal ultrasonographic findings with infant outcome. Am J Obstet Gynecol 165:384–388

    PubMed  CAS  Google Scholar 

  7. Wollenberg A, Neuhaus TJ, Willi UV, Wisser J (2005) Outcome of fetal renal pelvic dilatation diagnosed during the third trimester. Ultrasound Obstet Gynecol 25:483–488

    Article  PubMed  CAS  Google Scholar 

  8. Coelho GM, Bouzada MC, Lemos GS, Pereira AK, Lima BP, Oliveira EA (2008) Risk factors for urinary tract infection in children with prenatal renal pelvic dilatation. J Urol 179:284–289

    Article  PubMed  Google Scholar 

  9. Coelho GM, Bouzada MC, Pereira AK, Figueiredo BF, Leite MR, Oliveira DS, Oliveira EA (2007) Outcome of isolated antenatal hydronephrosis: a prospective cohort study. Pediatr Nephrol 22:1727–1734

    Article  PubMed  Google Scholar 

  10. Mandell J, Peters CA, Retik AB (1998) Perinatal urology. Campbells urology, 7th edn. W.B.Saunders, Philadelphia

  11. Siemens DR, Prouse KA, MacNeily AE, Sauerbrei EE (1998) Antenatal hydronephrosis: thresholds of renal pelvic diameter to predict insignificant postnatal pelviectasis. Tech Urol 4:198–201

    PubMed  CAS  Google Scholar 

  12. Fernbach SK, Maizels M, Conway JJ (1993) Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr Radiol 23:478–480

    Article  PubMed  CAS  Google Scholar 

  13. Lim DJ, Park JY, Kim JH, Paick SH, Oh SJ, Choi H (2003) Clinical characteristics and outcome of hydronephrosis detected by prenatal ultrasonography. J Korean Med Sci 18:859–862

    PubMed  Google Scholar 

  14. Phan V, Traubici J, Hershenfield B, Stephens D, Rosenblum ND, Geary DF (2003) Vesicoureteral reflux in infants with isolated antenatal hydronephrosis. Pediatr Nephrol 18:1224–1228

    Article  PubMed  Google Scholar 

  15. Gloor JM (1995) Management of prenatally detected fetal hydronephrosis. Mayo Clin Proc 70:145–152

    Article  PubMed  CAS  Google Scholar 

  16. Kitagawa H, Pringle KC, Stone P, Flower J, Murakami N, Robinson R (1998) Postnatal follow-up of hydronephrosis detected by prenatal ultrasound: the natural history. Fetal Diagn Ther 13:19–25

    Article  PubMed  CAS  Google Scholar 

  17. Nguyen HT, Herndon CD, Cooper C, Gatti J, Kirsch A, Kokorowski P, Lee R, Perez-Brayfield M, Metcalfe P, Yerkes E, Cendron M, Campbell JB (2010) The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol 6:212–231

    Article  PubMed  Google Scholar 

  18. Oliveira EA, Rabelo EA, Pereira AK, Diniz JS, Cabral AC, Leite HV, Silva JM, Fagundes TA (2002) Prognostic factors in prenatally-detected posterior urethral valves: a multivariate analysis. Pediatr Surg Int 18:662–667

    PubMed  Google Scholar 

  19. Mure PY, Mouriquand P (2008) Upper urinary tract dilatation: prenatal diagnosis, management and outcome. Semin Fetal Neonatal Med 13:152–163

    Article  PubMed  Google Scholar 

  20. Shipp TD, Nguyen HT, Bromley B, Lyons JG, Benacerraf BR (2011) Importance of renal abnormalities first identified in the third trimester after normal findings on a detailed second-trimester structural fetal survey. J Ultrasound Med 30:1567–1572

    PubMed  Google Scholar 

  21. Herndon CD, Ferrer FA, Freedman A, McKenna PH (2000) Consensus on the prenatal management of antenatally detected urological abnormalities. J Urol 164:1052–1056

    Article  PubMed  CAS  Google Scholar 

  22. Holmes N, Harrison MR, Baskin LS (2001) Fetal surgery for posterior urethral valves: long-term postnatal outcomes. Pediatrics 108:E7

    Article  PubMed  CAS  Google Scholar 

  23. Spitzer A (1996) The current approach to the assessment of fetal renal function: fact or fiction? Pediatr Nephrol 10:230–235

    Article  PubMed  CAS  Google Scholar 

  24. Laing FC, Burke VD, Wing VW, Jeffrey RB Jr, Hashimoto B (1984) Postpartum evaluation of fetal hydronephrosis: optimal timing for follow-up sonography. Radiology 152:423–424

    PubMed  CAS  Google Scholar 

  25. Dejter SW Jr, Gibbons MD (1989) The fate of infant kidneys with fetal hydronephrosis but initially normal postnatal sonography. J Urol 142:661–662, discussion 667-668

    PubMed  Google Scholar 

  26. Conway JJ, Maizels M (1992) The "well tempered" diuretic renogram: a standard method to examine the asymptomatic neonate with hydronephrosis or hydroureteronephrosis. A report from combined meetings of The Society for Fetal Urology and members of The Pediatric Nuclear Medicine Council—The Society of Nuclear Medicine. J Nucl Med 33:2047–2051

    PubMed  CAS  Google Scholar 

  27. Perez-Brayfield MR, Kirsch AJ, Jones RA, Grattan-Smith JD (2003) A prospective study comparing ultrasound, nuclear scintigraphy and dynamic contrast enhanced magnetic resonance imaging in the evaluation of hydronephrosis. J Urol 170:1330–1334

    Article  PubMed  Google Scholar 

  28. Ismaili K, Avni FE, Hall M (2002) Results of systematic voiding cystourethrography in infants with antenatally diagnosed renal pelvis dilation. J Pediatr 141:21–24

    Article  PubMed  Google Scholar 

  29. Mandell J, Blyth BR, Peters CA, Retik AB, Estroff JA, Benacerraf BR (1991) Structural genitourinary defects detected in utero. Radiology 178:193–196

    PubMed  CAS  Google Scholar 

  30. Matsui F, Shimada K, Matsumoto F, Takano S (2008) Late recurrence of symptomatic hydronephrosis in patients with prenatally detected hydronephrosis and spontaneous improvement. J Urol 180:322–325, discussion 325

    Article  PubMed  Google Scholar 

  31. Gatti JM, Broecker BH, Scherz HC, Perez-Brayfield MR, Kirsch AJ (2001) Antenatal hydronephrosis with postnatal resolution: how long are postnatal studies warranted? Urology 57:1178

    Article  CAS  Google Scholar 

  32. Koff SA, Campbell K (1992) Nonoperative management of unilateral neonatal hydronephrosis. J Urol 148:525–531

    PubMed  CAS  Google Scholar 

  33. Docimo SG, Silver RI (1997) Renal ultrasonography in newborns with prenatally detected hydronephrosis: why wait? J Urol 157:1387–1389

    Article  PubMed  CAS  Google Scholar 

  34. Riccabona M, Avni FE, Blickman JG, Dacher JN, Darge K, Lobo ML, Willi U (2008) Imaging recommendations in paediatric uroradiology: minutes of the ESPR workgroup session on urinary tract infection, fetal hydronephrosis, urinary tract ultrasonography and voiding cystourethrography, Barcelona, Spain, June 2007. Pediatr Radiol 38:138–145

    Article  PubMed  Google Scholar 

  35. van Eerde AM, Meutgeert MH, de Jong TP, Giltay JC (2007) Vesico-ureteral reflux in children with prenatally detected hydronephrosis: a systematic review. Ultrasound Obstet Gynecol 29:463–469

    Article  PubMed  Google Scholar 

  36. Passerotti CC, Kalish LA, Chow J, Passerotti AM, Recabal P, Cendron M, Lee RS, Lopez AB, Retik AB, Nguyen HT (2011) The predictive value of the first postnatal ultrasound in children with antenatal hydronephrosis. J Pediatr Urol 7:128–136

    Article  PubMed  Google Scholar 

  37. Sidhu G, Beyene J, Rosenblum ND (2006) Outcome of isolated antenatal hydronephrosis: a systematic review and meta-analysis. Pediatr Nephrol 21:218–224

    Article  PubMed  Google Scholar 

  38. Signorelli M, Cerri V, Taddei F, Groli C, Bianchi UA (2005) Prenatal diagnosis and management of mild fetal pyelectasis: implications for neonatal outcome and follow-up. Eur J Obstet Gynecol Reprod Biol 118:154–159

    Article  PubMed  Google Scholar 

  39. Odibo AO, Raab E, Elovitz M, Merrill JD, Macones GA (2004) Prenatal mild pyelectasis: evaluating the thresholds of renal pelvic diameter associated with normal postnatal renal function. J Ultrasound Med 23:513–517

    PubMed  Google Scholar 

  40. Brophy MM, Austin PF, Yan Y, Coplen DE (2002) Vesicoureteral reflux and clinical outcomes in infants with prenatally detected hydronephrosis. J Urol 168:1716–1719, discussion 1719

    Article  PubMed  Google Scholar 

  41. Farhat W, McLorie G, Geary D, Capolicchio G, Bagli D, Merguerian P, Khoury A (2000) The natural history of neonatal vesicoureteral reflux associated with antenatal hydronephrosis. J Urol 164:1057–1060

    Article  PubMed  CAS  Google Scholar 

  42. Vates TS, Shull MJ, Underberg-Davis SJ, Fleisher MH (1999) Complications of voiding cystourethrography in the evaluation of infants with prenatally detected hydronephrosis. J Urol 162:1221–1223

    Article  PubMed  CAS  Google Scholar 

  43. Fefer S, Ellsworth P (2006) Prenatal hydronephrosis. Pediatr Clin North Am 53:429–447, vii

    Article  PubMed  Google Scholar 

  44. Elder JS (1997) Antenatal hydronephrosis. Fetal and neonatal management. Pediatr Clin North Am 44:1299–1321

    Article  PubMed  CAS  Google Scholar 

  45. Penido Silva JM, Oliveira EA, Diniz JS, Bouzada MC, Vergara RM, Souza BC (2006) Clinical course of prenatally detected primary vesicoureteral reflux. Pediatr Nephrol 21:86–91

    Article  PubMed  Google Scholar 

  46. Estrada CR, Peters CA, Retik AB, Nguyen HT (2009) 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? J Urol 181:801–806, discussion 806-807

    Article  PubMed  Google Scholar 

  47. Lee JH, Choi HS, Kim JK, Won HS, Kim KS, Moon DH, Cho KS, Park YS (2008) Nonrefluxing neonatal hydronephrosis and the risk of urinary tract infection. J Urol 179:1524–1528

    Article  PubMed  Google Scholar 

  48. Yavascan O, Aksu N, Anil M, Kara OD, Aydin Y, Kangin M, Cetinkaya E, Bal A (2010) Postnatal assessment of growth, nutrition, and urinary tract infections of infants with antenatally detected hydronephrosis. Int Urol Nephrol 42:781–788

    Article  PubMed  Google Scholar 

  49. Walsh TJ, Hsieh S, Grady R, Mueller BA (2007) Antenatal hydronephrosis and the risk of pyelonephritis hospitalization during the first year of life. Urology 69:970–974

    Article  PubMed  Google Scholar 

  50. Alconcher L, Tombesi M (2004) Mild antenatal hydronephrosis: management controversies. Pediatr Nephrol 19:819–820

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Children’s Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Hunnewell-353, Boston, MA, 02115, USA

    Kleiton G. R. Yamaçake & Hiep T. Nguyen

Authors
  1. Kleiton G. R. Yamaçake
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hiep T. Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiep T. Nguyen.

Additional information

Answers to the questions:

1.A

2.D

3.B

4.C

5.C

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yamaçake, K.G.R., Nguyen, H.T. Current management of antenatal hydronephrosis. Pediatr Nephrol 28, 237–243 (2013). https://doi.org/10.1007/s00467-012-2240-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-012-2240-7

Keywords

Search

Navigation