[Hydronephrosis. II. Excretion rates of urinary components in experimental hydronephrosis and prediction of functional recovery].
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Animals↗
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[Study on hydronephrosis--urinary components and renal function in hydronephrosis].
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Adolescent↗
Apoptosis of renal tubular cells in congenital hydronephrosis.
OBJECTIVE: To assess apoptosis in congenital hydronephrosis and discuss its clinical significance. METHODS: Apoptosis was detected in 15 kidneys from children with congenital hydronephrosis (5 mild hydronephrosis, 5 moderate hydronephrosis and 5 severe hydronephrosis) using the electronmicroscope, in situ gap labeling of fragmented nuclear DNA and DNA fragmentation analysis. RESULTS: Apoptosis was seen in kidneys from children with congenital hydronephrosis. Margination of nuclear chromatin was identified and rounded apoptotic bodies were seen. The mean apoptotic index was 0.0941 +/- 0.017 in severe hydronephrosis, 0.0325 +/- 0.0169 in moderate hydronephrosis, and 0.0021 +/- 0.0031 in mild hydronephrosis. There was a significant difference between severe and moderate hydronephrosis (P = 0.0005), as well as between moderate and mild hydronephrosis (P = 0.0154). Moreover, with an increasing degree of hydronephrosis, the number of apoptotic cells also increased. Five kidneys with severe hydronephrosis and one kidney with moderate hydronephrosis showed typical apoptotic bands. CONCLUSION: Apoptosis might participate in damaging kidneys in children with congenital hydronephrosis.
Apoptosis↗
Surgical or conservative treatment of congenital hydronephrosis. Ten years' experience.
BACKGROUND: Controversy exists concerning the ideal management of hydronephrosis diagnosed in the perinatal period. Different opinions depend on the absence of an accurate tool and of well-defined cut-off values for each test. For these reasons we retrospectively evaluated our management protocol. METHODS: Two-hundred and seventy-two patients with single system hydronephrosis were evaluated. Patients with bilateral hydronephrosis or with other renal or ureteral abnormalities were excluded. Diagnosis and grading of hydronephrosis were done by ultrasound. Before 1995, grade II or greater hydronephrosis was also evaluated with diuretic intravenous urography, but in cases studied afterwards, a functional evaluation of the obstruction was reached with well tempered diuretic renogram. Indications for surgery were considered: recurrent urinary tract infections, grade IV hydronephrosis, obstructive drainage pattern and differential renal function less than 40%. Patients managed non-operatively received serial re-evaluation with US-scan, urine test and functional tests if necessary. RESULTS: Hydronephrosis was on the right side in 98 cases (36%), and on the left side in the other 174 (64%). There were 129 grade I hydronephrosis (47%), 46 grade II (17%), 57 grade III (21%), 40 grade IV (15%). Fifty-seven (21%) cases of hydronephrosis underwent surgery: 49 (86%) showing obstructive pattern at functional tests, 40 (70%) presenting a differential renal function less than 40%, 5 (8%) because recurrent urinary tract infections, 40 (70%) affected by grade IV hydronephrosis. No children received nephrectomy. Average postoperative follow-up was 2.8 years: pelvic dilatation improved or remained unchanged but the obstructive pattern at functional tests always disappeared after surgery. The average follow up in the observational group of 163 patients (60%) was 4.1 years. In 149 (91%) pelvic dilatation improved, but in 14 (9%) it remained unchanged. CONCLUSIONS: The ideal management of congenital hydronephrosis is still debated since the natural history of these disease is not still completely understood and there is no accurate tool to assess these renal units. We believe that grade IV hydronephrosis always need surgery as well as those ones with recurrent urinary tract infections, longer drainage time or a differential renal function less than 40%. On the other hand grade I hydronephrosis never need surgery. Mild grade hydronephrosis can be safely managed non-operatively with a meticulous follow-up and undergoing surgery only when signs of deterioration occur.
Female↗
Natural history of fetal hydronephrosis diagnosed on mid-trimester ultrasound.
OBJECTIVES: Renal tract dilatation is a common finding in routine prenatal ultrasound. However, there is no consensus as to the criteria used for differentiating pathological from physiological dilatation. The aim of this study was to evaluate the natural history and postnatal outcome of fetal hydronephrosis in an unselected obstetric population. DESIGN: This was a prospective study of fetal hydronephrosis, detected at 18-23 weeks' gestation, in a routine obstetric population. Fetal hydronephrosis was diagnosed as 'mild' if the antero-posterior renal pelvic diameter (APRPD) measured >or = 4 mm and as 'moderate/severe' if the APRPD measured > or = 7 mm or if there was associated calyceal dilatation. The postnatal outcome of fetuses with persistent hydronephrosis (> or = 10 mm in the third trimester) was determined from a postal questionnaire. RESULTS: During the study period, 11 465 women underwent an anomaly scan at 18-23 weeks of gestation. Fetal hydronephrosis was identified in 2.3% (268/11 465) of women. Mild hydronephrosis was present in 80.6% (216/268) and moderate/severe hydronephrosis in 19.4% (52/268). The hydronephrosis resolved in the antenatal or early neonatal period in 88% of fetuses. None of the fetuses with mild hydronephrosis and approximately one in three fetuses with persistent moderate/severe hydronephrosis required postnatal surgery. Overall, only one in every 1000 total births in the study population required postnatal urological surgery. CONCLUSIONS: The current study highlights the natural history of antenatally detected hydronephrosis. Mild fetal hydronephrosis appears to be associated with an excellent prognosis and probably represents the group with physiological renal pelvic dilatation. Moderate/severe fetal hydronephrosis is associated with poorer outcome and is perhaps the group that will need more intense follow up both antenatally and postnatally.
Adult↗
Antenatal hydronephrosis as a predictor of postnatal outcome: a meta-analysis.
OBJECTIVE: Antenatal hydronephrosis is diagnosed in 1% to 5% of all pregnancies; however, the antenatal and postnatal management of hydronephrosis varies widely. No previous studies define the risk of postnatal pathology in infants with antenatal hydronephrosis. Our objective was to review the current literature to determine whether the degree of antenatal hydronephrosis and related antenatal ultrasound findings are associated with postnatal outcome. METHODS: We searched Medline (1966-2005), Embase (1991-2004), and the Cochrane Library databases for articles on antenatal hydronephrosis. We required studies to have subjects selected on the basis of documented measurements of antenatal hydronephrosis and followed to a postnatal diagnosis. We excluded case reports, review articles, and editorials. Two independent investigators extracted data. RESULTS: We screened 1645 citations, of which 17 studies met inclusion criteria. We created a data set of 1308 subjects. The risk of any postnatal pathology per degree of antenatal hydronephrosis was 11.9% for mild, 45.1% for moderate, and 88.3% for severe. There was a significant increase in risk per increasing degree of hydronephrosis. The risk of vesicoureteral reflux was similar for all degrees of antenatal hydronephrosis. CONCLUSIONS: The findings of this meta-analysis can potentially be used for prenatal counseling and may alter current postnatal management of children with antenatal hydronephrosis. Overall, children with any degree of antenatal hydronephrosis are at greater risk of postnatal pathology as compared with the normal population. Moderate and severe antenatal hydronephrosis have a significant risk of postnatal pathology, indicating that comprehensive postnatal diagnostic management should be performed. Mild antenatal hydronephrosis may carry a risk for postnatal pathology, but additional prospective studies are needed to determine the optimal management of these children. A well-defined prospective analysis is needed to further define the risk of pathology and the appropriate management protocols.
Case Management↗
The correlation of serum carbohydrate antigen 19-9 with benign hydronephrosis.
PURPOSE: High serum carbohydrate antigen 19-9 in patients with hydronephrosis but without malignant disease is reportedly rare but to our knowledge the clinical features of hydronephrosis that affect this level have not yet been clarified. We examined the correlation of serum carbohydrate antigen 19-9 with hydronephrosis status in patients with benign hydronephrosis. MATERIALS AND METHODS: We used 123 serum samples from 68 patients with and 55 without hydronephrosis. All patients enrolled in this study had no malignant disease. Serum carbohydrate antigen 19-9 was measured by immunoradiometric assay and that level was correlated with clinical factors. RESULTS: Serum carbohydrate antigen 19-9 in patients with hydronephrosis was significantly higher than in those without hydronephrosis (p <0.0001). The serum level was elevated to greater than 37 units per ml. in 25% of the patients with but in only 1.8% of those without hydronephrosis. In the hydronephrosis group the clinical features that significantly correlated with the increased serum level were bilateral hydronephrosis, urinary tract infection, proteinuria, increased serum blood urea nitrogen, severe urinary tract occlusion and high grade hydronephrosis. CONCLUSIONS: Serum carbohydrate antigen 19-9 was significantly elevated in patients with benign hydronephrosis. Hydronephrosis causes false-positive results when screening for malignant disease by serum carbohydrate antigen 19-9 measurement.
Adolescent↗
Prevalence of hydronephrosis in patients undergoing surgery for pelvic organ prolapse.
OBJECTIVE: To determine the prevalence of hydronephrosis in patients undergoing surgery for pelvic organ prolapse and to determine whether hydronephrosis is associated with the type and severity of prolapse. METHODS: The charts of 375 consecutive patients undergoing surgery for pelvic organ prolapse at the Cleveland Clinic Foundation between January 1, 1990, and December 31, 1993 were reviewed. Preoperative renal ultrasounds and intravenous pyelograms (IVP) were evaluated for hydronephrosis based on the final diagnosis established by the radiologists. The severity of prolapse was determined from the preoperative office examination or from the examination under anesthesia at the time of surgery. RESULTS: Of 375 patients, 323 had either a preoperative renal ultrasound or IVP. The mean age was 66.0 +/- 10.2 years (range 35-93) and median parity was 3.0 (range 0-10). Of the 323 patients, 25 (7.7%, 95% confidence interval 5, 11) had hydronephrosis. Thirteen patients (4.0%) had mild hydronephrosis, nine (2.8%) had moderate hydronephrosis, and three (0.9%) had severe hydronephrosis. The prevalence of hydronephrosis increased with increasing severity of prolapse. Two patients with hydronephrosis had evidence of renal insufficiency (creatinine > or = 1.6), and both had severe bilateral hydronephrosis and complete procidentia. The prevalence of hydronephrosis was lower in patients with vaginal vault prolapse versus uterine prolapse (3.9% compared with 12.6%, P < .01), CONCLUSION: The prevalence of hydronephrosis in patients undergoing surgery primarily for pelvic organ prolapse is low, increases with worsening pelvic organ prolapse, and is lower in patients with vaginal vault prolapse that in those with uterine prolapse.
Adult↗
Maternal hydronephrosis in pregnancy: poor association with symptoms of flank pain.
The purpose of our investigation was to determine the association between flank pain and maternal hydronephrosis during pregnancy. Eighty-one gravidas were evaluated longitudinally with renal ultrasound in each trimester and postpartum. Each was asked about symptoms of flank pain, and then a renal ultrasound was performed. We defined hydronephrosis as a mean pelvic-calyceal measurement of 10 mm or greater. None of the cohort had hydronephrosis in the first trimester, and four had hydronephrosis in the second trimester; almost all maternal hydronephrosis was seen initially in the third trimester. Seventeen (21%) of 81 women had hydronephrosis; 14 on the right side and three bilateral. Nine women reported significant flank pain, and three of these had hydronephrosis. Fourteen women with hydronephrosis reported no flank pain. There was no association observed between flank pain and hydronephrosis ( P = 0.39). All women with hydronephrosis had complete resolution at 6 weeks postpartum. During pregnancy, the association between maternal hydronephrosis and flank pain symptoms is poor. In the clinical evaluation of pregnant women with flank pain, hydronephrosis should not be considered etiologic in the absence of other clinical evidence.
Female↗
Optimal timing of initial postnatal ultrasonography in newborns with prenatal hydronephrosis.
PURPOSE: Conflicting data exist concerning optimal timing for initial postnatal ultrasound in newborns with prenatal hydronephrosis. To determine whether timing significantly affects the accuracy of postnatal ultrasound, we conducted a prospective study comparing ultrasound within 48 hours of birth and at 7 to 10 days of life. MATERIALS AND METHODS: A total of 21 consecutive newborns with prenatal hydronephrosis were enrolled in 14 months. Prenatal hydronephrosis was defined as a pelvic diameter 4 mm. or greater before 33 weeks and 8 mm. or greater beginning at 33 weeks of gestation. Postnatal hydronephrosis was assessed using the Society for Fetal Urology grading system. Patients were subsequently followed with serial ultrasound and adjunctive imaging studies. RESULTS: Of the 32 evaluable renal units a majority had a change in the degree of hydronephrosis between the first and second ultrasound. An increase in hydronephrosis was found in 14 (44%) renal units with an increase of 2 or greater grades in 8 (25%). At a median followup of 15 months only 3 renal units had a persistent increase in hydronephrosis. None had greater than grade 2 hydronephrosis or required therapeutic intervention. A decrease in hydronephrosis between the first and second ultrasound was noted in 8 (25%) renal units. Seven renal units were excluded from analysis due to unequivocal obstruction, and none of these demonstrated a change between the 2 sonograms. CONCLUSIONS: The degree of hydronephrosis varied between scans performed in the first 48 hours and 7 to 10 days of life in most newborns. The initial ultrasound more commonly underestimated the degree of hydronephrosis but this difference was not clinically significant at further followup. We recommend initial postnatal sonogram at 7 to 10 days of life for routine prenatal hydronephrosis but earlier scans may be appropriate in select cases.
Age Factors↗
The clinical implications of hydronephrosis and the level of ureteral obstruction in stage IIIB cervical cancer.
PURPOSE: There are two criteria for the diagnosis of Stage IIIB cervical cancer in the FIGO staging system: tumor fixation to the pelvic side wall and/or the presence of hydronephrosis due to tumor. However, we often encounter hydronephrosis without tumor fixed to the pelvic side wall or the level of ureteral obstruction not corresponding to the main tumor mass in the pelvis. The clinical implication of these phenomena remains unclear. We investigated the Stage IIIB population treated at the Mallinckrodt Institute of Radiology and hypothesized that, if hydronephrosis presents without tumor fixation to the pelvic side wall or if the level of ureteral obstruction is above the main pelvic tumor mass, it most likely resulted from external compression of ureter(s) by enlarged lymph nodes and, consequently, a worse outcome is expected. METHODS AND MATERIALS: From 1959 to 1989, there were 297 patients with Stage IIIB cervical cancer who received definitive radiation therapy at the Mallinckrodt Institute of Radiology and were assessable for the presence of hydronephrosis and the level of ureteral obstruction. There were 281 patients who presented with tumor fixed to the pelvic side wall, and 62 of them were associated with concurrent hydronephrosis. An additional 16 patients presented with hydronephrosis without tumor fixation to the pelvic side wall. Among these 78 documented cases of hydronephrosis, the level of ureteral obstruction was above the true pelvis in 39 patients, and below the true pelvis in the other 39. Radiation therapy was individualized according to tumor extension and configuration; para-aortic lymph nodes were not routinely treated except in patients with clinical evidence of nodal metastasis. RESULTS: The progression-free survival (PFS) at 5 years was 35% in 62 patients with hydronephrosis and tumor fixed to the pelvic side wall vs. 43% in 213 patients with tumor fixed to the pelvic side wall only (p=0.12). However, PFS at 5 years decreased to 23% in 16 patients who presented with hydronephrosis without tumor fixation to the pelvic side wall (p < 0.001). When the level of ureteral obstruction was investigated, 5-year PFS was 39% vs. 22%, respectively, for the obstruction below vs. above the true pelvis (p=0.02). The majority of patients with ureteral obstruction above the true pelvis died of distant metastasis. CONCLUSIONS: The additional presence of hydronephrosis did not significantly worsen the PFS among Stage IIIB patients with tumor fixation to the pelvic side wall. However, hydronephrosis without tumor extending to the pelvic side wall or the level of ureteral obstruction above the true pelvis was associated with poor outcome due to a significant increase in distant failure. We propose that this population be separated from current Stage IIIB classification.
Disease-Free Survival↗
[Severe primary congenital unilateral hydronephrosis. A review of 98 cases].
INTRODUCTION: Currently, consensus is lacking on the indications for surgery in primary congenital unilateral hydronephrosis. OBJECTIVES: To analyze the clinical characteristics, treatment and outcome of severe asymptomatic primary congenital unilateral hydronephrosis (grades 3 and 4). PATIENTS AND METHODS: We performed a retrospective study of 98 neonates with severe primary congenital unilateral hydronephrosis. Diagnostic techniques consisted of ultrasound, renogram, and DMSA scan. RESULTS: The mean age at diagnosis was 24 days. The mean length of follow-up was 4 years. Forty-eight percent of cases were grade 3 and the remaining cases were grade 4. Fifty-six percent of the patients received conservative treatment. Forty-four percent underwent surgery. Surgical indications consisted of prolonged T1/2, reduced differential renal function and/or very severe hydronephrosis. The mean age at surgery was 5.5 months. In 94 % of the patients who received conservative treatment, hydronephrosis resolved spontaneously. In this group, renal parenchyma and renal function were normal in all patients except two. In 97 % of the patients who received surgical treatment, hydronephrosis was corrected or improved after pyeloplasty. At diagnosis, 19 kidneys had reduced function. In the postsurgical renogram, although T1/2 had markedly improved, 8 kidneys showed reduced function. DMSA performed in 63 patients belonging to both groups, outside the active phase of hydronephrosis, revealed 8 atrophic kidneys, 4 with moderately reduced renal size and function and 4 with scarring and normal renal size and function. During the study period, overall function was maintained in all patients and none developed hypertension. CONCLUSIONS: Severe congenital unilateral hydronephrosis resolves spontaneously in most patients. Consequently, clinicians increasingly adopt a conservative approach. The available diagnostic techniques cannot identify patients who will benefit from pyeloplasty. In general, accepted surgical indications are an increase in hydronephrosis and/or worsening of renal function. In our series, 15 % of the patients with hydronephrosis had an irreversible lesion of variable severity, which in some patients seemed to have developed during embryogenesis. Kidneys at risk of presenting a lesion were those that had grade 4 hydronephrosis.
Child, Preschool↗
Pelvic radiotherapy in patients with hydronephrosis in stage IIIB cancer of the cervix: renal effects and the optimal timing for urinary diversion?
BACKGROUND AND PURPOSE: Many patients with Stage IIIB cervix cancer (Ca) and hydronephrosis will require ureteral stenting. The timing is important as delays or prolonged overall treatment times adversely affect outcome. Our aim was to measure the effect of pelvic radiotherapy (R/T) on renal function and identify a subset of patients at high risk of acute urinary obstruction during R/T. PATIENTS AND METHODS: From 1/1/2000 to 1/1/2002, all patients with Stage IIIB cervix Ca and hydronephrosis were analysed retrospectively. To quantify the impact of pelvic R/T, all eligible patients from 1/7/2002-1/7/2004 had prospectively recorded baseline biochemistry, creatinine clearance and renal ultrasounds; these were repeated weekly to detect any change in renal function or degree of hydronephrosis. RESULTS: 13 eligible patients were analysed retrospectively, 5 with unilateral hydronephrosis with 40% requiring urinary diversion (UD). 8 had bilateral hydronephrosis, with 75% requiring UD; 50% before R/T and 35% during R/T. Average creatinine clearance (CrCl) was 74 mL/min (1.24 mL/s) in unilateral hydronephrosis , bilateral = 52 mL/min (0.87 mL/s), in those stented during R/T it was < 40 mL/min (0.67 mL/s). The resulting break in R/T was 6 and 19 days. In the prospective study, 5 patients were eligible and 4 consented. 75% had unilateral hydronephrosis and did not require UD with an average CrCl = 71 mL/min (1.19 mL/s). 1 patient with bilateral hydronephrosis had a CrCl of < 20 mL/min (0.33 mL/s) with bilateral stents placed before R/T. CONCLUSIONS: Patients with bilateral hydronephrosis and a low CrCl < 50 mL/min (0.84 mL/s) should be considered for elective UD prior to R/T. Pelvic R/T did not induce any deterioration in renal function or degree of hydronephrosis.
Acute Kidney Injury↗
Does every patient with prenatal hydronephrosis need voiding cystourethrography?
PURPOSE: Prenatal ultrasound has allowed early identification of urinary tract abnormalities that may require urological followup or early intervention. While all children with prenatal hydronephrosis should undergo ultrasound within the first few weeks of life, we believe that there is a subset of postnatal hydronephrosis for which voiding cystourethrography can be avoided if careful observation is continued. MATERIALS AND METHODS: For 5 years 175 infants with a history of prenatal hydronephrosis were evaluated by ultrasound. Of 60 infants with less than Society for Fetal Urology grade II unilateral or bilateral hydronephrosis 44 underwent voiding cystourethrography as part of the early evaluation and 16 were observed without voiding cystourethrography. Four infants for whom we would routinely obtain voiding cystourethrography were excluded from study due to severe prenatal hydronephrosis, renal duplication, hydroureter, ipsilateral small or echogenic kidney and grade II or higher hydronephrosis. RESULTS: Voiding cystourethrography was positive in 6 of the 40 infants (15%) with less than grade II hydronephrosis. Of these cases 3 had grade III or higher vesicoureteral reflux and 1 with high grade reflux required reimplantation. None of the 16 patients followed without voiding cystourethrography has required further evaluation or intervention. In all patients with negative or no voiding cystourethrography parenchyma was preserved and hydronephrosis stabilized or resolved. CONCLUSIONS: Prenatal and postnatal ultrasound in infants should be used to guide further urological evaluation. Among infants with less than grade II hydronephrosis postnatally 15% had reflux on voiding cystourethrography, which is significantly higher than that reported among normal children (approximately 1%). However, none of the 16 infants observed without voiding cystourethrography on short-term antibiotic prophylaxis had deleterious renal events with 6 months to 4.5 years of followup. Therefore, we question the actual significance of the reflux detected in the first cohort of infants. Voiding cystourethrography can provide a definitive answer. However, we also believe that it is not absolutely mandatory based on the outcome in the observed group. With careful counseling and followup most patients with less than grade II hydronephrosis can be observed without urological sequela.
Female↗
Rapid oral hydration results in hydronephrosis as demonstrated by bedside ultrasound.
STUDY OBJECTIVE: To determine whether vigorous oral hydration (20 mL/kg) causes hydronephrosis as determined by bedside ultrasound. METHODS: We conducted a prospective laboratory trial in 35 healthy volunteers weighing less than 90 kg and between the ages of 18 and 50 years. The right kidney of the volunteers was scanned by emergency physicians at time 0 both before and after voiding, and the volunteers then drank 20 mL/kg of bottled water. The kidney was scanned in the transverse and sagittal planes both before and after voiding at 60 and 90 minutes after completion of the water load. The scans were interpreted by a physician trained and credentialed in emergency ultrasound, blinded to the volunteers' identity, the time of the scan, and the volume of urine voided by the subject. Images were rated as to the degree of hydronephrosis according to literature-established criteria, as follows: grade 0=no hydronephrosis, grade 1=mild, grade 2=moderate, and grade 3=severe hydronephrosis. RESULTS: Hydronephrosis was present in 3 (8.6%) of the 35 subjects at time 0 (prehydration), 24 (68.6%) at 60 minutes, and 20 (57.1%) at 90 minutes. Overall, hydronephrosis occurred at least once in 28 (80%) of the 35 subjects after oral hydration compared with 3 (8.6%) of the 35 subjects before hydration. Hydronephrosis was found to be significantly related to forced hydration for all posthydration times (60 minutes, 90 minutes, and 60+90 minutes combined) versus prehydration time 0 (P <.001). CONCLUSION: Without prior fluid intake, even mild degrees of hydronephrosis were relatively uncommon, and seen in only 8.6% of study patients. In the presence of vigorous oral hydration, however, mild or moderate hydronephrosis is a frequent occurrence seen at least once in 80% of our study of healthy volunteers after hydration. Caution is warranted in this setting when interpreting mild or moderate hydronephrosis found on bedside ultrasound by emergency physicians.
Adolescent↗
Evaluation and follow-up of fetal hydronephrosis.
OBJECTIVE: To determine the antenatal course and neonatal follow-up of isolated fetal hydronephrosis. METHODS: We reviewed our ultrasonography database from January 1989 to June 1999 for all cases of unilateral or bilateral fetal hydronephrosis that had at least 1 follow-up ultrasonographic examination. Cases were defined as mild, moderate, or severe depending on the renal pelvis anteroposterior diameter and gestational age. Data were analyzed using the chi2 test with the Fisher exact test where appropriate. Medical records were reviewed, and telephone interviews were performed to determine which infants received follow-up after birth. RESULTS: Of 57,966 ultrasonographic examinations in 20,049 women during the study period, 393 patients met criteria for evaluation. Of these, 347 (88%) had fetuses with mild hydronephrosis. Most of these had complete resolution during the pregnancy. Forty patients had fetuses classified as having moderate hydronephrosis, and 6 patients had fetuses with severe hydronephrosis. Of those classified as moderate hydronephrosis, 15% resolved, 25% improved, 48% remained unchanged, and 12% worsened during the pregnancy. There were no cases of in utero resolution in the severe group; however, 4 of 6 cases improved to moderate or mild, and 2 cases remained unchanged. Of the cases identified prenatally, 25 received consultation by a pediatric urologist in the newborn period, and 7 of these required surgical intervention. CONCLUSIONS: Our population-based data suggest that most cases of mild hydronephrosis will resolve before delivery. In contrast, cases of moderate or severe hydronephrosis are less likely to have resolution in utero and are more likely to worsen or remain unchanged. Of those fetuses with persistent hydronephrosis, only a small number required some surgical intervention after birth. This information is useful in counseling the patient whose fetus is noted to have isolated hydronephrosis.
Female↗
[Natural history of prenatally diagnosed hydronephrosis: possible recurrence of dilatation after spontaneous reduction, in cases with pelvic diameter larger than 20 mms, recommends long term follow-up].
BACKGROUND: Long term follow-up of a prenatally diagnosed hydronephrosis usually extends no longer than the first two years from diagnosis. During this period spontaneous reduction occurs in most of the dilatations, not sustained by obstruction or reflux. Late recurrence of hydronephrosis is considered to be unusual. The aim of the present work has been to verify the risk of recurrent hydronephrosis long time after reduction and to identify factors associated to recurrence. MATERIALS AND METHODS: In a seven years period (1992-99) 276 patients with hydronephrosis unrelated to Reflux, Duplex kidney, Megaureter of vesical obstruction have been observed. Of these 231 were referred on the basis of a prenatal diagnosis. Hydronephrosis of grade III or more was recorded in 73/231 with a pelvic diameter > or = 15 mm at ultrasonography (US) and a normal counter lateral kidney. Surgical treatment was planned in 39 cases on the basis of a separate function < 40%, either deterioration during follow-up or occurrence of clinical symptoms. Thirty four cases were treated conservatively and four were lost at follow. Of the remaining 30 cases, 14 had a pelvic diameter lager than 20 mm. They were all followed for a mean of 16,6 months (range 7-26) and spontaneous significant reduction of pelvic dilatation was recorded in all of them. RESULTS: Patients were recalled after a mean of 32,1 months from the last US. In 3 cases, of 14 with a pelvic diameter > 20 mm a recurrent severe hydronephrosis was found respectively at 39,56 and 68 months. In two of them, isotopic scan documented a reduced separate function. The third case reported recurrent symptoms. A pyeloplasty was performed in all the cases. CONCLUSIONS: Spontaneous reduction in most of the prenatally detected cases of neonatal hydronephrosis within the first two months of life make follow-up beyond this term controversial, whenever complete disappearance of pelvic dilatation has been documented. The Authors report three cases with severe hydronephrosis (pelvic diameter > 20 mm) among a group of patients treated conservatively. Long time after spontaneous reduction recurrent hydronephrosis was documented in all of them by a new US, associated with deterioration of separate function and symptoms. Long term follow-up is recommendable in major cases of prenatally detected hydronephrosis cases, even after reduction, to warrant from recurrence and renal damage.
Female↗
[Natural history of prenatally diagnosed hydronephrosis: possible recurrence of dilatation after spontaneous reduction, in cases with pelvic diameter larger than 20 mms, recommends long term follow-up].
BACKGROUND: Long term follow-up of a prenatally diagnosed hydronephrosis usually extends no longer than the first two years of life. During this period spontaneous reduction occurs in most of the dilatations, not sustained by obstruction or reflux. Late recurrence of hydronephrosis is considered to be unusual. The aim of the present work has been to verify the risk of recurrent hydronephrosis long time after reduction and to identify factors associated to recurrence. MATERIALS AND METHODS: In a seven years period (1992-99) 276 patients with hydronephrosis unrelated to reflux, duplex kidney, megaureter or vesical obstruction have been observed. Among them, 231 were referred after prenatal diagnosis. Hydronephrosis of grade III or more was recorded in 73/231 with a pelvic diameter > or = 15 mms at ultrasonography (US) and a normal counter-lateral kidney. Surgical treatment was elected in 39 cases on the basis of a separate function < 40%, deterioration during follow-up, or occurrence of clinical symptoms. Thirthy four cases were treated conservatively and four were lost at follow. Among the remaining 30 cases, 14 had a pelvic diameter lager than 20 mms. They were followed for a mean of 16.6 months (range 7-26) and spontaneous significant reduction of pelvic dilatation was recorded in all of them. RESULTS: Patients were recalled after a mean of 32.1 months from the last US. In 3 cases among 14 with a pelvic diameter larger than 20 mms a recurrent severe hydronephrosis was found respectively at 39, 56, and 68 months. In two of them, isotopic scans documented a reduced separate function. The third case reported recurrent symtpoms. A pyeloplasty was performed in all cases. CONCLUSIONS: Spontaneous reduction in most of the prenatally detected cases of neonatal hydronephrosis within the first two months of life make follow-up beyond this term controversial, whenever complete disappearance of pelvic dilatation has been documented. The Authors report three cases with severe hydronephrosis (pelvic diameter > 20 mms) among a group of patients treated conservatively. Long time after spontaneous reduction, recurrent hydronephrosis was documented in all by US, associated to deterioration of separate function and symptoms. Long term follow-up is recommendable in severe cases of prenatally detected hydronephrosis cases, even after reduction, to warrant from recurrence and renal damage.
Child, Preschool↗