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PubMed1997

Fetal pyelectasis: comparison of postnatal renal pathology with unilateral and bilateral pyelectasis.

The aim of this study was to determine the prenatal fetal pyelectasis which requires postnatal evaluation. This was a retrospective analysis involving 65 infants with complete urological follow-up; 59 had shown prenatal evidence of pyelectasis using previously published standards. Males were more common in both the normal (75 per cent) and the abnormal (77 per cent) postnatal outcome groups. Unilateral prenatal lesions were less common than bilateral, but had significant postnatal pathology in 47 and 26 per cent, respectively (n.s.). Persistent dilatation was likely to be associated with postnatal pathology. A 6 mm threshold of dilatation predicted the 19 infants with significant postnatal pathology. The majority of fetuses with pyelectasis in the study had normal outcomes, with males often showing 'transitory pyelectasis'. A repeat prenatal scan at 30-40 weeks' gestation is recommended for all fetuses where 6 mm or more of renal pelvic dilatation is detected prior to 28 weeks. Postnatal follow-up is required for persistent pyelectasis.

Dilatation, Pathologic↗
PubMed1997

Mild pyelectasis ascertained with prenatal ultrasonography is pediatrically significant.

Isolated 'mild renal collecting system dilatation' (mild pyelectasis) is a common prenatal sonographic finding. An association between mild pyelectasis and fetal aneuploidy has been established, but in the absence of a concomitant anomaly, mild pyelectasis is usually regarded as benign and of no clinical consequence, and follow-up is often not obtained after the initial ascertainment. To test this, we investigated the relationship between mild pyelectasis and (1) progression to hydronephrosis; (2) postnatal vesicoureteral reflux (VUR); and (3) postnatal surgery. Between 1 January 1992 and 1 January 1995, we performed 453 prenatal sonographic examinations of 306 patients with mild fetal pyelectasis and no other anomalies. During the course of a routine sonographic examination, we performed a detailed evaluation of the fetal genitourinary tract, Mild pyelectasis was defined as a pelvocalyceal fluid-filled space with the smallest of two transverse perpendicular sonographic measurements of > or = 4 mm and < 10 mm. Hydronephrosis was defined similarly, but with a measurement of > or = 10 mm. Postnatal urological assessment was obtained with routine renal ultrasonography, and voiding cystourethrography (VCUG), measurement of 99mTc-labelled diethylenetriamine pentaacetic acid (DPTA) mercaptacetyltriglycerine (MAG3), and intravenous pyelogram, as necessary. After exclusion criteria were applied, 294 (96%) patients with isolated fetal pyelectasis were considered. A total of 251 (82%) of these were followed with ultrasonography prenatally and during the postnatal period. Two or more prenatal examinations were carried out in 129 patients (51%) and in 35 (27%) of these cases the biometry progressed to frank hydronephrosis (> 10 mm). In only six (5%) of the cases followed prenatally did the measurement diminish to < 4 mm. We found a greater variability in prenatal renal biometry throughout gestation in infants found to have VUR, when compared with those who had no VUR. On postnatal follow-up, 84 patients had VCUG. Sixteen of these patients (6% of all patients [16/251] and 19% [16/84] of those who had the test) were found to have an abnormal finding. Whereas the prenatal appearance of mild pyelectasis improved in only a small number of cases, we found that it progressed to hydronephrosis in 27% of cases. Postnatal evaluation found VUR to be common in apparent uncomplicated mild prenatal pyelectasis. Although postnatal surgery was necessary in only a small number of cases, surgical intervention was necessary in 33% (four of 12) of those with VUR.

Adolescent↗
PubMed1996

Isolated fetal pyelectasis: assessment of risk for postnatal uropathy and Down syndrome.

Eight-two consecutive fetuses with ultrasound evidence of isolated pyelectasis (defined as dilation in the antero-posterior renal pelvic dimension of > or = 4 mm) were prospectively followed to determine the risk of postnatal uropathy and Down syndrome. In 98 (60%) kidneys, isolated pyelectasis was shown to be the first manifestation of a pathophysiological process that evolved into a gamut of postnatal uropathies (defined as urological conditions requiring remedial surgery or extended medical surveillance). Data quantifying the risk for postnatal uropathy in fetuses with varying degrees of isolated pyelectasis, at different gestational ages, are presented in figure format to facilitate prenatal counselling. Bivariate analysis showed that the evolution of isolated pyelectasis to uropathy was statistically significant when in utero progression was noted or in conjunction with other findings including contralateral pyelectasis (p < 0.01), male gender (p < 0.01) and increased kidney length (p < 0.001). Importantly, 55% of the infants requiring corrective surgery demonstrated in utero progression of pyelectasis (p < 0.002). Serial ultrasound examinations were necessary to evaluate progression or regression in the extent of pyelectasis. Finally, isolated pyelectasis was associated with an increase risk for Down syndrome, beginning at maternal age of 31 years, in the interval of 16-20 week's gestation.

Adult↗
PubMed1996

Prognostic significance of antenatally detected fetal pyelectasis.

In order to evaluate the prognostic significance of ultrasonographically detected fetal pyelectasis, a retrospective review was performed of patients evaluated for fetal pyelectasis over a 24-month period. From 84 patients a total of 98 fetal kidneys with pyelectasis were identified. Fetal pyelectasis was more common in the left kidney and in males. Postpartum evaluation revealed 48 (57.1%) neonates with hydronephrosis. Among these, mean (SD; range) values of antenatal fetal pyelectasis were 17.0 mm (8.4; 5-26) before 33 weeks and 16.9 mm (8.5; 5-34) after 33 weeks in the left kidney and 15.4 mm (3.3; 10-24) and 17.1 mm (5.1; 5-36), respectively, in the right kidney. Thirteen infants (15.4%) with hydronephrosis required surgical pyeloplasties (mean age 6 months; range 3-18 months). It was found, from a receiver-operating characteristic curve, that fetal pyelectasis of 8 mm was 91% sensitive and 72% specific in predicting subsequent hydronephrosis. Use of a threshold of 5 mm yielded a sensitivity of 100% and a specificity of 24%. On the basis of these findings, we recommend that women with ultrasonographically detected antenatal fetal pyelectasis of > or = 5 mm at any gestational age have follow-up ultrasound examinations and detailed postnatal evaluation.

Dilatation, Pathologic↗
PubMed2001

The association of aneuploidy and mild fetal pyelectasis in an unselected population: the results of a multicenter study.

INTRODUCTION: Mild pyelectasis is a common finding and there is some debate as to its association with aneuploidy. The results of a large, prospective, multicenter study of mild pyelectasis designed to determine the incidence and association with aneuploidy in an unselected population are reported. METHODS: A large multicenter, prospective observational study of unselected fetuses with mild pyelectasis identified between 16 and 26 weeks' gestation in routine ultrasound departments. RESULTS: There were 737 fetuses with mild pyelectasis of which 12 had an abnormal karyotype. Pyelectasis was isolated in three fetuses with Down syndrome, but in one the mother was older (36 years). CONCLUSION: These data confirm the fact that the presence of mild fetal pyelectasis increases the risk for aneuploidy, in particular trisomy 21. However, other risk factors should be considered before embarking on fetal karyotyping, as for most pregnancies complicated by isolated mild pyelectasis, risks of aneuploidy will remain small.

Adult↗
PubMed1992

Fetal pyelectasis and Down syndrome: is genetic amniocentesis warranted?

An association between pyelectasis and Down syndrome has recently been reported. The purpose of this investigation was twofold: 1) to test the hypothesis that pyelectasis is more common in fetuses with Down syndrome, and 2) to determine whether genetic amniocentesis should be offered when dilated renal pelves are identified during fetal ultrasound examination. The study population of 5944 fetuses was separated into two groups by infant outcome: 1) phenotypically and/or chromosomally normal, and 2) chromosomally abnormal. Each group was examined for the presence of pyelectasis, defined as an anteroposterior renal pelvic diameter of 4 mm or greater before 33 weeks or 7 mm or greater after 33 weeks. Pyelectasis was observed in 17.4% (four of 23) of Down syndrome fetuses versus only 2% (120 of 5876) of normal controls, a statistically significant difference (P less than .001). The predictive value of pyelectasis for Down syndrome (one in 90) compares favorably with other accepted indications for genetic amniocentesis, such as advanced maternal age and low maternal serum alpha-fetoprotein (MSAFP). When fetuses with concomitant sonographic abnormalities were excluded, the predictive value of isolated pyelectasis fell to one in 340. We conclude that although renal pyelectasis is more common in Down syndrome fetuses, genetic amniocentesis should be reserved for those cases presenting other risk factors such as advanced maternal age, low MSAFP, or other sonographic abnormalities.

Amniocentesis↗
PubMed1996

Pyelectasis of the newborn.

In the course of the ultrasound screening of 7057 newborns, 429 (6.1%) pyelectases were encountered (the pyelon was 5 mm or wider). Up to the termination of the study 91.7% of the newborns with pyelectasis could be controlled. In 341 (86.3%) out of the 395 controlled cases, pyelectasis disappeared without causing any disturbances. In 54 cases (13.7%) pyelectasis increased, or the considerable pyelectasis accompanied by calyectasis was not found to be reduced by the first control examinations. Vesicoureteral reflux was observed in 8 (14.8%) of these cases. Following a long-term observation period, all pyelectases disappeared or diminished considerably. Hydronephrosis was encountered in 23 newborns, 9 of them underwent surgery. The frequency of pyelonephritides was 1.4% during infancy of the newborns with pyelectasis. Pyelectasis of the newborn is considered a benign alteration. Its further examination is indicated if it increases and is accompanied by considerable calyectasis or ureterectasis.

Dilatation, Pathologic↗
PubMed1998

Detection and assessment of pyelectasis in the fetus: relationship to postnatal renal function.

OBJECTIVE: To assess the relationship between fetal pyelectasis determined by ultrasonography and postnatal renal function. METHODS: We first established normal values for anteroposterior, transverse, and longitudinal diameters of the renal pelvis sonographically in 68 normal fetuses at 30-40 weeks' gestation. We also evaluated prospectively the relationship between the severity of pyelectasis (diameter at least two standard deviations above the normal mean) in 36 fetuses at 30-40 weeks' gestation and postnatal renal function. Fetal renal function also was evaluated through measurement of the hourly urine production rate, whereas postnatal renal function was assessed by technetium 99m-diethylenetriamine penta-acetic acid renography and excretory urography. RESULTS: Fetal pyelectasis was diagnosed when renal pelvic diameters were at least 8 mm (anteroposterior), 11 mm (transverse), and 14 mm (longitudinal), all upper limits of normal diameters of 68 normal fetuses as determined in the first part of the study. Pyelectasis was associated with a normal urine production rate in all fetuses, but in six fetuses it was associated with a normal urine production rate in all fetuses, but in six fetuses it was associated with a progressive deterioration of renal function within the 1st month of life, requiring neonatal surgery. In the other 30 fetuses with pyelectasis, who did not require neonatal surgery, pyelectasis decreased gradually or totally disappeared within 2 years. Renal pelvic anteroposterior, transverse, and longitudinal pelvic diameters were at least 20, 25, and 26 mm, respectively, during late fetal life in those neonates at the time of corrective surgery. The mean anteroposterior diameter in those fetuses who did not require surgery at infancy (11 +/- 6 mm) was significantly less than in those requiring surgery (33 +/- 14 mm, P < .01). Likewise, the transverse diameters were 17 +/- 10 mm and 38 +/- 16 mm (P < .01) and the longitudinal diameters were 20 +/- 10 mm and 48 +/- 22 mm (P < .01). CONCLUSION: Neonatal surgery is recommended when the anteroposterior, transverse, and longitudinal renal pelvic diameters during the prenatal period are at least 20, 25, and 26 mm, respectively. Surgery is not necessary when the diameters are less than 20 mm.

Dilatation, Pathologic↗
PubMed1998

Effect of maternal hydration on fetal renal pyelectasis.

OBJECTIVE: To assess the effect of maternal hydration on fetal pyelectasis. METHODS: Thirteen pregnant women with fetal pyelectasis and 13 controls matched for gestational age were recruited during the same period. Ultrasound and Doppler studies and maternal urine specific gravity measurements were carried out before and after maternal oral hydration. The data were analyzed by either a two- or three-factor analysis of variance. RESULTS: Renal artery Doppler pulsatility index was significantly greater in the study group than in the controls (2.37 versus 1.83; P=.009) and this finding was unaffected by maternal hydration status. After hydration, the maternal urinary specific gravity decreased significantly (1.018 versus 1.009; P < .001), the amniotic fluid index (AFI) increased significantly (14.27 versus 18.24 cm; P < .001), and the fetal renal pelvis diameter increased significantly (0.29 versus 0.46 cm; P=.002) in both the study and control groups. Renal pelvis anteroposterior diameter after hydration did not differ significantly whether the fetal bladder was full or empty (0.7 versus 0.6 cm; P=.1). In this study, each subject served as her own control (ie, from before to after hydration). Three of 13 controls met the diagnostic criteria for pyelectasis after maternal hydration. CONCLUSION: The AFI increases after maternal hydration in both normal fetuses and those with pyelectasis. The fetal renal pelvis anteroposterior diameter increases with maternal hydration in both normal fetuses and those with pyelectasis and is independent of the state of the fetal bladder. The renal artery Doppler pulsatility index is significantly greater in fetuses with pyelectasis than in controls.

Dilatation, Pathologic↗
PubMed1998

Isolated mild fetal pyelectasis detected by transvaginal sonography in advanced maternal age.

OBJECTIVE: To evaluate the importance and evolution of isolated, mild fetal pyelectasis, detected in early pregnancy by high-resolution transvaginal sonography, and to determine its association with abnormal fetal karyotypes. METHODS: Transvaginal scan at 11-16 weeks' gestation and transabdominal ultrasound examinations at the time of amniocentesis (16-18 weeks) were performed in 1093 pregnant women undergoing genetic amniocentesis because of advanced maternal age. In 795 cases, transabdominal scans were repeated at 22-24 weeks. Women were excluded if they had a spontaneous abortion, chose to terminate their pregnancy, or declined amniocentesis. Each patient was screened for fetal pyelectasis, defined as an increase in anteroposterior renal pelvic diameter, using cutoff values related to various stages of pregnancy. RESULTS: Isolated fetal pyelectasis was detected at the first ultrasound examination in 56 women (5.1%) in early pregnancy, in 32 (2.9%) at the time of amniocentesis, and in 23 (2.9%) at 22-24 weeks' gestation. Two fetuses with diagnoses of mild pyelectasis at the first transvaginal ultrasound demonstrated abnormal karyotypes at amniocentesis. In one case, the pyelectasis disappeared at 22-24 weeks' gestation. CONCLUSION: This retrospective study shows that pyelectasis is more frequently detectable by high-resolution transvaginal sonography in the first half of pregnancy than in the second half. When detected in early pregnancy, the finding is frequently transient and not associated with an increased risk of abnormal fetal karyotypes.

Adult↗
PubMed1996

A prospective study of the association between isolated fetal pyelectasis and chromosomal abnormality.

OBJECTIVE: To determine the incidence of chromosomal abnormalities among fetuses with isolated pyelectasis. METHODS: Between March 1991 and March 1994, 121 cases of isolated fetal pyelectasis were identified at our institution. Pyelectasis was defined as a renal pelvis anteroposterior diameter of at least 4 mm before 33 weeks' gestation, and at least 7 mm at 33 weeks or thereafter. Once identified, women were offered antenatal genetic testing; if they declined, consent was sought for umbilical cord blood studies at delivery. RESULTS: Chromosomal evaluation was available in 99 women. Two chromosomal abnormalities were identified: one trisomy 21 and one mosaic 46, XY/47, XYY. The ages of the women were 32 and 28 years, respectively. Calculation of adjusted risks for Down syndrome and all chromosomal abnormalities indicated a 3.9-fold increase in Down syndrome risk and a 3.3-fold increase in risk for all chromosomal abnormalities in the presence of isolated fetal pyelectasis. CONCLUSION: Isolated fetal pyelectasis is associated with increased risk, over that related to age, for both Down syndrome and all chromosomal abnormalities. These factors may be valuable in counseling individual patients regarding the appropriateness of amniocentesis.

Adult↗
PubMed1992

Renal pyelectasis in pregnancy: correlative evaluation of fetal and maternal collecting systems.

OBJECTIVE: The current study is aimed at assessing the possibility of a statistical relationship between fetal and maternal collecting system dilatation during pregnancy. STUDY DESIGN: Two hundred thirty consecutive pregnant women and their fetuses (20 to 40 weeks' gestation) were simultaneously examined by ultrasonography. The renal collecting systems were measured, and the frequency of dilatation was subjected to chi 2 analysis. The temporal incidence of fetal pyelectasis was compared with the maternal incidence. RESULTS: Dilatation of maternal collecting systems was detected in 91 of 230 patients (40%) and fetal pyelectasis occurred in 60 of 230 (26%). Fetal pyelectasis was 5.6 times more likely to occur in fetuses of mothers with dilated collecting systems. Furthermore, the temporal incidence of fetal pyelectasis throughout pregnancy appeared similar to that of maternal pyelectasis. CONCLUSION: This study points out the existence of a statistically significant association between maternal and fetal collecting system dilatation during pregnancy.

Chi-Square Distribution↗
PubMed1985

Minimal fetal renal pyelectasis.

To assess the possible relationship between the degree of maternal hydration and the sonographic identification of minimal fetal renal pyelectasis, a prospective study was performed in which fetuses demonstrating mild dilation of the renal pelvis (maximum diameter ranging from 3 to 11 mm) were reexamined after the mothers refrained from oral intake for 12 hours. Complete or almost complete resolution of the pyelectasis occurred in only four of 17 kidneys (23.5 per cent) while the remaining fetal kidneys demonstrated little or no change in the degree of pyelectasis following maternal dehydration. This observation, as well as previous experimental research, suggests that the state of maternal oral hydration is not a major cause of minimal fetal pyelectasis. Additionally, the observation of fetal pyelectasis measuring at least 3 mm in greatest dimension is common, occurring in approximately 18 per cent of fetuses older than 24 menstrual weeks.

Dehydration↗
PubMed2002

The association between fetal pyelectasis on second trimester ultrasound scan and aneuploidy among 25,586 low risk unselected women.

OBJECTIVE: To determine the association of fetal pyelectasis FP found at the time of second trimester detailed ultrasound scan with aneuploidy in an unselected low-risk population. DESIGN: Retrospective study of ultrasonographic reports, films and hospital notes over an eight-year period from 1991 to 1998. SETTING: District general hospital obstetric department with 3500 deliveries annually serving a low-risk cosmopolitan population. MAIN OUTCOME MEASURE: The prevalence of aneuploidy in cases of fetal pyelectasis. METHODS: The obstetric ultrasound reports and films of 29,591 cases were reviewed to identify those with FP at their detailed anomaly scan between 18 and 24-weeks gestation. The study sample included women whose scan showed the fetal renal pelvis of either kidney to be five millimetres or more in the anteroposterior diameter. Demographic data and other ultrasonographic abnormalities were noted. The genotype and phenotype of the babies were traced from a combination of cytogenetic reports and paediatric notes. RESULTS: There were 320 cases of FP among the 25,586 low-risk study population available in the studied gestational period (18-24 weeks) giving a prevalence of 1.25 percent. Of these, 301 cases of FP were found in isolation and 19 were found in association with another ultrasonographic marker. None of the 315 cases delivering at the Northwick Park & St. Mark's Hospital had aneuploidy. Pyelectasis was more likely to be bilateral (57%), and more in male fetuses (72%). The mean diameter for the pyelectasis at diagnosis was 6.5 mm (1.4 SD) ranging between 5 and 15 mm. One hundred and thirty seven cases (43%) resulted in spontaneous resolution. CONCLUSION: The prevalence of FP at the anomaly scan in an unselected low-risk population is not high (1.25%). Our data suggest that the risk of aneuploidy associated with isolated FP in a low-risk, unselected population is so small that it should not be an indication for invasive prenatal karyotyping.

Adolescent↗
PubMed1997

Fetal pyelectasis in consecutive pregnancies: a possible genetic predisposition.

Mild fetal pyelectasis is a relatively common finding. The objective of this study was to assess its recurrence rate in subsequent pregnancies. The study comprised 420 women with two consecutive normal uncomplicated pregnancies screened at 15-24 weeks' gestation by ultrasound. Pyelectasis was defined as a fetal pelvis of 4 mm or more in its anterior-posterior dimensions. Of 64 fetuses with pyelectasis, 43 (67%) had a recurrence of this finding in their subsequent pregnancy. Compared with normal fetuses, those with pyelectasis had a relative risk of 6.1 to have a recurrence of this finding in their next pregnancy (95% confidence interval, 4.3-7.5, p < 0.001). These results suggest a predisposition for pyelectusis that may be influenced by genetic and/or environmental factors. More data are needed before an accurate adjustment based on previous results can be made.

Adult↗
PubMed2001

Prenatal diagnosis of de novo distal 11q deletion associated with sonographic findings of unilateral duplex renal system, pyelectasis and orofacial clefts.

In utero diagnosis of de novo distal 11q deletion associated with renal and orofacial malformations has not been previously described. We present a 35-year-old pregnant woman with prenatal sonographic findings of a unilateral duplex renal system, pyelectasis and orofacial clefts at 20 weeks' gestation. Both genetic amniocentesis and postnatal cytogenetic analysis revealed de novo 46,XX,del(11)(q23). After birth, the fetus manifested a dysmorphic phenotype correlated with del(11q) syndrome. Genetic marker analysis showed a paternally derived distal deletion of chromosome 11q and a breakpoint centromeric to D11S1341. The present case represents the earliest prenatal diagnosis of a duplex renal system, pyelectasis and an additional feature of orofacial clefts associated with distal 11q deletion. Prenatal sonographic detection of a duplex renal system, pyelectasis and orofacial clefts should warrant a careful assessment of fetal anatomy and prompt cytogenetic analysis looking for chromosomal aberrations.

Abortion, Induced↗
PubMed1995

Fetal pyelectasis: is it always "physiologic"?

OBJECTIVE: Our purpose was to determine the degree of fetal pyelectasis predictive of neonatal renal pathologic processes. STUDY DESIGN: Eighty-four cases of pyelectasis were identified during the study period (1989 through 1993). Fetuses with anteroposterior diameter of the renal pelvis > or = 4 mm before 33 weeks or > or = 7 mm after 33 weeks without caliectasis were included. Fetuses with an anteroposterior diameter of > 10 mm were excluded. Postnatal evaluation included renal sonogram, voiding cystourethrogram, and renal flow and function studies. RESULTS: Sixteen cases were excluded because of incomplete postnatal workup. Renal pathologic processes were found in 30 of 68 (44%) at birth; the most common were ureteropelvic junction obstruction (37%) and vesicoureteral reflux (33%). Only four cases required surgical intervention (13%), and the remaining 87% were managed conservatively. A normal urinary tract was found in 25% of the infants and the remaining 21 of 68 (31%) had regression of pyelectasis before birth. Fetuses with a dilated anteroposterior diameter > or = 8 mm after 28 weeks' gestation were found to have renal pathologic features in two of three of the cases, with sensitivity, specificity, and positive and negative predictive values of 87%, 41%, 66.7% and 70%, respectively. CONCLUSION: Fetuses with an anteroposterior diameter of the renal pelvis > or = 8 mm after 28 weeks' gestation require appropriate urologic evaluation after birth.

Dilatation, Pathologic↗
PubMed2000

Pyelectasis and hydronephrosis in the newborn and infant.

UNLABELLED: The aim of this review is to describe the present status of prenatally diagnosed pyelectasis and hydronephrosis. Ultrasonographic definitions are presented, along with guidelines for the management of urinary tract dilatations. Isolated pyelectasis without caliceal involvement rarely constitutes a pathological situation and does not require any particular diagnostic or therapeutic measures. Obstructive dilatation is characterized by an obstacle to normal urinary flow situated at any level in the urinary tract, with consequent stagnation of urine and dilatation upstream of the obstruction. If the obstruction is not correctly treated it can cause a progressive deterioration of renal function. The presence of ureterectasia plays a crucial role in the diagnostic algorithm and a micturitional cystourethrography is necessary to look for a vesicoureteric reflux (VUR). The significance of urinary tract dilatation is discussed in detail. CONCLUSION: In newborns with pyelectasis or hydronephrosis the paediatrician's goal should be to strike the right balance between excessive medical intervention and sufficient intervention for the diagnosis of potentially dangerous conditions.

Dilatation, Pathologic↗