Child Kidney Dis.  2015 Apr;19(1):8-13. 10.3339/chikd.2015.19.1.8.

Evaluation and Management of Antenatal HydronephrosisEvaluation and Management of Antenatal Hydronephrosis

• Hong YK
• Lee JH

• KMID: 2134408
• DOI: http://doi.org/10.3339/chikd.2015.19.1.8

Abstract

Antenatal hydronephrosis (ANH) is one of the most common abnormal findings detected on prenatal ultrasound (US), and it has been reported in 1-5% of all pregnancies. The likelihood of significant postnatal pathologic abnormality in the urinary tract correlates with the degree of anterior-posterior diameter (APD) according to the gestational age. Detection of urologic anomalies prenatally permits fetal interventions that avoid complications in rare cases of bladder outlet obstruction with oligohydramnios even though their final benefits still remain controversial. There is no clear consensus on the extent and mode of postnatal imaging after a diagnosis of ANH. US is the mainstay of the postnatal evaluation and helps guide further testing with voiding cystourethrography (VCUG) and diuretic renography. Although most algorithms continue to recommend generous VCUG for identification of lower urinary tract anomalies, VCUG may be safely reserved for high grade ANH cases or any grade of ANH with dilated distal ureter without increasing the risk of urinary tract infection (UTI). There are conflicting studies about efficacy of postnatal prophylactic antibiotics. It still seems reasonable to consider use of a prophylactic antibiotic to prevent infant UTIs in high-risk populations, such as females and uncircumcised males with high grades of hydronephrosis, hydroureteronephrosis, or vesicouretral reflux.

Keyword

Hydronephrosis; Prenatal diagnosis; Child; Diagnostic imaging

MeSH Terms

Anti-Bacterial Agents
Child
Consensus
Diagnosis
Diagnostic Imaging
Female
Gestational Age
Humans
Hydronephrosis*
Infant
Male
Oligohydramnios
Pregnancy
Prenatal Diagnosis
Radioisotope Renography
Ultrasonography
Ureter
Urinary Bladder Neck Obstruction
Urinary Tract
Urinary Tract Infections
Anti-Bacterial Agents