Clinical Outcome of Prenatal Hydronephrosis

Song, Phil Hyun; Cho, Chul Kyu; Park, Tong Choon

Abstract

PURPOSE: The popular use of prenatal ultrasonography has lead to an increase in the diagnosis of hydronephrosis in fetuses. However, there is little data available, in Korea, on the natural progress of prenatal hydronephrosis. Therefore, to help in the management of patients, the follow-up data on fetuses, with antenatally diagnosed hydronephrosis, were analyzed.
MATERIALS AND METHODS
Fifty-five (71 renal units) of 102 patients (118 renal units), with antenatally diagnosed hydronephrosis, were available for followed up from the 27th to the 36th fetal week. The follow-up postnatal ultrasonographs were retrospectively reviewed to try and determine the etiology, natural progress, prognosis and treatment of prenatal hydronephrosis. Diuretic 99mTc-DTPA renal and 99mTc-DMSA renal scans, intravenous pyelography and voiding cystourethrography were performed in the unimproved cases.
RESULTS
The etiologies of prenatal hydronephrosis were ureteropelvic junction obstruction, VACTERL syndrome, vesicoureteral reflux, duplicated ureter, ureterovesical junction obstruction and polycystic kidney. During the follow-up period, 38 renal units, with prenatal hydronephrosis, improved spontaneously, but 18 units were aggravated. Operations were performed in 13 units.
CONCLUSIONS
Many of the fetal hydronephrosis, diagnosed antenatally, disappeared postnatally. It is suggested that fetal, or neonatal, hydronephrosis does not necessarily imply the presence of obstructive uropathy or significant functional abnormality. The fetal antenatally diagnosed hydronephrosis, with clinical symptoms of pyuria, hematuria or a palpable abdominal mass, were often aggravated to a significant uropathy, which required a follow up evaluation and treatment.