Skip to main content

Advertisement

Log in

Prenatal Hydronephrosis: Postnatal Evaluation and Management

  • Pediatric Urology (M Castellan and R Gosalbez, Section Editors)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Congenital hydronephrosis is one of the most common anomalies identified on antenatal ultrasound. The underlying etiology of congenital hydronephrosis is multifold, ranging from transient hydronephrosis in utero to clinically significant congenital anomalies of the kidney and urinary tract. While traditional management of hydronephrosis was aimed at relieving symptoms, the advent of routine prenatal ultrasound has led to a shift in the goal of treatment to prevention of renal injury in the asymptomatic patient. However, despite this focus on renal preservation, the diagnostic criteria for identification of children “at risk” for renal damage that can be alleviated by surgical treatment remain a subject of debate. Both antenatal and postnatal imaging studies have been evaluated as indicators for potential reversible renal damage and have been used as potential indicators of the need for surgical intervention. The aim of this review is to discuss the current literature regarding the role of postnatal clinical and radiographic evaluation to identify children who may benefit from early surgical intervention.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Sutherland R, Chung S, Roth D, Gonzales E. Pediatric pyeloplasty: outcome analysis based on patient age and surgical technique. Urology. 1997;50:963–6.

    Article  CAS  PubMed  Google Scholar 

  2. Woodward M, Frank D. Postnatal management of antenatal hydronephrosis. BJU Int. 2002;89:149–56.

    Article  CAS  PubMed  Google Scholar 

  3. Adra A, Mejides A, Dennaoui M, Beydoun S. Fetal pyelectasis: is it always “physiologic”? Am J Obstet Gynecol. 1995;173:1263–6.

    Article  CAS  PubMed  Google Scholar 

  4. Ismaili K, Hall M, Donner C, Thomas D, Vermeylen D, Avni F. Results of systematic screening for minor degress of fetal renal pelvis dilatation in an unselected population. Am J Obstet Gynecol. 2003;188:242–6. This article is a prospective cohort study that established the AP diameter cut off of 7 mm as a predictor of post-natal pathology.

    Article  PubMed  Google Scholar 

  5. Lee R, Cendron M, Kinnamon D, Nguyen H. Antenatal hydronephrosis as a predictor of postnatal outcome: a meta-analysis. Pediatrics. 2006;118:586–93. This meta-analysis of antenatal hydronephrosis and postnatal pathology established the relative risk of vesicoureteral reflux, ureteropelvic junction obstruction, and other postnatal diagnoses based on degree of antenatal dilation.

  6. Ismaili K, Avni F, Piepsz A, Wissing K, Cochat P, Aubert D, et al. Current management of infants with fetal renal pelvis dilation: a survey by French-speaking pediatric nephrologists and urologists. Pediatr Nephrol. 2004;19:966–71.

    Article  PubMed  Google Scholar 

  7. Sidhu G, Beyene J, Rosenblum N. Outcome of isolated antenatal hydronephrosis: a sytematic review and meta-analysis. Pediatr Nephrol. 2006;21:218–24.

    Article  PubMed  Google Scholar 

  8. Nguyen HT, Herndon CD, Cooper C, Gatti J, Kirsch A, Kokorowski P, et al. The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol. 2010;6(3):212–31.

    Article  PubMed  Google Scholar 

  9. Ciardelli V, Rizzo N, Farina A, Vitarelli M, Boni P, Bovicelli L. Prenatal evaluation of fetal renal function based on serum beta(2)-microglobulin assessment. Prenat Diagn. 2001;21(7):586–8.

    Article  CAS  PubMed  Google Scholar 

  10. Bokenkamp A, Dieterich C, Dressler F, Muhlhaus K, Gembruch U, Bald R. Kirschstein. Fetal serum concentrations of cystatin C and beta2-microglobulin as predictors of postnatal kidney function. Am J Obstet Gynecol. 2001;185(2):468–75.

    Article  CAS  PubMed  Google Scholar 

  11. Morin LCM, Crombleholme TM, Garmel SH, Klauber GT, D'alton ME. Minimal hydronephrosis in the fetus: clinical significance and implications for I. J Urol. 1996;155:2047–9.

    Article  CAS  PubMed  Google Scholar 

  12. Signorelli M, Cerri V, Taddei F, Groli C, Bianchi UA. Prenatal diagnosis and management of mild fetal pyelectasis: implications for neonatal outcome and follow-up. Eur J Obstet Gynecol Reprod Biol. 2005;118(2):154–9.

    Article  PubMed  Google Scholar 

  13. Wiener J, O'hara S. Optimal timing of initial postnatal ultrasonography in newborns with prenatal hydronephrosis. J Urol. 2002;168:1826–9.

    Article  PubMed  Google Scholar 

  14. Docimo S, Silver R. Renal ultrasonography in newborns with prenatally detected hydronephrosis: why wait? J Urol. 1997;157:1387–9.

    Article  CAS  PubMed  Google Scholar 

  15. Hafez AT, McLorie G, Bagli D, Khoury A. Analysis of trends on serial ultrasound for high grade neonatal hydronephrosis. J Urol. 2002;168(4 pt 1):1518–21.

    Article  PubMed  Google Scholar 

  16. Keays MA, Guerra LA, Mihill J, Raju G, Al-Asheeri N, Geier P, et al. Reliability assessment of Society for Fetal Urology ultrasound grading system for hydronephrosis. J Urol. 2008;180(4 Suppl):1680–2.

    Article  CAS  PubMed  Google Scholar 

  17. Belarmino J, Kogan B. Management of neonatal hydronephrosis. Early Hum Dev. 2006;82:9–14.

    Article  PubMed  Google Scholar 

  18. Srivastava T, Betts G, Rosenberg A, Kainer G. Perception of fear, distress, and pain by parents of children undergoing a micturating cystourethrogram: a prospective studey. J Paediatr Child Health. 2001;37:271–3.

    Article  CAS  PubMed  Google Scholar 

  19. Riccabona M. Assement and management of newborn hydronephrosis. World J Urol. 2004;22:73–8.

    PubMed  Google Scholar 

  20. Yerkes E, Adams M, Pope J, Brock J. Does every patient with hydronephrosis need voiding cystourethrography? J Urol. 1999;162:1218–20.

    Article  CAS  PubMed  Google Scholar 

  21. Ismaili KAF, Hall M. Results of systematic voiding cystourethrography in infants with antenatally diagnosed renal pelvis dilation. J Pediatr. 2002;141:21–4.

    Article  PubMed  Google Scholar 

  22. Vemulakonda VM, Chiang G, Corbett ST. Variability in use of voiding cystourethrogram during initial evaluation of infants with congenital hydronephrosis. Urology. 2014;83(5):1135–8.

  23. Ransley PGDH, Gordon I, Duffy PG, Dillon MJ, Barratt TM. The postnatal management of hydronehrosis diagnosed by prenatal ultrasound. J Urol. 1990;144:584–7.

    CAS  PubMed  Google Scholar 

  24. Muller-Suur R, Tyden O. Evaluation of hydronephrosis in pregnancy using ultrasound and renography. Scand J Urol Nephrol. 1985;19(4):267–73.

    Article  CAS  PubMed  Google Scholar 

  25. Kass EJ, Fink-Bennet D. Contemporary techniques for the radioisotopic evaluation of the dilated urinary tract. Urol Clin North Am. 1990;17(2):273–89.

    CAS  PubMed  Google Scholar 

  26. Eskild-Jenson A, Gordon I, Piepsz A, Frokler J. Congenital unilateral hydronephrosis: a review of the impact of diuretic renography on clinical treatment. J Urol. 2005;173:1471–6.

    Article  Google Scholar 

  27. Karnak I, Woo LL, Shah SN, Sirajuddin A, Ross JH. Results of a practical protocol for management of prenatally detected hydronephrosis due to ureteropelvic junction obstruction. Pediatr Surg Int. 2009;25(1):61–7.

    Article  PubMed  Google Scholar 

  28. Gordon I. Diuretic renography in infants with prenatal unilateral hydronephrosis: an explanation for the controversy about poor drainage. BJU Int. 2001;87:551–5.

    Article  CAS  PubMed  Google Scholar 

  29. Eskild-Jensen A, Gordon I, Piepsz A, Frokiaer J. Interpretation of the renogram: problems and pitfalls in hydronephrosis in children. BJU Int. 2004;94(6):887–92.

    Article  PubMed  Google Scholar 

  30. Koff SA. Postnatal management of antenatal hydronephrosis using an observational approach. Urology. 2000;55(5):609–11.

    Article  CAS  PubMed  Google Scholar 

  31. Dhillon H. Prenatally diagnosed hydronephrosis: the Great Ormond Street experience. Br J Urol. 1998;81:39–44.

    Article  PubMed  Google Scholar 

  32. Ulman I, Jayanthi V, Koff S. The long-term followup of newborns with severe unilateral hydronephrosis initially treated nonoperatively. J Urol. 2000;164:1101. This prospective cohort study better defined the association between initial imaging and risk of renal deterioration in infants with severe hydronephrosis.

    Article  CAS  PubMed  Google Scholar 

  33. Castagnetti M, Novara G, Beniamin F, Vezzu B, Rigamonti W, Artibani W. Scintigraphic renal function after unilateral pyeloplasty in children: a systematic review. BJU Int. 2008;102(7):862–8.

    Article  PubMed  Google Scholar 

  34. McAleer IM, Kaplan GW. Renal function before and after pyeloplasty: does it improve? J Urol. 1999;162(3 pt 2):1041–4.

    CAS  PubMed  Google Scholar 

  35. Eskild-Jensen A, Munch Jorgensen T, Olsen LH, Djurhuus JC, Frokiaer J. Renal function may not be restored when using decreasing differential function as the criterion for surgery in unilateral hydronephrosis. BJU Int. 2003;92(7):779–82.

    Article  CAS  PubMed  Google Scholar 

  36. Sharma G, Sharma A, Maheshwari P. Predictive value of decreased renal pelvis anteroposterior diameter in prone position for prenatally detected hydronephrosis. J Urol. 2012;187(5):1839–43.

    Article  PubMed  Google Scholar 

  37. Thorup J, Jokela R, Cortes D, Nielsen OH. The results of 15 years of consistent strategy in treating antenatally suspected pelvi-ureteric junction obstruction. BJU Int. 2003;91(9):850–2.

    Article  CAS  PubMed  Google Scholar 

  38. Vasconcelos MA, Bouzada MC, Silveira KD, Moura LR, Santos FF, Oliveira JM, et al. Urinary levels of TGF β-1 and of cytokines in patients with prenatally detected nephrouropathies. Pediatr Nephrol. 2011;26(5):739–47.

    Article  PubMed  Google Scholar 

  39. Madsen MG, Norregaard R, Frokiaer J, Jorgensen TM. Urinary biomarkers in prenatally diagnosed unilateral hydronephrosis. J Pediatr Urol. 2011;7:105–12.

    Article  PubMed  Google Scholar 

  40. Furness III PD, Maizels M, Han SW, Cohn RA, Cheng EY. Elevated bladder urine concentration of transforming growth factor-beta1 correlates with upper urinary tract obstruction in children. J Urol. 1999;162(3 pt 2):1033–6.

    Article  PubMed  Google Scholar 

  41. Madsen MG, Norregaard R, Palmfeldt J, Olsen LH, Frokiaer J, Jorgensen TM. Epidermal growth factor and monocyte chemotactic peptide-1: potential biomarkers of urinary tract obstruction in children with hydronephrosis. J Pediatr Urol. 2013;9(6 pt A):838–45.

    Article  PubMed  Google Scholar 

  42. Taranta-Janusz K, Wasilewska A, Debek W, Waszkeiwicz-Stojda M. Urinary cytokine profiles in unilateral congenital hydronephrosis. Pediatr Nephrol. 2012;27:2107–13.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Madsen MG, Norregaard R, Palmfeldt J, Olsen LH, Frokiaer J, Jorgensen TM. Urinary NGAL, cystatin C, β2-microglobulin, and osteopontin significance in hydronephrotic children. Pediatr Nephrol. 2012;27(11):2099–106.

    Article  PubMed  Google Scholar 

  44. Cost NG, Noh PH, Devarajan P, Ivancic V, Reddy PP, Minevich E, et al. Urinary NGAL levels correlate with differential renal function in patients with ureteropelvic junction obstruction undergoing pyeloplasty. J Urol. 2013;190(4 Suppl):1462–7.

    Article  CAS  PubMed  Google Scholar 

  45. Passerotti CC, Kalish LA, Chow J, Passerotti AM, Recabal P, Cendron M, et al. The predictive value of the first postnatal ultrasound in children with antenatal hydronephrosis. J Pediatr Urol. 2011;7(2):128–36.

    Article  PubMed  Google Scholar 

  46. Barbosa JA, Chow JS, Benson CB, Yorioka MA, Bull AS, Retik AB, et al. Postnatal longitudinal evaluation of children diagnosed with prenatal hydronephrosis: insights in natural history and referral pattern. Prenat Diagn. 2012;32(13):1242–9.

    Article  PubMed  Google Scholar 

  47. Matsui F, Shimada K, Matsumoto F, Takano S. Late recurrence of symptomatic hydronephrosis in patients with prenatally detected hydronephrosis and spontaneous improvement. J Urol. 2008;180:322.

    Article  PubMed  Google Scholar 

  48. Koff SA, Campbell K. Nonoperative management of unilateral neonatal hydronephrosis. J Urol. 1992;148:525.

    CAS  PubMed  Google Scholar 

  49. Chertin B, Pollack A, Koulikov D, Rabinowitz R, Hain D, Hadas-Halpren I, et al. Conservative treatment of ureteropelvic junction obstruction in children with antenatal diagnosis of hydronephrosis: lessons learned after 16 years of follow-up. Eur Urol. 2006;49(4):734–8.

    Article  PubMed  Google Scholar 

  50. Koff S, Campbell K. The nonoperative management of unilateral neonatal hydronephrosis: natural history of poorly functioning kidneys. J Urol. 1994;152:593–5.

    CAS  PubMed  Google Scholar 

  51. Molina CA, Facincani I, Muglia VF, Araujo WM, Cassini MF, Tucci Jr S. Postnatal evaluation of intrauterine hydronephrosis due to ureteropelvic junction obstruction. Acta Cir Bras. 2013;28 Suppl 1:33–6.

    Article  PubMed  Google Scholar 

  52. Bajpai M, Chandrasekharam VV. Nonoperative management of neonatal moderate to severe bilateral hydronephrosis. J Urol. 2002;167(2 pt 1):662–5.

    Article  PubMed  Google Scholar 

  53. Hubertus J, Plieninger S, Martinovic V, Heinrich M, Schuster T, Burst M, et al. Children and adolescents with ureteropelvic junction obstruction: is an additional voiding cystoureterogram necessary/ Results of a multicenter study. World J Urol. 2013;3193:683–7.

    Article  Google Scholar 

  54. Wheeler DM, Vimalachandra D, Hodson EM, Roy LP, Smith GH, Craig JC. Interventions for primary vesicoureteral reflux. Cochrane Database Syst Rev 2004. This meta-analysis questioned the role of antibiotic prophylaxis and surgery in preventing renal scarring in children with vesicoureteral reflux and established the number needed to treat to prevent one febrile UTI in this population.

  55. de Bruyn R, Marks SD. Postnatal investigation of fetal renal disease. Semin Fetal Neonatal Med. 2008;13:133–41.

    Article  PubMed  Google Scholar 

  56. Onen A, Jayanthi VR, Koff SA. Long-term follow up of prenatally detected severe bilateral newborn hydronephrosis initially managed nonoperatively. J Urol. 2002;168(3):1118–20.

    Article  CAS  PubMed  Google Scholar 

  57. Braga LH, Mijovic H, Farrokhyar F, Pemberton J, Demaria J, Lorenzo AJ. Antibiotic prophylaxis for urinary tract infections in antenatal hydronephrosis. Pediatrics. 2013;131(1):251–61.

    Article  Google Scholar 

  58. Alconcher L, Tombesi M. Mild antenatal hydronephrosis: management controversies. Pediatr Nephrol. 2004;19:819.

    Article  PubMed  Google Scholar 

  59. Roth CC, Hubanks JM, Bright BC, Heinlen JE, Donovan BO, Kropp BP, et al. Occurrence of urinary tract infection in children with significant upper tract obstruction. Urology. 2009;73(1):74–8.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Dr. Vijaya Vemulakonda, Dr. Jenny Yiee, and Dr. Duncan T. Wilcox declare that they have no conflicts of interest to report.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Vijaya Vemulakonda.

Additional information

This article is part of theTopical Collection on Pediatric Urology

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vemulakonda, V., Yiee, J. & Wilcox, D.T. Prenatal Hydronephrosis: Postnatal Evaluation and Management. Curr Urol Rep 15, 430 (2014). https://doi.org/10.1007/s11934-014-0430-5

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11934-014-0430-5

Keywords

Navigation