Pediatric Urology, Marburg 1, North Wolfe St., Baltimore, MD This review will encompass the identification of antenatal hydronephrosis as. Department of Pediatric Nephrology. Ankara- Antenatal hydronephrosis is present if. APD ≥4 mm in . Sinha A. Indian Pediatrics Neonates with normal. Hydronephrosis. Antenatal hydronephrosis (ANH) is one of the most common abnormal findings Department of Pediatrics, CHA. Bundang.

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When and how to evaluate Initially? Pediatr Med Chir ; Long-term clinical outcome of infants with mild and moderate fetal pyelectasis: But can the diagnosis of obstruction be made based on the curve pattern in the presence of well preserved renal function, the answer is probably not.

Diuretic renography in hydronephrosis: Guidelines atenatal standard and diuretic renogram in children. Use of a ureteral pacemaker in the treatment of ureteral reflux. Primary vesicoureteric reflux–how useful is postnatal ultrasound?

Wang F S- Editor: At present, this seems to be the simplest way of differentiating a dilated but non obstructed system from a dilated and obstructed system.

Revised guidelines on management of antenatal hydronephrosis.

This constitutes the largest category of patients with prenatally detected hydronephrosis. WB Saunders Co; ; Prospective study of outcome in antenatally antenatl renal pelvis dilatation.

However these parameters have not found widespread acceptance. Studies have shown that urinary obstruction can cause renal dysplasia and relief of that obstruction can prevent dysplasia if performed early enough[ 22 ]. J Korean Med Sci. Prenatal diagnosis and treatment of obstructive uropathies. How long are postnatal studies warranted? Nonoperative management of unilateral neonatal hydronephrosis. Current management of antenatal hydronephrosis.

Whenever the sonography shows resolution of hydronephrosis a repeat ultrasonography at mo is warranted to hydroenphrosis the finding as recurrence is noted in previously resolved hydronephrosis[ 34 ]. However given the subjective nature of sonography and the factors like maternal hydration affecting the measurements, this issue has not been resolved as of today and hence clinicians should follow a standard classification and grade the dilatation as mild, moderate and severe as suggested in Table 2.


Postnatal management of antenatally detected hydronephrosis

A radionuclide study at 6 years, before stopping follow up, would be useful to confirm the good functional status of the kidney and establish a baseline value for further comparison in future. The important questions to be answered during follow up of these infants are: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers.

An alternative grading system to refine the criteria for severity of hydronephrosis and optimal treatment guidelines in neonates with primary UPJ-type hydronephrosis.

When the diagnosis of ANH is made indoan parents often have apprehension that the child will need surgery postnatally[ 25 ]. Impaired drainage on diuretic renography using half-time or pelvic excretion efficiency is not a sign of obstruction in children with a prenatal diagnosis of unilateral renal pelvic dilatation. When is it necessary to perform nuclear renogram in patients with a unilateral neonatal hydronephrosis?

The aim of evaluation by noninvasive and inexpensive modality like ultrasonography is to diagnose those patients at risk of deterioration of renal function, differentiate them from those who would do well in the long run and help in judiciously utilizing renogram to intervene at the optimum moment before antejatal function is affected.

These patients are on prophylactic antibiotics, hence to diagnose or rule out VUR, it would be prudent to wait till the neonate is old enough. Corresponding Hydrpnephrosis of This Article.

Prenatal diagnosis of urinary tract abnormalities by ultrasound. The exceptions to this caveat are: The issue which remains ambiguous at present and is the area of much study and research is how to differentiate a dilated but non obstructed system from a dilated and obstructed system.


Number of Hits and Downloads for This Article. Traditionally hydronephrosis was defined as dilatation of the pelvicalyceal system due to partial or complete obstruction. Once the diagnosis of a dilated collecting system is made, it should be objectively described using one of the various classification systems.

Urol Clin North Am ; The landmark study by Dhillon et al[ 58 ] inproposed the measurement of APD of the renal pelvis as a means of judging the severity of hydronephrosis and predicting the need for surgery.

Diuresis renography in equivocal urinary tract obstruction. Surgery versus observation for managing obstructive grade 3 to 4 unilateral hydronephrosis: But as those cases where the follow up is unlikely to be very rigorous and methodical as occurs in the low socio economic group especially in developing countries, advising prophylactic antibiotics would be a natural extension of the logic to make attempts to prevent renal damage.

Antenatal hydronephrosis current evaluation and management Mathews R – Indian J Urol

Short-term outcome of mild isolated antenatal hydronephrosis conservatively managed. The dilemma gains much significance as the clinician has to choose between conservative approach vs surgery.

This review was undertaken to discuss the issues in evaluation, diagnosis and management of neonates born with hydronephrosis diagnosed on prenatal ultrasound. This needs to be diagnosed as early as possible so that intervention can be done before renal damage occurs. Sibai et al[ 60 ] antenatsl sub classifying SFU grade 4 into Grade 4 A-with segmental cortical thinning and Grade 4 B-diffuse cortical thinning. Article-Type of This Article. USG Suspected lower jndian obstruction, e.

Postnatally hydronephrosis HN in children with antenatally diagnosed hydronephrosis: