Outcomes of Children with Antenatal Hydronephrosis Admıtted to Our Polyclinic; The Significance of Pathological Hydronephrosis and Impact of Severe Antenatal Hydronephrosis on Prognosis

Abstract

Antenatal hydronephrosis is the most common renal abnormalities detected during pregnancyand the extensive use of ultrasonography during pregnancy has resulted in a greater detectionrate for antenatal hydronephrosis. The objective of our study is to investigate etiology of patientsthat were diagnosed antenatal hydronephrosis, to emphasize the significance of pathologicalhydronephrosis, to investigate the relationship between hydronephrosis scores and urinarysystem anomalies and contribute to the literature. Patients, admitted to pediatric nephrologypolyclinic between October 2008 and February 2013, were investigated retrospectively; 85patients and 124 kidneys were taken into study. The majority of patients were boys. 36.5% ofthe patients were first diagnosed on 2nd trimester, and 63.5 % were first diagnosed on the 3rdtrimester. 73.9% of the patients had antenatal hydronephrosis on their left kidney. Urinaryinfection rate in all the patients was 18.8%, and it was significantly high in patients withpathologic hydronephrosis. Detection of pathologic hydronephrosis by ultrasonography wassignificantly higher in patients with severe hydronephrosis. During their follow-up 12.9% ofthe patients underwent surgery. Surgery rate was significantly higher in patients with pathologichydronephrosis. The majority of patients with antenatal hydronephrosis are found to have nonpathological hydronephrosis in their follow-up. Diagnosing severe and pathologichydronephrosis is important for follow-up and treatment strategies

Keywords

• antenatal hydronephrosis,prenatal diagnosis,hydronephrosis follow-up

POLİKLİNİĞİMİZE BAŞVURAN ANTENATAL HİDRONEFROZ TANILI ÇOCUKLARIN TAKİP SONUÇLARI; PATOLOJİK HİDRONEFROZUN ÖNEMİ VE AĞIR DERECE ANTENATAL HİDRONEFROZUN PROGNOZA ETKİSİ

Abstract

Antenatal hidronefroz en sık belirlenen genitoüriner sistem anomalisidir ve tanı sıklığıultrasonografinin yaygın kullanımı sonrası artmıştır. Bu çalışmada amacımız antenatalhidronefroz tanısı alan hastalarda etiyolojik nedenleri ortaya koymak, patolojik hidronefrozunönemini vurgulamak, hidronefroz dereceleri ile üriner sistem anomalileri arasındaki ilişkiyiirdelemek ve literatüre katkıda bulunmaktır. Ekim 2008 ve Şubat 2013 tarihleri arasında çocuknefroloji polikliniğine başvuran 85 hasta ve 124 böbrek geriye yönelik değerlendirildi.Hastaların; çoğu erkekti,%36,5’i 2. trimesterde, %63,5’i 3. trimesterde tanı almıştı. Hastaların%73,9’nda sol böbrekte antenatal hidronefroz mevcuttu. Tüm hastalarda idrar yolu enfeksiyonugeçirme oranı %18,8 olarak saptandı, patolojik hidronefrozlu hastalarda anlamlı derecede yükseksaptandı. Yapılan USG'lerde ağır derecede hidronefroz saptanan hastalarda patolojik hidronefrozsaptanma oranı anlamlı olarak yüksekti. Takip süresi boyunca hastaların %12,9’u operasyongeçirdi. Patolojik hidronefrozlu hastalarda operasyon geçirme oranı anlamlı derecede yükseksaptandı. Antenatal hidronefroz tanılı hastaların takipleri sonucunda büyük çoğunluğu patolojikolmayan hidronefroz tespit edilmektedir. Ağır derece ve patolojik hidronefrozların saptanmasıtakip ve tedavi açısından önemlidir

Keywords

• antenatal hidronefroz,prenatal tanı,hidronefroz takibi

References

1. Fatih Yanaral ZT. Antenatal Hydronephrosis. Review, Clinic of Urology, Taksim Training and Research Hospital, Istanbul, Turkey. 2013;3:60-5.
2. Nguyen HT, Herndon CA, 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. Journal of Pediatric Urology. 2010;6(3):212- 31.
3. González R, Schimke CM. Urteropelvıc Junctıon Obstructıon in Infants and Children. Pediatric Clinics of North America. 2001;48(6):1505-18.
4. Robyr R, Benachi A, Daikha-Dahmane F, Martinovich J, Dumez Y, Ville Y. Correlation Between Ultrasound and Anatomical Findings in Fetuses with Lower Urinary Tract Obstruction in the First Half of Pregnancy. Ultrasound in Obstetrics & Gynecology. 2005;25(5):478-82.
5. Fefer S, Ellsworth P. Prenatal hydronephrosis. Pediatric Clinics of North America. 2006;53(3):429-47.
6. Woodward M, Frank D. Postnatal Management of Antenatal Hydronephrosis. BJU International. 2002;89(2):149-56.
7. Yavascan O, Aksu N, Anil M, Kara OD, Aydin Y, Kangin M, et al. Postnatal Assessment of Growth, Nutrition, and Urinary Tract Infections of Infants with Antenatally Detected Hydronephrosis. International Urology and Nephrology. 2010;42(3):781-8.
8. Fernbach S, Maizels M, Conway J. Ultrasound Grading of Hydronephrosis: Introduction to the System Used by the Society for Fetal Urology. Pediatric Radiology. 1993;23(6):478-80.

9. Lee RS, Cendron M, Kinnamon DD, Nguyen HT. Antenatal Hydronephrosis as a Predictor of Postnatal Outcome: A Meta- Analysis. Pediatrics. 2006;118(2):586-93.
10. Ek S, Lidefeldt K-J, Varricio L. Fetal Hydronephrosis; Prevalence, Natural History and Postnatal Consequences in an Unselected Population. Acta Obstetricia et Gynecologica Scandinavica. 2007;86(12):1463-6.
11. Becker A, Baum M. Obstructive Uropathy. Early Human Development. 2006;82(1):15-22.
12. Grazioli S, Parvex P, Merlini L, Combescure C, Girardin E. Antenatal and Postnatal Ultrasound in the Evaluation of the Risk of Vesicoureteral Reflux. Pediatric Nephrology. 2010;25(9):1687-92.
13. Quirino IG, Diniz JSS, Bouzada MCF, Pereira AK, Lopes TJ, Paixão GM, et al. Clinical Course of 822 Children with Prenatally Detected Nephrouropathies. Clinical Journal of the American Society of Nephrology. 2012;7(3):444-51.
14. De Kort E, Bambang Oetomo S, Zegers S. The Long-Term Outcome of Antenatal Hydronephrosis up to 15 Millimetres Justifies A Noninvasive Postnatal Follow-Up. Acta pædiatrica. 2008;97(6):708-13.
15. Aksu N, Yavaşcan Ö, Kangın M, Kara OD, Aydın Y, Erdoğan H, et al. Postnatal Management of Infants with Antenatally Detected 2005;20(9):1253-9. Pediatric Nephrology.
16. Mallik M, Watson AR. Antenatally Detected Urinary Tract Abnormalities: More Detection But Less Action. Pediatric Nephrology. 2008;23(6):897-904.
17. Ismaili K, Hall M, Donner C, Thomas D, Vermeylen D, Avni FE. Results Of Systematic Screening For Minor Degrees of Fetal Renal Pelvis Dilatation in an Unselected Population. American Journal of Obstetrics and Gynecology. 2003;188(1):242-6.
18. Rickard M, Easterbrook B, Kim S, Farrokhyar F, Stein N, Arora S, et al. Six of One, Half a Dozen of the Other: A Measure of Multidisciplinary Inter/intra-rater Reliability of the Society for Fetal Urology and Urinary Tract Dilation Grading Systems for Hydronephrosis. Journal of Pediatric Urology. 2016.
19. Walsh TJ, Hsieh S, Grady R, Mueller BA. Antenatal Hydronephrosis and The Risk of Pyelonephritis Hospitalization During the First Year of Life. Urology. 2007;69(5):970-4.
20. Coelho GM, Bouzada MCF, Lemos GS, Pereira AK, Lima BP, Oliveira EA. Risk Factors for Urinary Tract Infection in Children with Prenatal Renal Pelvic Dilatation. The Journal of Urology. 2008;179(1):284-9.
21. Sidhu G, Beyene J, Rosenblum ND. Outcome of Isolated Antenatal Hydronephrosis: a Systematic Review and Meta- analysis. Pediatric Nephrology. 2006;21(2):218-24.
22. Psooy K, Pike J. Investigation and Management of Antenatally Detected hydronephrosis. Canadian Urological Association Journal. 2009;3(1):69.
23. Szymanski KM, Al-Said AN, Salle JLP, Capolicchio J-P. Do Infants with Mild Prenatal Hydronephrosis Benefit From Screening for Vesicoureteral Reflux? The Journal of Urology. 2012;188(2):576-81.
24. Peters CA, Skoog SJ, Arant BS, Copp HL, Elder JS, Hudson RG, et al. Summary of the AUA Guideline on Management of Primary Vesicoureteral Reflux in Children. The Journal of Urology. 2010;184(3):1134-44.
25. Longpre M, Nguan A, MacNeily AE, Afshar K. Prediction of the Outcome of Antenatally Diagnosed Hydronephrosis: A Multivariable Analysis. Journal of Pediatric Urology. 2012;8(2):135-9.
26. Passerotti CC, Kalish LA, Chow J, Passerotti AMA, Recabal P, Cendron M, et al. The Predictive Value of the First Postnatal Ultrasound in Children with Antenatal Hydronephrosis. Journal of Pediatric Urology. 2011;7(2):128-36.
27. Ismaili K, Avni FE, Hall M, Group BFUPNS. Results of Systematic Voiding Cystourethrography in Infants with Antenatally Diagnosed Renal Pelvis Dilation. The Journal of Pediatrics. 2002;141(1):21-4.
28. Sairam S, Al-Habib A, Sasson S, Thilaganathan B. Natural History of Fetal Hydronephrosis Diagnosed on Mid-trimester Ultrasound. Ultrasound in Obstetrics and Gynecelogy. 2001;17(3):191-6
29. Becker AM. Postnatal Evaluation of Infants with an Abnormal Antenatal Renal Sonogram. Current Opinion in Pediatrics. 2009;21(2):207-13.
30. Estrada Jr CR. Prenatal Hydronephrosis: Early Evaluation. Current Opinion in Urology. 2008;18(4):401-3.
31. Tibballs J, De Bruyn R. Primary Vesicoureteric Reflux--How Useful is Postnatal Ultrasound? Archives of Disease in Childhood. 1996;75(5):444-7.
32. Nerli R, Amarkhed S, Ravish I. Voiding Cystourethrogram in the Diagnosis of Vesicoureteric Reflux in Children with Antenatally Diagnosed Hydronephrosis. Therapeutics and Clinical Risk Management. 2009;5:35-9.
33. Gordon I, Piepsz A, Sixt R. Guidelines for Standard and Diuretic Renogram in Children. European Journal of Nuclear Medicine and Molecular Imaging. 2011;38(6):1175-88.
34. 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. European Urology. 2006;49(4):734-9.
35. Gugliota A, Reis L, Alpendre C, Ikari O, Ferreira U. Postnatally hydronephrosis (HN) in Children with Antenatally Diagnosed Hydronephrosis: Surgery or Medical Treatment?. Actas Urologicas Espanolas. 2007;32(10):1031-4.
36. Thorup J, Jokela R, Cortes D, Nielsen O. The Results of 15 Years of Consistent Strategy in Treating Antenatally Suspected Pelviureteric Junction Obstruction. BJU International. 2003;91(9):850-2.