Epidemiological and clinical characteristics, management, and outcomes of antenatal hydronephrosis: a single-center experience of 229 cases

Year 2023, Volume: 40 Issue: 1, 113 - 115, 18.03.2023

Mesut Önal , Hülya Gözde Önal

Abstract

The advances in utilization of USG in antenatal routine follow-up resulted with increased diagnosis of antenatal hydronephrosis (ANH). This study was conducted to elaborate the epidemiological and clinical characteristics, management, outcomes, and possible risk factors of the ANH. A total of 229 cases diagnosed with ANH during the antenatal follow-up at the Obstetrics and Gynecology Department of OndokuzMayis University between 2004 and 2022 were included. The ANH was defined as an USG finding suggesting a hydronephrosis  7 mm. The epidemiological and clinical characteristics, risk factors, treatment and outcomes in the postnatal period were assessed retrospectively. About 75% of the cases were male, 8% were premature births, and the mean gestational week of diagnosis was 22±3 weeks. About 43.7% of mothers had urinary tract infections, and family history of a kidney disease was present in 24.5% of mothers’ and 20.5% of fathers’ family histories.38.7% of cases undergone surgery. At the end of 6-month follow-up, 37.3% had regressed and 38.7% of them had stable hydronephrosis, and 18.9% of them had normal findings in USG. Male gender, increased gestational urinary tract infections, and family histories of parents for a kidney disease were found as possible risk factors for development of ANH. Close follow-up and timely intervention including surgery provides favorable outcomes in these cases.

Keywords

Antenatal hydronephrosis, antenatal ultrasonography, ANH epidemiology, risk factors, ANH surgery, ANH outcomes

References

• 1. Liu DB, Armstrong WR 3rd, Maizels M. Hydronephrosis: prenatal and postnatal evaluation and management. Clin Perinatol. 2014 Sep;41(3):661-78.
• 2. Corteville JE, Gray DL, Crane JP. Congenital hydronephrosis: correlation of fetal ultrasonographic findings with infant outcome. Am J Obstet Gynecol. 1991 Aug;165(2):384-8.
• 3. Tonni G, Vito I, Ventura A, Grisolia G, De Felice C. Fetal lower urinary tract obstruction and its management. Arch Gynecol Obstet. 2013 Feb;287(2):187-94.
• 4. Kim SY, Kim MJ, Yoon CS, Lee MS, Han KH, Lee MJ. Comparison of the reliability of two hydronephrosis grading systems: the Society for Foetal Urology grading system vs. the Onen grading system. Clin Radiol. 2013 Sep;68(9):e484-90.
• 5. Choi YH, Cheon JE, Kim WS, Kim IO. Ultrasonography of hydronephrosis in the newborn: a practical review. Ultrasonography. 2016 Jul;35(3):198-211.
• 6. Sinha A, Bagga A, Krishna A, Bajpai M, Srinivas M, Uppal R, et al. Revised guidelines on management of antenatal hydronephrosis. Indian J Nephrol. 2013 Mar;23(2):83-97.
• 7. Liu Y, Shi H, Yu X, Xiang T, Fang Y, Xie X, et al. Risk Factors Associated With Renal and Urinary Tract Anomalies Delineated by an Ultrasound Screening Program in Infants. Front Pediatr. 2022 Jan 24;9:728548.
• 8. Woodward M, Frank D. Postnatal management of antenatal hydronephrosis. BJU Int. 2002 Jan;89(2):149-56.
• 9. Silay MS, Undre S, Nambiar AK, Dogan HS, Kocvara R, Nijman RJM, et al. Role of antibiotic prophylaxis in antenatal hydronephrosis: A systematic review from the European Association of Urology/European Society for Paediatric Urology Guidelines Panel. J Pediatr Urol. 2017 Jun;13(3):306-315.
• 10. Anderson NG, Fischer J, Leighton D, Hector-Taylor J, McEwing RL. Management in children of mild postnatal renal dilatation but without vesicoureteral reflux. Pediatr Nephrol. 2010 Mar;25(3):477-83.
• 11. Koff SA, Campbell KD. The nonoperative management of unilateral neonatal hydronephrosis: natural history of poorly functioning kidneys. J Urol. 1994 Aug;152(2 Pt 2):593-5.
• 12. Agras K. Diagnostic evaluation of infants with antenatal hydronephrosis. Turk J Urol. 2011;37 47-53.