Abstract
Between 1987 and 1991, 160 hydronephrotic kidneys were diagnosed prenatally and confirmed postnatally in 100 infants. The aim of the study was to describe the natural history and management of primary hydronephrosis detected prenatally. We devised a new classification of obstructive uropathy outcome using ultrasonography and the diethylenetriamine penta-acetic acid scan. Accordingly, we classified the patients as having mild, moderate or severe hydronephrosis. Nine patients had pyeloplasties and 5 had ureteric reimplantations. We conclude that in most cases there is no need for immediate surgery, and that the initial approach to the management of congenital hydronephrosis should be conservative. We suggest that anti-bacterial prophylaxis be conventionally given to infants with vesicoureteral reflux and for the first 6 months of life to infants demonstrating moderate to severe newborn primary hydronephrosis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Thomas DFM (1990) Fetal uropathy. Br J Urol 66:225–231
Thomas DFM, Gordon AC (1989) Management of prenatally diagnosed uropathies. Arch Dis Child 64: 58–63
Elder JS, Ducket JW, Snyder HM (1987) Intervention for fetal obstructive uropathy: has it been effective? Lancet II: 1007–1010
Jeanty P, Romero R (1984) Obstetrical ultrasound. McGraw Hill, New York, p 143
Kleiner B, Callen PW, Filly RA (1987) Sonographic analysis of the fetus with ureteropelvic junction obstruction. Am J Radiol 148: 359–363
Potter EL (1972) Normal and abnormal development of the kidney. Yearbook Medical, Chicago, pp 209–221
Wasnick RJ, Hanna MK, Cartwright PC, Snyder HM, Duckett JW, Koff SA, Froemming C, Gonzalez R, Ehrlich RM (1991) Neonatal UPJ obstruction: current controversies. Dial Pediatr Urol 14: 1–6
Dowling KJ, Harmon EP, Ortenberg J, Polanco E, Evans BB (1988) Ureteropelvic junction obstruction: the effect of pyeloplasty on renal function. J Urol 140: 1227–1230
Hoddic WK, Filly RA, Mahony BS, Callen PW (1985) Minimal fetal renal pyelectasis. J Ultrasound Med 4: 85–89
Homsy YL, Saad F, Laberge I, Williot P, Pison C (1990) Transitional hydronephrosis of the newborn and infant. J Urol 144: 579–583
Ransley PG, Dhillon HK, Gordon I, Duffy PG, Dillon MJ, Barratt TM (1990) The postnatal management of hydronephrosis diagnosed by prenatal ultrasound. J Urol 144: 584–587
Gordon I, Dhillon HK, Peters AM (1991) Antenatal diagnosis of renal pelvic dilatation — the natural history of conservative management. Pediatr Radiol 21: 272–273
Koff SA, Campbell K (1992) Nonoperative management of unilateral neonatal hydronephrosis. J Urol 148: 525–531
Maizels M, Reisman ME, Flom LS, Nelson J, Fernbach S, Firlit CF, Conway JJ (1992) Grading nephroureteral dilatation detected in the first year of life: correlation with obstruction. J Urol 148: 609–614
Dejer SW Jr, Gibbons MD (1989) The fate of the infant kidneys with fetal hydronephrosis but initially normal postnatal sonography. J Urol 142: 661–662
Claesson G, Josephson S, Robertson B (1986) Experimental partial ureteric obstruction in newborn rat. Are the long term effects on renal morphology avoided by release of the obstruction? J Urol 136: 1330–1334
Laing FC, Burke VD, Wing VW, Jeffrey RB, Hashimoto B (1984) Postpartum evaluation of fetal hydronephrosis: optimal timing for follow-up sonography. Radiology 152: 423–424
Tsai TC, Lee HC, Huang FY (1989) The size of the renal pelvis on ultrasonography in children. J Clin Ultrasound 17: 647–651
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Blachar, A., Blachar, Y., Livne, P.M. et al. Clinical outcome and follow-up of prenatal hydronephrosis. Pediatr Nephrol 8, 30–35 (1994). https://doi.org/10.1007/BF00868254
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00868254