Management of antenatal hydronephrosis
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EDUCATIONAL REVIEW
Management of antenatal hydronephrosis Fatoş Yalçınkaya 1,2
&
Z. Birsin Özçakar 1
Received: 27 February 2019 / Revised: 4 November 2019 / Accepted: 8 November 2019 # IPNA 2019
Abstract Antenatal hydronephrosis (AHN) is the most frequently detected abnormality by prenatal ultrasonography. Differential diagnosis of AHN includes a wide variety of congenital abnormalities of the kidney and urinary tract ranging from mild abnormalities such as transient or isolated AHN to more important ones as high-grade congenital vesicoureteral reflux or ureteropelvic junction obstruction. It is well known that the outcome depends on the underlying etiology. Various grading systems have been proposed for the classification of AHN on prenatal and postnatal ultrasonography. Mild isolated AHN represents up to 80% of cases, is considered to be benign, and majority of them resolve, stabilize, or improve during follow-up. Controversies exist regarding the diagnosis and management of some important and severe causes of AHN such as high-grade vesicoureteral reflux and ureteropelvic junction obstruction. Current approach is becoming increasingly conservative during diagnosis and follow-up of these patients with less imaging and close follow-up. However, there is still no consensus regarding the clinical significance, postnatal evaluation, and management of infants with AHN. The aim of this review is to discuss the controversies and provide an overview on the management of AHN. Keywords Antenatal hydronephrosis . Ultrasonography . Ureteropelvic junction obstruction . Urinary tract infection . Vesicoureteral reflux
Introduction Antenatal hydronephrosis (AHN), defined as dilation of renal pelvis and/or calyces, is the most frequently detected abnormality by prenatal ultrasonography (US) occurring in 0.5–1% of all pregnancies [1]. Although it is generally postulated as a marker of congenital abnormalities of the kidney and urinary tract (CAKUT), a specific disorder could not be identified in pretty good number of patients. However, it is well known that the outcome depends on the underlying etiology (Table 1), and CAKUT includes a spectrum of malformations that can occur at the level of the kidney, ureters, bladder, and/or urethra. On the other hand, more than half the cases of AHN resolve spontaneously by the end of gestation or during the first year of life [2]. Accordingly, differential diagnosis includes a wide variety of
* Fatoş Yalçınkaya [email protected]
CAKUT ranging from mild abnormalities such as transient or isolated AHN to more important ones as high grade congenital vesicoureteral reflux (VUR) or ureteropelvic junction obstruction (UPJO). The underlying cause may also be a severe lower urinary tract obstruction (LUTO) such as posterior urethral valves (PUV) or prune-belly syndrome (PBS), requiring early diagnosis and urgent treatment. Despite the continuous advances in the understanding of the genetic basis and outcomes of CAKUT, there is still no consensus regarding the clinical significance,
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