Conversations for the future in the follow-up of antenatally diagnosed renal pelvicalyceal dilatation
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EDITORIAL COMMENTARY
Conversations for the future in the follow-up of antenatally diagnosed renal pelvicalyceal dilatation Aniruddh V. Deshpande 1,2,3 Received: 16 August 2020 / Accepted: 7 September 2020 # IPNA 2020
Introduction Antenatally detected renal pelvic dilatation and/or antenatally detected hydronephrosis is associated with a definite health burden [1]. This brief editorial, which is drafted in response to the study by Herthelius et al., looks at the results of the reported long-term follow-ups [2–5], compares between similar studies and discusses the direct and indirect future implications of such precious data on healthcare. The authors of this index study have reported a longterm follow-up of a cohort of children diagnosed with antenatal renal pelvic dilation[4]. The median/mean follow-up is 13.5 years approximately. Such data are indeed scarce and the study is a welcome addition. Whilst the study is rigorous and well designed, it is admittedly small and discordant with its handful of peers. In my view, this study generates a few significant, guiding conversations for the paediatric nephro-urological community with perhaps, a few sub-conversations within.
Conversation 1: What is the CKD risk and safe, optimal follow-up of mild renal pelvic dilatation? (ARPD ≤ 7 mm or SFU 1) The findings of this study perhaps argue for a limited followup for patients whose pelvic dilation is less than or equal to 7 mm. Similar suggestions have recently been made in other * Aniruddh V. Deshpande [email protected] 1
Urology Unit, Department of Surgery, The Children’s Hospital at Westmead (SCHN), Sydney, Australia
2
Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia
3
School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
publications [6, 7]. In a study focussed on unilateral dilatation and need for surgery for pelviureteric junction obstruction (PUJO), Yang et al. confirmed that SFU grade 1 dilatations did not progress to needing intervention [2]. Nevertheless, the highlight of this study is the correlation to a lack of long-term kidney morbidity which few other studies comment on (Table 1). In perhaps the only other study to add to these data, Costa et al. also report no CKD in the low-severity cohort (SFU 1–2) in their study [5]. Clinicians should feel more reassured by this.
Conversation 2: What is the optimal management of moderate to severe renal pelvic dilatation? (ARPD ≥ 7 mm or SFU 2–4) Sub-conversation 1: What is the risk of permanent kidney damage and CKD risk in moderate/severe dilatation (> 7 mm, SFU grades 3 and 4)? This index study argues indirectly perhaps for a structured surveillance of the other arm (group B) mentioning a higher risk of kidney damage albeit with no reported CKD. [4] In the study, 36% cases (approximately 20% of total) in group B (>7mm RPD) had progression/new evidence of kidney damage. This is a significant finding of this study. Of note, the odds for permanent kidney damage in dilatation > 15 mm o
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