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Year : 2013  |  Volume : 23  |  Issue : 2  |  Page : 83-97

Revised guidelines on management of antenatal hydronephrosis


1 Department of Pediatrics, Division of Nephrology, All India Institute of Medical Sciences, Ansari Nagar, India
2 Max Institute of Pediatrics and Pediatric Surgery, Vellore, Tamil Nadu, India
3 Department of Pediatric Surgery, All India Institute of Medical Sciences, Ansari Nagar, India
4 Uppal Radiology Center, Christian Medical College, Vellore, Tamil Nadu, India
5 Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India

Correspondence Address:
A Sinha
Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-4065.109403

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Widespread antenatal screening has resulted in increased detection of anomalies of the kidneys and urinary tract. The present guidelines update the recommendations published in 2000. Antenatal hydronephrosis (ANH) is transient and resolves by the third trimester in almost one-half cases. The presence of oligohydramnios and additional renal or extrarenal anomalies suggests significant pathology. All patients with ANH should undergo postnatal ultrasonography; the intensity of subsequent evaluation depends on anteroposterior diameter (APD) of the renal pelvis and/or Society for Fetal Urology (SFU) grading. Patients with postnatal APD exceeding 10 mm and/or SFU grade 3-4 should be screened for upper or lower urinary tract obstruction and vesicoureteric reflux (VUR). Infants with VUR should receive antibiotic prophylaxis through the first year of life, and their parents counseled regarding the risk of urinary tract infections. The management of patients with pelviureteric junction or vesicoureteric junction obstruction depends on clinical features and results of sequential ultrasonography and radionuclide renography. Surgery is considered in patients with increasing renal pelvic APD and/or an obstructed renogram with differential renal function < 35-40% or its subsequent decline. Further studies are necessary to clarify the role of prenatal intervention, frequency of follow-up investigations and indications for surgery in these patients.






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Indian Journal of Nephrology
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Online since 20th Sept '07