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. 2010 Dec;20(4):427-34.

Significance of Postnatal Follow-up of Infants with Vesicoureteral Reflux Having Antenatal Hydronephrosis

Murat Kangin  1 , Nejat Aksu, Onder Yavascan, Murat Anil, Orhan Deniz Kara, Alkan Bal, Fulya Kamit
Affiliations

Significance of Postnatal Follow-up of Infants with Vesicoureteral Reflux Having Antenatal Hydronephrosis

Murat Kangin et al. Iran J Pediatr. 2010 Dec.

Abstract

Objective: To evaluate the frequency of urinary tract infections (UTIs) and degree of renal parenchymal damage as well as the parameters of growth, development and nutritional status in antenatal hydronephrosis cases with vesicoureteral reflux (VUR).

Methods: Infants, whose antenatal ultrasonography (US) showed a fetal renal pelvic diameter of 5 mm or greater were investigated. Of the 277 infants with antenatal HN, 36 [56 renal units (RUs)] were diagnosed with VUR. All cases with VUR were evaluated in terms of the frequency of UTIs, scars appearing on (99m)Technetium-dimercaptosuccinic acid scan (DMSA), growth and development [height and weight standard deviation scores (HSDS and WSDS)], and nutritional status [relative weight (RW)]. Statistical evaluation was performed using the Chi-squared test.

Findings: Of these 36 patients with VUR, 25 (69.4%) were males and 11 (30.6%) females. Of the 56 RUs, 48 (85.7%) had severe VUR (≥ Grade III). The mean duration of postnatal follow-up was 37.8±24.50 months. The annual UTI frequency was found to be 1.25±0.83 episodes/year. Of these 36 infants, 32 (88.8%) recovered from VUR following either medical (17 patients, 47.2%) or surgical (15 patients, 41.6%) treatment. The initial DMSA showed parenchymal defects in 16 (44.4%) RUs, and 4 RUs showed recovery in the final DMSA. Although statistically insignificant (P>0.05), initial growth and development (HSDS: -0.17±0.86; WSDS: 0.00±0.14) and nutritional status (RW: 98.19±8.81) values gradually improved (0.05±1.06, 0.06±1.071 and 101.97±14.85, respectively).

Conclusion: Postnatal early diagnosis and appropriate management of VUR in infants with antenatal hydronephrosis can prevent the occurrence of frequent UTIs, renal scarring and malnutrition, enabling normal growth and development.

Keywords: Antenatal Diagnosis; Hydronephrosis; Infant; Urinary tract infections; Vesicoureteral reflux.

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Figures

Fig. 1
Fig. 1
Simplified algorithm for postnatal evaluation of infants with prenatally detected hydronephrosis (US: Ultrasonography, VCUG: Voiding cystourethrogram, VUR: Vesicoureteral reflux, DMSA: 99mTechnetium-dimercaptosuccinic acid scan, DTPA: 99mTechnetium-diethylene triamine penta-acetic scan, IVP: Intravenous urogram, UTI: Urinary tract infection)
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