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. 2018 Mar;12(3):E137-E141.
doi: 10.5489/cuaj.4587. Epub 2017 Dec 22.

Prenatally detected, unilateral, high-grade hydronephrosis: Can we predict the natural history?

Osama M Sarhan  1   2 , Ahmed El Helaly  2 , Abdul Hakim Al Otay  2 , Mustafa Al Ghanbar  2 , Ziad Nakshabandi  2
Affiliations

Prenatally detected, unilateral, high-grade hydronephrosis: Can we predict the natural history?

Osama M Sarhan et al. Can Urol Assoc J. 2018 Mar.

Abstract

Introduction: Fetal hydronephrosis (HN) occurs in approximately 5% of pregnancies and its prognosis depends mainly on the grade of the dilation. We attempted to determine the fate of isolated, unilateral, high-grade HN in children with antenatal diagnosis, emphasizing the risk factors for progression.

Methods: We retrospectively evaluated 424 children (690 kidney units) with antenatal HN in the period between 2010 and 2014. We included only those patients with isolated high-grade HN (Society for Fetal Urology [SFU] Grade 3 or 4). Patients with bilateral HN or unilateral HN associated with dilated ureter or reflux and patients with missed followup were excluded. The prognosis of HN (whether improved, stabilized, or progressed) and the need for surgical intervention in this subset of patients was evaluated.

Results: A total of 44 children (34 boys and 10 girls) were identified. Ultrasounds showed SFU Grade 3 HN in 24 (54%) and SFU Grade 4 HN in 20 (46%). After a mean followup of three years (range 1-5), 10 children (23%) needed surgical intervention; four Grade 3 HN (16%) and six Grade 4 HN (30%). The majority of children with differential renal function (DRF) ≥40% (69.5%) were stable or improved. Five girls (50%) and five boys (17%) progressed and required surgical intervention. No patient with a renal pelvis anteroposterior diameter (APD) <1.5 cm needed surgical intervention.

Conclusions: Infants with isolated, unilateral, high-grade HN might be managed conservatively. Male gender, DRF ≥40%, SFU Grade 3 HN, and APD <1.5 cm were favourable prognostic factors.

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Conflict of interest statement

Competing interests: The authors report no competing personal or financial interests related to this work.

Figures

Fig. 1
Fig. 1
Kaplan-Meier curve showing incidence of progression of hydronephrosis stratified by gender.
Fig. 2
Fig. 2
Kaplan-Meier curve showing incidence of progression of hydronephrosis stratified by anteroposterior diameter (APD).
Fig. 3
Fig. 3
Kaplan-Meier curve showing incidence of progression of hydronephrosis stratified by differential renal function (DRF).
See this image and copyright information in PMC

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