POST NATAL MANAGEMENT OF ANTENATALLY DETECTED HYDRONEPHROSIS
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 53
Abstract
BACKGROUND Ultrasound screening during pregnancy has resulted in increasing recognition of foetal hydronephrosis. Depending on diagnostic criteria and gestation, the prevalence of antenatally detected hydronephrosis (ANH) ranges from 0.6 to 5.4%. The investigations that predict the progression of hydronephrosis and progressive loss of renal functions are limited. Pressure flow studies and diuretic renography have been developed to try to predict as to which dilated kidney will undergo progressive deterioration. However, in order to interpret the significance of neonatal hydronephrosis, and to apply the diagnostic tests accurately, it must be recognised that tests do not actually recognise obstruction; they merely identify, and monitor parameters shared by obstructed kidneys that seem to correlate empirically with the potential for progressive renal deterioration. MATERIALS AND METHODS All cases satisfying the criteria for ANH were followed up after delivery. Postnatal USG was performed, and severity was assessed. Society of Foetal Urology (SFU) grade I/II were followed up by USG. SFU grades III/IV were investigated for cause of obstruction by Micturating cystourethrogram (MCU) and Diuretic Renogram (DR) at 1 month. Surgery is performed if obstruction is identified. Patient is followed up post operatively with USG and DR. RESULTS The incidence of antenatal hydronephrosis was 0.134%. Only patients with renal pelvic Antero Posterior Diameter (APD) >7mm in third trimester showed any post natal pathology. 100% of patients with severe disease on antenatal scan showed post natal pathology compared to 33.33% on post natal evaluation 100% of patients with grade I/II disease showed resolution within 1yr. 100% of patients with grade II/IV disease showed post natal pathology. Most common cause of hydronephrosis was transient cause (33.33%) followed by PUJ obstruction (20%). CONCLUSION Only patients with renal pelvic APD > 7 mm in third trimester have postnatal pathology, which should be taken as cut off. ANH is caused by transient cause, pelviureteric junction obstruction, megaureter, posterior urethral valves, VUR and cystic disease of kidney. Patients with SFU grade I/II HN will resolve and only need regular follow up with ultra sonogram. Patients with SFU grade III/IV will have a pathology that needs intervention. Pathology needs to be identified by MCU and Diuretic Renogram. Early relief of obstruction will prevent progressive renal damage.
Authors and Affiliations
Ravikumar Jadav, Manjuprasad G. B
Keywords
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- EP ID EP550513
- DOI 10.14260/jemds/2018/1236
- Views 97
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