ANTENATAL HYDRONEPHROSIS: Fetal and Neonatal Management
Section snippets
DEVELOPMENT OF KIDNEY AND RENAL FUNCTION
The kidney is derived from the ureteral bud and the metanephric blastema. During the fifth week of gestation, the ureteral bud arises from the mesonephric (wolffian) duct and penetrates the metanephric blastema, which is an area of undifferentiated mesenchyme on the nephrogenic ridge. The ureteral bud undergoes a series of approximately 15 generations of divisions, and by 20 weeks' gestation forms the entire collecting system, that is, the ureter, renal pelvis, calyces, papillary ducts, and
MANAGEMENT OF THE FETUS WITH ANTENATAL HYDRONEPHROSIS
When a fetus is identified with a suspected urinary tract abnormality, the goals of management include determining the differential diagnosis, assessment of associated anomalies, and determining the fetal and postnatal risk of the anomaly.
Hydronephrosis is recognized by demonstrating a dilated renal pelvis and calyces. The ureter and bladder may be dilated also. The likelihood of having a significant urinary tract abnormality is directly proportional to the severity of hydronephrosis.4, 42, 81
Management in the Nursery
At birth, the abdomen is inspected to detect the presence of a mass, which often is secondary to a multicystic kidney or UPJ obstruction. In male newborn infants with posterior urethral valves, often a walnut-shaped mass, representing the bladder, is palpable just superior to the pubic symphysis. Newborn infants also should be evaluated for anomalies involving other organ systems. Renal function should be monitored with serial serum creatinine levels, particularly in infants with bilateral
SUMMARY
As many as 1% of newborn infants have a prenatal diagnosis of hydronephrosis or significant renal pelvic dilation. Hydronephrosis often is caused by nonobstructive conditions. The likelihood of significant urologic pathology is directly related to the size of the fetal renal pelvis, and 90% with an anteroposterior diameter more than 2 cm need surgery or long-term urologic medical care. Following delivery, antibiotic prophylaxis should be administered and a renal sonogram and voiding
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Mothers’ perception of prenatal counseling following diagnosis of congenital anomalies of the urinary tract
2021, Archives de PediatrieCitation Excerpt :Congenital abnormalities of the genitourinary tract are the most common sonographically identified malformations, accounting for 15–20% of all prenatally diagnosed congenital anomalies, and an overall incidence of 1–4 per 1000 pregnancies [1,2].
Outcomes of urinary tract abnormalities diagnosed by the routine third trimester scan
2020, European Journal of Obstetrics and Gynecology and Reproductive BiologyDoes the body weight influence the outcome in children treated with robotic pyeloplasty?
2020, Journal of Pediatric UrologyManagement of antenatally detected kidney malformations
2018, Early Human DevelopmentCitation Excerpt :Congenital abnormalities of the genitourinary tract are the most common sonographically identified malformations, with an incidence of approximately 1 to 4 per 1000 pregnancies [1]. These represent 15–20% of all prenatally diagnosed congenital anomalies [2]. The majority of cases have mild dilatation of the renal pelvis and a good outcome [3] but they tend to get aggregated into the ‘obstructive uropathy’ group with more severe bilateral pelvis and bladder dilatation secondary to lower urinary tract obstruction, typically posterior urethral valves in boys [4].
What is the risk of urinary tract infection in children with antenatally presenting dilating vesico-ureteric reflux?
2015, Journal of Pediatric UrologyObstructive Uropathy: Assessment of Renal Function in the Fetus
2012, Nephrology and Fluid/Electrolyte Physiology
Address reprint requests to Jack Elder, MD, Rainbow Babies and Children's Hospital, Division of Pediatric Urology, 2074 Abington Road, Cleveland, OH 44106
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From the Department of Urology and Pediatrics, Case Western Reserve University School of Medicine, and the Department of Pediatric Urology, Rainbow Babies & Children's Hospital, Cleveland, Ohio