Results of Treatment of Neonatal Hydronephrosis
Authors:
J. Sedláček 1; R. Kočvara 1,4; J. Langer 2; Z. Dítě 1,4; J. Dvořáček 1; H. Jiskrová 3
Authors‘ workplace:
Urologická klinika VFN a UK 1. LF, Praha
přednosta prof. MUDr. J. Dvořáček, DrSc.
1; Klinika dětského a dorostového lékařství VFN a UK 1. LF, Praha
přednosta prof. MUDr. J. Zeman, DrSc.
2; Ústav nukleární medicíny VFN a UK 1. LF, Praha
přednosta prof. MUDr. M. Šámal, DrSc.
3; Institut postgraduálního vzdělávání ve zdravotnictví, Praha
ředitel MUDr. Z. Hadra
4
Published in:
Čes-slov Pediat 2008; 63 (12): 653-659.
Category:
Original Papers
Overview
Study objective:
Evaluation of 141 newborns and sucklings with unilateral asymptomatic hydronephrosis (HN) aimed at natural development of kidney function and development of kidney function in relation to surgical treatment.
Methods:
The cohort was divided in two groups. The first group with HN grade I–II included 82 children and 2nd group with HN grade III–IV included 59 children. Individuals in both groups were followed conservatively. In the course of observation, 29 children were operated on, all of them from the 2nd group. The surgery was indicated by growing degree of HN in 14 patients (group 2/A), decrease of the separated kidney function in 12 cases (group 2/B) and low separated kidney function during the first examination in three cases (group 2/C). The remaining 30 children of the 2nd group were not treated by surgery (group 2/D). The mean period of observation was 28 months (3 to 165 months).
Results:
In the group 1 and 2/D there was a gradual decrease of HN and the kidney function proved to be good during the period of observation. In the group of children operated on for growing dilatation (2/A), the separated function remained stationary (46% versus 49%); in the group of children with decreased separated kidney function (2/B), it proved to adjust after the operation (46% versus 36% versus 43%), whereas in the kidneys with primarily low function (2/C) there was only an improvement (19% vs. 34%).
Conclusion:
Congenital hydronephrosis of lower grade (I–II) and more than a half of hydronephrosis cases of higher grade (III–IV) is associated with a favorable development during the conservative follow-up. Twenty one percent of children underwent surgery for increased dilatation of the calix-pelvic system, decrease of the separated function or primary hypofunction of the affected kidney. The post-operation function was dependent on primary function of the affected kidney. The decrease of the separated function was reversible in all individuals.
Key words:
neonatal hydronephrosis, pyeloureteral obstruction, pyeloplasty
Sources
1. Grignon A, Filiatrault D, Homsy Y, et al.: Ureteropelvic junction stenosis: antenatal ultrasonographic diagnosis, postnatal investigation, and follow-up. Radiology 1986;160: 649–651.
2. Dhillon H. Imaging and follow up of neonatal hydronephrosis. Curr. Opin. Urol. 1995;5: 75–78.
3. Dudley JA, Haworth JM, McGraw ME. Clinical relevance and implications of antenatal hydronephrosis. Arch. Dis. Childhood 1997;76: 31–34.
4. Brogan PA, Chiyende J. Antenatally diagnose renal pelvis dilatation. Arch. Dis. Child Fetal. Neonatal Ed. 2000;82(2): 171–172.
5. Woodward M, Frank D. Postnatal management of antenatal hydronephrosis. BJU Int. 2002;89: 149–156.
6. Homsy YL, Mehta PH, Huot D, et al. Intermittent hydronephrosis: a diagnostic challenge. J. Urol. 1988;140: 1222–1226.
7. Koff SA, Hayden LJ, Cirulli C, et al. Pathophysiology of ureteropelvic junction obstruction: experimental and clinical observations. J. Urol. 1986;136: 336–338.
8. Dhillon HK. Prenatally diagnosed hydronephrosis: the Great Ormond Street experience. Br. J. Urol. 1998;81(Suppl 2): 39–44.
9. Ulman I, Jayanthi VR, Koff SA. The long-term follow up of newborns with sewere unilateral hydronephrosis initially treated nonoperatively. J. Urol. 2000;164: 1101–1105.
10. Palmer LS, Maizels M, Catwright PC, et al. Surgery versus observation for managing obstructive grade 3 to 4 unilateral hydronephrosis: a report from the Society for Fetal Urology. J. Urol. 1998;159: 222–228.
11. Belarmino JM, Kogan BA. Management of neonatal hydronephrosis. Early Human Development 2006;82: 9–14.
12. Maizels M, Reisman ME, Flom LS, et al. Grading nephroureteral dilatation detected in the first year of life: correlation with obstruction. J. Urol. 1992;148(2Pt2): 609–614.
13. Fernbach SK, Maizels M, Conway JJ. Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr. Radiol. 1993;23: 478–480.
14. Pates JA, Dashe JS. Prenatal diagnosis and management of hydronephrosis. Early Human Development 2006;82: 3–8.
15. Bowie JD, Rosenberg ER, Andreotti RF, et al. The changing sonographic appearance of fetal kidneys during pregnancy. J. Ultrasound Med. 1983;2: 505–507.
16. Dudley JA, Haworth JM, McGraw ME. Clinical relevance and implications of antenatal hydronephrosis. Arch. Dis. Childhood 1997;76: 31–34.
17. Tekgül S, Riedmiller H, Kočvara R, et al. Guidelines on Paediatric Urology, 2006. Edition: 34.
18. Riccabona M. Assessment and management of newborn hydronephrosis. World J. Urol. 2004;22: 73–78.
19. Koff SA, Campbell K. Nonoperative management of unilateral neonatal hydronephrosis. J. Urol. 1992;148: 525–531.
20. Ransley PG, Dhillon HK, Gordon I, et al. The postnatal management of hydronephrosis diagnosed by prenatal ultrasound. J. Urol. 1990;144: 584–587.
21. Belarmino JM, Kogan BA. Management of neonatal hydronephrosis: Early Human Development 2006;82: 9–14.
22. O’Reilly PH, Srirangam SR. Unusual aspects of idiopathic hydronephrosis. BJU Int. 2003;92: 662–663.
23. Eskild-Jensen A, Gordon I, Piepsz A, et al. Interpretation of the renogram: problems and pitfalls in hydronephrosis in children. BJU Int. 2004;94: 887–892.
24. Amarante J, Anderson PJ, Gordon I. Impaired drainage on diuretic renography using half-time or pelvic excretion efficacy is not a sign of obstruction in children with a prenatal diagnosis of unilateral renal pelvic dilatation. J. Urol. 2003;169: 1828–1831.
25. Ischikawa I, Brener BM. Local intrarenal vasoconstrictor – vasodilator interactions in mild partial ureteral obstruction. Am. J. Physiol. 1979;236: 131–140.
26. Chevalier RL, Gomez AR. Obstructive uropathy: Physiology. In Pediatric Nephrology. 4th ed. Baltimore: Lippincott Williams and Wilkins, 1999: 873–886.
27. Misseri R, Meldrum KK. Mediators of fibrosis and apoptosis in obstructive uropathies. Curr. Urol. Rep. 2005;6(2): 140–145.
28. Murer L, Benetti E, Centi S, et al. Clinical and molecular markers of chronic interstitial nephropathy in congenital unilateral ureteropelvic junction obstruction. J. Urol. 2006;176: 2668–2673.
29. Geier P, Šmakal O, Tichý T, et al. Histologické nálezy u dětí s hydronefrózou. Čes.-slov. Pediat. 2004;59(3): 123–127.
30. Koff SA, Campbell KD. The nonoperative management of unilateral hydronephrosis: natural history of poorly functioning kidneys. J. Urol. 1994;152: 593–595.
31. Michaelson G. Percutaneous puncture of the renal pelvis, intrapelvic pressure and the concentrating capacity of the kidney in hydronephrosis. Acta Med. Scand. 1974;559(Suppl): 1–26.
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Neonatology Paediatrics General practitioner for children and adolescentsArticle was published in
Czech-Slovak Pediatrics
2008 Issue 12
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