POSTNATAL FOLLOW-UP AND OUTCOME OF INFANTS DIAGNOSED WITH ANTENATALLY DETECTED HYDRONEPHROSIS: AN OBSERVATIONAL STUDY

AKASH YADAV; SINDHU N; GAUTAM MUTHU

doi:10.22159/ajpcr.2025v18i11.56779

Authors

AKASH YADAV Department of Radiodiagnosis, Rajarajeswari Medical College and Hospital, University - Dr. M.G.R. Educational and Research Institute, Bengaluru, Karnataka, India
SINDHU N Department of Radiodiagnosis, Rajarajeswari Medical College and Hospital, University - Dr. M.G.R. Educational and Research Institute, Bengaluru, Karnataka, India
GAUTAM MUTHU Department of Radiodiagnosis, Rajarajeswari Medical College and Hospital, University - Dr. M.G.R. Educational and Research Institute, Bengaluru, Karnataka, India

DOI:

https://doi.org/10.22159/ajpcr.2025v18i11.56779

Keywords:

Hydronephrosis, Antenatal Diagnosis, Pelviureteric Junction Obstruction, Vesicoureteral reflux, Postnatal ultrasound

Abstract

Objectives: The objectives of this study were to evaluate the postnatal outcomes of neonates with antenatally detected hydronephrosis (ANH), to determine the prevalence of associated urinary tract anomalies such as pelviureteric junction obstruction (PUJO), vesicoureteral reflux (VUR), and posterior urethral valves (PUV), and to assess the requirement for surgical versus conservative management

Methods: This prospective observational study included 60 neonates diagnosed with ANH based on antenatal ultrasound criteria (anteroposterior renal pelvic diameter >4 mm in the second trimester or >7 mm in the third). Postnatal evaluations included serial ultrasonography and, in selected cases, micturating cystourethrogram. Hydronephrosis was graded using the Society for Fetal Urology system. Primary outcomes included resolution rates, incidence of urinary tract anomalies, surgical intervention rates, and urinary tract infection occurrence. Data were analyzed using SPSS v23. p<0.05 was considered statistically significant.

Results: Among 60 infants, 68.3% were male, with a male-to-female ratio of 2.2:1. Hydronephrosis was unilateral in 54 cases (90.0%) and most commonly left-sided. On initial postnatal ultrasound, 63.3% had mild, 25.0% moderate, and 11.7% severe hydronephrosis. Till the time of final follow-up, 44 (73.3%) cases resolved spontaneously without intervention. Specific pathologies identified were PUJO (11.7%), VUR (13.3%), and PUV (3.3%). Surgical intervention was required in 13.3% of infants. The reduction in hydronephrosis severity from antenatal to postnatal imaging was statistically significant (p<0.001).

Conclusion: Most cases of ANH resolve without any interventions. Serial postnatal follow-up using ultrasonography is important for identifying infants at risk for the presence of clinically significant anomalies such as PUJ obstruction, VUR, and PUV. Regular follow-up facilitates timely intervention while avoiding unnecessary procedures in low-risk cases.

Downloads

Download data is not yet available.

References

1. Sinha A, Bagga A, Krishna A, Bajpai M, Srinivas M, Uppal R, et al. Revised guidelines on management of antenatal hydronephrosis. Indian J Nephrol. 2013 Mar;23(2):83-97. doi: 10.4103/0971-4065.109403, PMID 23716913, PMCID PMC3658301

2. Wong J, Rickard M, Dos Santos J, Lorenzo AJ. Antenatal hydronephrosis: An updated review on postnatal care and management. Curr Opin Pediatr. 2025 Aug 22;37(5):473-81. doi: 10.1097/ MOP.0000000000001485, PMID 40842394

3. Has R, Sarac Sivrikoz T. Prenatal diagnosis and findings in ureteropelvic junction type hydronephrosis. Front Pediatr. 2020 Sep 4;8:492. doi: 10.3389/fped.2020.00492, PMID 33014923, PMCID PMC7498649

4. Balasankar S, Balasubramanian J. A study on postnatal evaluation and follow-up of infants with antenatally detected hydronephrosis. Int J Contemp Pediatr. 2017;4(5):1677-81. doi: 10.18203/2349-3291. ijcp20173716

5. De Roo R, Voskamp BJ, Kleinrouweler CE, Mol BW, Pajkrt E, Bouts AH. Determination of threshold value for follow-up of isolated antenatal hydronephrosis detected in the second trimester. J Pediatr Urol. 2017 Dec;13(6):594-601. doi: 10.1016/j.jpurol.2017.06.001, PMID 29133166

6. Akyol Onder EN, Yilmaz O, Taneli C, Ertan P. Outcomes of children with isolated antenatal hydronephrosis. Pediatr Int. 2024 Jan- Dec;66(1):e15843. doi: 10.1111/ped.15843, PMID 39696908

7. Sencan A, Carvas F, Hekimoglu IC, Caf N, Sencan A, Chow J, et al. Urinary tract infection and vesicoureteral reflux in children with mild antenatal hydronephrosis. J Pediatr Urol. 2014 Dec;10(6):1008-13. doi: 10.1016/j.jpurol.2014.04.001, PMID 24863985

8. Yalçınkaya F, Özçakar ZB. Management of antenatal hydronephrosis. Pediatr Nephrol. 2020 Dec;35(12):2231-9. doi: 10.1007/s00467-019- 04420-6, PMID 31811536

9. 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(6):478-80. doi: 10.1007/BF02012459, PMID 8255658

10. Lee RS, Cendron M, Kinnamon DD, Nguyen HT. Antenatal hydronephrosis as a predictor of postnatal outcome: A meta-analysis. Pediatrics. 2006 Aug;118(2):586-93. doi: 10.1542/peds.2006-0120, PMID 16882811

11. Ismaili K, Hall M, Donner C, Thomas D, Vermeylen D, Avni FE, et al. Results of systematic screening for minor degrees of fetal renal pelvis dilatation in an unselected population. Am J Obstet Gynecol. 2003 Jan;188(1):242-6. doi: 10.1067/mob.2003.81, PMID 12548224

12. Sairam S, Al-Habib A, Sasson S, Thilaganathan B. Natural history of fetal hydronephrosis diagnosed on mid-trimester ultrasound. Ultrasound Obstet Gynecol. 2001 Mar;17(3):191-6. doi: 10.1046/j.1469- 0705.2001.00333.x, PMID 11309166

13. Braga LH, McGrath M, Farrokhyar F, Jegatheeswaran K, Lorenzo AJ. Society for Fetal Urology classification vs urinary tract dilation grading system for prognostication in prenatal hydronephrosis: A time to resolution analysis. J Urol. 2018 Jun;199(6):1615-21. doi: 10.1016/j. juro.2017.11.077, PMID 29198999

14. Riccabona M, Avni FE, Blickman JG, Dacher JN, Darge K, Lobo ML, et al. Imaging recommendations in paediatric uroradiology: Minutes of the ESPR workgroup session on urinary tract infection, fetal hydronephrosis, urinary tract ultrasonography and voiding cystourethrography, Barcelona, Spain, June 2007. Pediatr Radiol. 2008 Feb;38(2):138-45. doi: 10.1007/s00247-007-0695-7, PMID 18071685

15. Cooper CS, Andrews JI, Hansen WF, Yankowitz J. Antenatal hydronephrosis: Evaluation and outcome. Curr Urol Rep. 2002 Apr;3(2):131-8. doi: 10.1007/s11934-002-0024-5, PMID 1208420516. Gradwell LE, Neel AK, Somani BK. Predictive tools and scoring systems for surgical intervention in antenatal hydronephrosis and pelviureteric junction obstruction: An ATLAS based on comprehensive review of literature. Urol Ann. 2025 Jul-Sep;17(3):133-43. doi: 10.4103/ ua.ua_88_25, PMID 40843405

17. Zerin JM, Ritchey ML, Chang AC. Incidental vesicoureteral reflux in neonates with antenatally detected hydronephrosis and other renal abnormalities. Radiology. 1993 Apr;187(1):157-60. doi: 10.1148/ radiology.187.1.8451404, PMID 8451404

18. Herz D, Merguerian PA, McQuiston L, Hulbert WC, Snyder HM. Antibiotic prophylaxis for children with prenatal hydronephrosis. J Urol. 1997;158(3 Pt 2):1178-80. doi: 10.1016/s0022-5347(01)64460-6

19. Onen A. Treatment and outcome of prenatally detected newborn hydronephrosis. J Pediatr Urol. 2007 Dec;3(6):469-76. doi: 10.1016/j. jpurol.2007.05.002, PMID 18947797

20. Nguyen HT, Herndon CD, Cooper C, Gatti J, Kirsch A, Kokorowski P, et al. The society for fetal urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol. 2010 Jun;6(3):212-31. doi: 10.1016/j.jpurol.2010.02.205, PMID 20399145