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Antenatal hydronephrosis

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Antenatal hydronephrosis is diagnosed via ultrasound, where an anterior-posterior diameter greater than 15mm but less than 50mm is unlikely to cause functional issues, and above 50mm is associated with diminished renal function. It can be caused by pelviureteric junction obstruction, vesicoureteric reflux, or megaureter/ureterovesical junction obstruction. The majority of cases do not require treatment, but follow up ultrasound or nuclear medicine scans may be needed depending on the severity and whether it is unilateral or bilateral. Management involves conservative monitoring or intervention such as surgery depending on factors like obstruction severity and renal split function.

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Antenatal HydronephrosisAntenatal Hydronephrosis Causes and ManagementCauses and Management
DiagnosisDiagnosis UltrasoundUltrasound Anterior-posterior diameter usually < 6 mmAnterior-posterior diameter usually < 6 mm < 15 mm unlikely to be significant obstruction posing< 15 mm unlikely to be significant obstruction posing threat to functionthreat to function > 50 mm associated with diminished function> 50 mm associated with diminished function Ureteric dilatation is abnormal and ureter of normal calibreUreteric dilatation is abnormal and ureter of normal calibre cannot be seencannot be seen Gestational age importantGestational age important
CausesCauses PUJ ObstructionPUJ Obstruction VURVUR Megaureter/UVJ ObstructionMegaureter/UVJ Obstruction Posterior urethral valvesPosterior urethral valves
ManagementManagement < 5% have renal insufficiency< 5% have renal insufficiency Majority do not require any treatmentMajority do not require any treatment Depends whether unilateral or bilateralDepends whether unilateral or bilateral US 24-72 hoursUS 24-72 hours
PUJPUJ US and MAG 3US and MAG 3 Conservative:Conservative: AP diam < 20 30 mmAP diam < 20 30 mm split function > 40%split function > 40% Intervention:Intervention: SymptomaticSymptomatic < 40% split function if AP > 30 mm< 40% split function if AP > 30 mm failure of conservative (func or dilat)failure of conservative (func or dilat) prolonged asympt obstructionprolonged asympt obstruction
ManagementManagement Hydro with normal ureter or bladderHydro with normal ureter or bladder Unilateral - > 15 mm ---- MAG3Unilateral - > 15 mm ---- MAG3 Bilateral --- MCUG ----- VUR/PUV/NormalBilateral --- MCUG ----- VUR/PUV/Normal Unilateral - < 15 mm ----- repeat US @ 3/12 or if InfxnUnilateral - < 15 mm ----- repeat US @ 3/12 or if Infxn ---MCUG---MCUG
Bilateral or Unilat with ureteric or bladder abnormalBilateral or Unilat with ureteric or bladder abnormal Postnatal US @ 24 72 hours and MCUGPostnatal US @ 24 72 hours and MCUG PUV/VUR ----- DMSAPUV/VUR ----- DMSA Neither ---- Megaureter or PUJ ----- MAG3Neither ---- Megaureter or PUJ ----- MAG3

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Antenatal hydronephrosis

  • 1. Antenatal HydronephrosisAntenatal Hydronephrosis Causes and ManagementCauses and Management
  • 2. DiagnosisDiagnosis UltrasoundUltrasound Anterior-posterior diameter usually < 6 mmAnterior-posterior diameter usually < 6 mm < 15 mm unlikely to be significant obstruction posing< 15 mm unlikely to be significant obstruction posing threat to functionthreat to function > 50 mm associated with diminished function> 50 mm associated with diminished function Ureteric dilatation is abnormal and ureter of normal calibreUreteric dilatation is abnormal and ureter of normal calibre cannot be seencannot be seen Gestational age importantGestational age important
  • 3. CausesCauses PUJ ObstructionPUJ Obstruction VURVUR Megaureter/UVJ ObstructionMegaureter/UVJ Obstruction Posterior urethral valvesPosterior urethral valves
  • 4. ManagementManagement < 5% have renal insufficiency< 5% have renal insufficiency Majority do not require any treatmentMajority do not require any treatment Depends whether unilateral or bilateralDepends whether unilateral or bilateral US 24-72 hoursUS 24-72 hours
  • 5. PUJPUJ US and MAG 3US and MAG 3 Conservative:Conservative: AP diam < 20 30 mmAP diam < 20 30 mm split function > 40%split function > 40% Intervention:Intervention: SymptomaticSymptomatic < 40% split function if AP > 30 mm< 40% split function if AP > 30 mm failure of conservative (func or dilat)failure of conservative (func or dilat) prolonged asympt obstructionprolonged asympt obstruction
  • 6. ManagementManagement Hydro with normal ureter or bladderHydro with normal ureter or bladder Unilateral - > 15 mm ---- MAG3Unilateral - > 15 mm ---- MAG3 Bilateral --- MCUG ----- VUR/PUV/NormalBilateral --- MCUG ----- VUR/PUV/Normal Unilateral - < 15 mm ----- repeat US @ 3/12 or if InfxnUnilateral - < 15 mm ----- repeat US @ 3/12 or if Infxn ---MCUG---MCUG
  • 7. Bilateral or Unilat with ureteric or bladder abnormalBilateral or Unilat with ureteric or bladder abnormal Postnatal US @ 24 72 hours and MCUGPostnatal US @ 24 72 hours and MCUG PUV/VUR ----- DMSAPUV/VUR ----- DMSA Neither ---- Megaureter or PUJ ----- MAG3Neither ---- Megaureter or PUJ ----- MAG3