Outcome Of Isolated Antenatal Hydronephrosis: A Prospective Cohort Study
The group classified renal pelvic dilatation as mild when it was between 5 - 9.9 mm; moderate between 10 - 14.9 mm, or severe when it was greater or equal to 15 mm. They followed a total of 192 patients. Of the 192 patients, 114 of them (59.4%) were separated because their radiographic imaging had non-significant findings and fell into the group of mild to moderate dilation while the remaining 78 patients (40.6%) had significant uropathy.
The interesting patients are truly the ones that have a mild amount of renal pelvic dilation. I found that the focus of this paper is most interesting when looking at the 89 patients with the mild dilation. Interestingly, even though 89 patients had mild dilation 16 (18%) presented with significant uropathy later on. The mean follow up time was 24 months. When you looked at the total patient population of 192, 27 patients (15%) required surgical intervention. During the follow up, UTI occurred in 27 (14%) of the children. Even more interesting, of these 27 patients who had UTI, 7 of them only had mild renal pelvic dilation upon presentation. The remaining parameter such as renal function, blood pressure and somatic growth were within normal ranges at the last follow up appointment for all the patients.
Even though this paper shows that the majority of patients with mild fetal renal pelvic dilation have no significant findings during infancy, their prospective analysis proves that a fifth of these patients presented with uropathy and almost 8% had a urinary tract during a medium-term follow up. Their study further elucidates that there is a difference between the moderate to sever renal pelvic dilated infants and those with mild renal pelvic dilation and that diagnostic imaging does not have to be as invasive for the later group. Nonetheless, it appears that infants with mild renal pelvic dilation may have progression of their renal pelvic dilation and require more stringent clinical surveillance and they are still susceptible to urinary tract infection. One of the conclusions from this paper that 15% of children with renal pelvic dilation require some form of operative intervention adheres to the numbers that are seen typically between 5-10%. Early delineation of these 10-15% of children with renal pelvic dilation that require intervention is what appears to be the most critical aspect of all these studies. Differentiating them is the hardest job we have as clinicians. Even with strict surveillance, it is unclear whether earlier intervention is better than observation with intervention later on in life. Hopefully with the advent of proteomics in combination with urinary biomarkers, we can help differentiate which children are at most risk for urinary tract infection, scaring, and ultimate nephropathy.
Coelho GM, Bouzada MCF, Pereira AK, Figueiredo BF, Leite MRS, Oliveira DS, Oliveira EA
Pediatr Nephrol. 22(10): 1727-1734, October 2007
Doi: 10.1007/s00467-007-0539-6
Reported by UroToday.com Medical Editor Pasquale Casale, MD Assistant Professor, University of Pennsylvania University of Pennsylvania, Children's Hospital of Philadelphia
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Rezultatul izolate prenatalã Hydronephrosis: Un studiu de cohortã prospectiv - Outcome Of Isolated Antenatal Hydronephrosis: A Prospective Cohort Study - articole medicale engleza - startsanatate