OUTCOME OF ANTENATAL HYDRONEPHROSIS: A PROSPECTIVE COHORT STUDY.
Keywords:Antenatal Hydronephrosis, Ultrasound, Vesico-ureteric reflux, Outcome.
Fetal hydronephrosis is one of the common anomalies seen during antenatal scans. In many of the cases this antenatally detected hydronephrosis is self-limiting and most of the times it resolves on its own without any intervention whatsoever. However in a small number of cases this obstruction may be significant and may even lead to serious complications including cystic renal dysplasia and renal failure. In some cases hydronephrosis is associated with pathologies such as Vesico-Ureteric reflux reflux or posterior urethral wall and it is important to follow up these infants in postnatal life and intervention should be done if there is worsening of hydronephrosis.
Materials and Methods: This was a prospective cohort study in which 60 infants with antenatally detected hydronephrosis (Renal pelvic diameter more than 4mm before 33 weeks of gestation and more than 7 mm after 33 weeks) were included on the basis of a predefined inclusion and exclusion criteria. Post natal ultrasound of these infants was within 1st week of postnatal life and every monthly till hydronephrosis was resolved. At every follow up visits investigations such as complete blood count, C reactive protein levels, serum electrolytes, urine routine microscopy and culture was done. Micturating cystourethrography was done in selected cases. Prophylactic antibiotics were started in infants with VUR grade III and above. Final outcome was studied in these cases.
Results: Out of these 60 infants there were 49 (81.67%) males and 11 (18.33%) females with a M:F ratio of 1: 0.22. Vesico-Ureteric reflux was found in 12 (20%) infants. Out of these 12 infants with Vesico-Ureteric reflux 9 infants were found to have unilateral VUR whereas remaining 3 infants were found to have bilateral VUR. 21 (35.00%) and 16 (26.67%) infants with antenatally detected hydronephrosis completely resolved by 1st and last follow up visit respectively. In 8 (13.33%) patients hydronephrosis didn’t resolve but reduced in severity and hence these infants were managed medically while in remaining 15 (25.00%) infants there was worsening of severity of hydronephrosis and surgical intervention was required in these cases.
Conclusion: A strict follow up protocol in post natal life is important, in cases of antenatally detected hydronephrosis, to detect worsening of hydronephrosis and to identify cases that will require surgical intervention.
Keywords: Antenatal Hydronephrosis, Ultrasound, Vesico-ureteric reflux, Outcome.
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