The impact of fetal renal pelvic diameter on postnatal outcome.
OBJECTIVE
To determine thresholds for the fetal renal pelvic anterior-posterior diameter (APD) predicting postnatal clinically relevant pelvicaliceal dilatation.


METHODS
One hundred and forty-eight infants whose prenatal sonography had identified an isolated uni- or bilateral fetal APD of > or = 4 mm before 33 and/or > or = 7 mm after 33 weeks' gestational age were investigated postnatally. On the basis of postnatal ultrasound examination, these infants were grouped according to the Society for Fetal Urology Grading System: no pelvic dilatation (n = 38); only pelvic dilatation (n = 59); pelvicaliceal dilatation (n = 33); pelvicaliceal and ureter dilatation (n = 18).


RESULTS
Fetal pyelectasis of 7 mm was 89.3% sensitive and 78.9% specific < 33 weeks, and > or = 33 weeks pyelectasis of 10 mm was 88.4% and 78.6% in predicting subsequent postnatal pelvicaliectasis, respectively. Using a threshold of 4 mm < 33 weeks and 7 mm > or = 33 weeks yielded a sensitivity of 100% and a specificity of 18.7% and 47.8%, respectively. The median APD (range) at > or = 33 weeks was 19 mm (9-36 mm) in patients requiring surgery and 13 mm (7-21 mm) in conservatively treated patients (p = 0.001). Thirteen of fourteen patients with APD > or = 19 mm underwent surgery.


CONCLUSIONS
Women with ultrasonographically detected prenatal fetal pelvic dilatation of > or = 4 mm before 33 weeks and of > or = 7 mm from 33 weeks onwards of gestation should have repeated prenatal ultrasound scans and a detailed postnatal evaluation. The dilatations of an APD > 4 mm before 33 weeks, which have disappeared at the post-33-week scan need no further investigation in the postnatal period.
Division of Pediatric Nephrology, University Children's Hospital, Jena, Germany. ulrike.john@med.uni-jena.de
Ulrike
U
John
Christiane
C
Kähler
Sven
S
Schulz
Hans Joachim
HJ
Mentzel
Susanna
S
Vogt
Joachim
J
Misselwitz
D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007668:Kidney / Q000473:pathology*; D007674:Kidney Diseases / Q000601:surgery / Q000628:therapy; D007682:Kidney Pelvis / Q000000981:diagnostic imaging* / Q000196:embryology*; D011247:Pregnancy; D012372:ROC Curve; D016216:Ultrasonography, Prenatal