Antenatal renal pelvic dilatation; the long-term outlook.
OBJECTIVE
The purpose of this study was twofold: first to provide data for more accurate counselling of parents with regard to prognosis, and second, to ensure that by following a policy of selective micturating cystourethography (MCUG), significant pathology is not missed, in particular vesicoureteric reflux (VUR). (MCUG is only undertaken if the renal pelvic diameter (RPD) is >/= 10 mm or if there is calyceal or ureteric dilatation.)


METHODS
Data were collected prospectively over a 6-year period. Pre and postnatal imaging findings were collected for all infants in whom a RPD of >/= 5 mm was identified at any gestational age. The imaging records of all patients were reviewed in 2005 for evidence of pathology detected after re-presentation with symptoms. The age range at review varied from 2-8 years.


RESULTS
Complete data were available in 527 infants. The risk of significant pathology was related to the degree of antenatal renal pelvic dilatation varying from 6% for a RPD of 5 mm at 20 weeks gestation to 38% at 10 mm. At 28-33 weeks gestation the risk varied from 5% at 5mm to 15% at 10 mm. Subsequent imaging record review revealed only one patient with grade II VUR in the study population not picked up by our selective MCUG policy.


CONCLUSIONS
The present study provides prognostic information that can be given to parents both antenatally and postnatally, and reassurance that a selective MCUG policy is appropriate.
Duncan
K A
KA
Royal Aberdeen Children's Hospital and Aberdeen Maternity Hospital, Foresterhill, Aberdeen, UK. k.duncan@nhs.net
D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D004108:Dilatation, Pathologic / Q000175:diagnosis / Q000000981:diagnostic imaging; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007674:Kidney Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D007682:Kidney Pelvis / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D011181:Postnatal Care / Q000379:methods; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D011859:Radiography; D011877:Radionuclide Imaging