Antenatally detected urinary tract abnormalities: more detection but less action.
We present the findings of a prospective cohort study of babies born with antenatally detected urinary tract abnormalities (AUTAs) between 1999-2003 and compare the outcomes with those of an earlier cohort born between 1989 and 1993. All infants with a fetal anteroposterior renal pelvic diameter (APRPD) > or =7 mm in the third trimester or other urinary tract abnormality underwent a detailed postnatal ultrasound scan and other investigations as indicated. The incidence of AUTAs was significantly greater in the more recent cohort (7.6/1000 vs. 3/1000 live births; p<0.05). Of the 350 infants on which we had data, 48.6% (170/350) were in the non-specific dilatation (NSD) category, and vesicoureteric reflux (VUR) was detected in 12%. Restricting investigations to those who had an APRPD > or =10 mm at >30 weeks of gestation could have reduced the number with NSD in the more recent cohort (26/115; 25%), but 25% of those with pelviureteric junction hold-up and 50% with VUR would have been missed. Significantly fewer patients in the more recent cohort underwent surgery (7 vs. 21%; p<0.001). There is a trend towards larger APRPDs on third trimester scans being associated with more significant pathology, but there is a lot of clinical overlap. The study highlights the need for cautious antenatal counselling combined with an assurance to prospective parents that postnatal investigations will be performed in a stepwise manner based on the initial postnatal ultrasound scan and clinical findings.
Mallik
Meeta
M
Children & Young People's Kidney Unit, Nottingham University Hospitals NHS Trust, City Hospital Campus Hucknall Road, Nottingham NG5 1PB, UK.
Watson
Alan R
AR
D003952:Diagnostic Imaging / Q000379:methods; D004108:Dilatation, Pathologic; D005260:Female; D005865:Gestational Age; D006801:Humans; D006869:Hydronephrosis / Q000473:pathology; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D021782:Multicystic Dysplastic Kidney / Q000473:pathology; D011237:Predictive Value of Tests; D011247:Pregnancy; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012042:Registries; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal; D014551:Urinary Tract / Q000002:abnormalities* / Q000473:pathology* / Q000601:surgery; D014564:Urogenital Abnormalities / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D014567:Urography; D013520:Urologic Surgical Procedures; D014718:Vesico-Ureteral Reflux / Q000473:pathology