title: Revised guidelines on management of antenatal hydronephrosis.
abstract: Widespread antenatal screening has resulted in increased detection of anomalies of the kidneys and urinary tract. The present guidelines update the recommendations published in 2000. Antenatal hydronephrosis (ANH) is transient and resolves by the third trimester in almost one-half cases. The presence of oligohydramnios and additional renal or extrarenal anomalies suggests significant pathology. All patients with ANH should undergo postnatal ultrasonography; the intensity of subsequent evaluation depends on anteroposterior diameter (APD) of the renal pelvis and/or Society for Fetal Urology (SFU) grading. Patients with postnatal APD exceeding 10 mm and/or SFU grade 3-4 should be screened for upper or lower urinary tract obstruction and vesicoureteric reflux. Infants with vesicoureteric reflux should receive antibiotic prophylaxis through the first year of life, and their parents counseled regarding the risk of urinary tract infections. The management of patients with pelviureteric junction or vesicoureteric junction obstruction depends on clinical features and results of sequential ultrasonography and radionuclide renography. Surgery is considered in patients with increasing renal pelvic APD and/or an obstructed renogram with differential renal function <35-40% or its subsequent decline. Further studies are necessary to clarify the role of prenatal intervention, frequency of follow up investigations and indications for surgery in these patients.
authors.affiliation: Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India. aditisinhaaiims@gmail.com
authors.forename: Aditi
authors.initials: A
authors.lastname: Sinha
authors.forename: Arvind
authors.initials: A
authors.lastname: Bagga
authors.forename: Anurag
authors.initials: A
authors.lastname: Krishna
authors.forename: Minu
authors.initials: M
authors.lastname: Bajpai
authors.forename: M
authors.initials: M
authors.lastname: Srinivas
authors.forename: Rajesh
authors.initials: R
authors.lastname: Uppal
authors.forename: Indira
authors.initials: I
authors.lastname: Agarwal
mesh_terms: D019072:Antibiotic Prophylaxis; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods / Q000592:standards*; D011866:Radioisotope Renography / Q000592:standards; D016216:Ultrasonography, Prenatal