Primary upj-type fetal hydronephrosis: Prenatal approach and outcome

Amaç To determine the outeome of primary UPJ-type fetal hydronephrosis followed and/or managed antenatally and postnatally.

Yöntem

 Thirty-four fetuses (51 kidneys) with antenatally diagnosed primary UPJ-type hydronephrosis between September 2000 and August 2002 were prospectively followed. Antenatal standard ultrasound (SUS) and diuretic Doppler US (DDUS) were used for diagnosis and follow-up of these patients. Prenatal intervention was performed in some of persistent grade 4 (SFU) hydronephrotic kidneys of renal pelvic AP diameter greater than 35 mm, with no improvement in serial antenatal SUS and/or DDUS, and with renal dysplasia findings in fetal urine sample, particularly bilateral ones.

Bulgular

 Boy/Girl: 26/8. Antenatal diagnosis was made at 28 gestational weeks. All had normal amniotic fluid ineluding bilateral one. All delivered full term. The mean birth weight was significantly lower in patients with grade 4 compared to grade 3 or less patients. Fortyone kidneys were managed with non-operative approach. Surgery was required in 10 kidneys. The degree of hydronephrosis decreased in none of the kidney with grade 4 in antenatal anel postnatal period. Prenatal renal pelvic needling in four kid¬neys and pelviamniotic shunting in three kidneys associated with persistent grade 4 hydronephrosis (AP diameter greater than 35 mm) were performed.

Sonuç

This series may help in deseribing the natural history of fetal hydronephrosis. Close follow-up with DDUS in antenatal period may help to identify the subgroup of children who develop obstruction and who need prenatal intervention. Oligohydramnios is likely to be a late complication of renal dysplasia. Therefore, it might not be used as a certain criteria for prenatal intervention. in fact, it may cause a delay in prompt management of severe obstruction.

Anahtar Kelimeler

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