ANTENATAL HYDRONETHOSIS (KIDNEY EXPANSION IN THE WOMB)
With the widespread use of ultrasonography (US) in the antenatal period, there have been dramatic changes in the recognition of hydronephrosis (HN) cases. . Although it varies with diagnostic criteria and duration of pregnancy, the frequency of antenatal hydronephrosis (AH) varies between approximately 0.5-5.4%. It is reported that 17-54% of all AD cases are bilateral. In a case diagnosed with antenatal hydronephrosis, the course of the disease is more related to the underlying diagnosis. 41-88% of these cases completely regress at birth and after birth. It is stated that the rate of urological diseases requiring surgical intervention is between 4.1-15.4%. Especially in patients diagnosed with vesicoureteral reflux (VUR), the rates of urinary tract infection (UTI) are found to be several times higher. The priority here is to identify HN cases that require urgent surgical intervention. Another important point is to distinguish HN cases that require long-term follow-up or elective surgical intervention from temporary HN cases that require minimally invasive imaging and intervention.
Anteroposterior diameter of the renal pelvis before birth AD should be diagnosed using (PÖAÇ)and staged using the same method. Cases with a prenatal history of AHand all cases with PPAA measuring 4 mm or more in the 2ndtrimester and 7 mm or more in the 3rd trimester should be evaluated after birth
Babies with a high probability of being diagnosed with severe urological anomalies should be immediately referred to a Pediatric Nephrology Center after birth. Once during the 3rd trimester in cases with unilateral hydronephrosis in the intrauterine period, and once a month until birth, depending on the presence of findings suggestive of lower urinary tract obstruction (oligohydramnios, progressive hydronephrosis, dilated or thickened bladder) in cases with bilateral hydronephrosis USshould be performed.
Diagnostic and therapeutic intervention in the intrauterine period should be performed only in the presence of lower urinary tract obstruction. should be considered. The intervention decision should be made by an experienced center/team after detailed evaluation of each case. It should only be considered after one-on-one evaluation of patients with centers that have experience in these procedures. Pregnancy will not be terminated in any case of AH after the 20th week of pregnancy - unless there is a life-threatening problem outside the kidneys.
ANTEATAL HYDRONEPHROSIS, POSTnatal (Evaluation-Diagnosis-Approach)
1. All newborns with a history of FH should be evaluated in the first week of life.
2. Staging in the first postnatal evaluation PLANmeasurement in the first 3-7 days. It must be measured by USG
3. Even if the US performed in the first week after birth is normal, subsequent evaluation, monitoring and staging should continue and USG should be performed on days 4-6. It should be repeated weekly.
4. In the follow-up of babies with HN that persists in the first 4-6 weeks after birth, how frequently subsequent US evaluations will be made, the degree of pelvicalyceal dilatation or its rate of increase (SFU stage increase and/or It should be determined according to the severity indicators of HN, such as (increase in POAC) or ureteral dilatation or cortical thinning
Mixocystoureterography (MSUG) should be performed in the following 3 cases (PUBLICLY CALLED FILM)
a) Lower urinary tract obstruction (double-sided hydronephrosis, progressive hydronephrosis, dilated or thickened wall bladder with insufficient emptying, dilated within 1-3 days of life in babies with posterior urethra) findings
b) Unilateral or bilateral USs after birth >PÖAÇ>15 mm and SFU within 4-6 weeks in babies with stage 3-4 or ureteral dilatation
c) AH In babies who are diagnosed with a febrile UTI during follow-up, MSUG should be performed after the urine is sterile
Diuretic renography should be performed within 6-8 weeks of life in the following 2 cases. Preferably, 99mTc- mercaptoacetyltriglycine (MAG3) should be used. Differential function in evaluation The renogram curve should be taken into consideration along with the instructions. The procedure can be repeated every 3-6 months depending on the signs of worsening in US findings.
a) Moderate-Severe unilateral or bilateral HN (PÖAÇ>). 10 mm and SFU stage 3-4)but VUR is not detected
patients
b) Whatever the degree Patients with dilated ureters and no VUR should be evaluated with diuretic reno
graphy
Patients who need to be evaluated with surgery (Table 4), (30) ,42).
a) Lower urinary tract obstruction (bilateral hydronephrosis, progressive hydronephrosis, dilated or thickened wall bladder with inadequate emptying, dilated posterior urethra ) babies with symptoms
b) Babies with grade 4 and 5 VUR at the end of the first year
c) Babies with VUR causing recurrent UTIs and developing new scars in the kidney parenchyma
d ) Radionuclide half-life in diuretic renography (t1/2) >Differential kidney on the side that is found to be longer than 20 minutes,
does not allow flow and/or obstruction is detected
Babies whose function is 40%.
e) But they have the findings in item “d” In undecidable babies, babies with worsening of US findings
or babies with 5-10% deterioration in differential function
f ) Babies with bilateral HN whose dilatation worsens or whose function continues to deteriorate
Babies with HN detected in a solitary kidney should be evaluated together with surgery
Table 1. Differential diagnosis in patients with AD
Etiology %
Transient hydronephrosis 41-88
Pelviureteric stenosis 10-30
Vesicoureteral reflux 10-20
Ureterovesical junction stenosis, megaureter 5-10
Multicistic dysplastic kidney 4 -6
Double collecting system ± ureterocele 2-7
Posterior urethral valve 1-2
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