Friday, August 20, 2010

AUA Recommendations for Prenatal Hydronephrosis

These are published recently

Recommendation: Voiding cystourethrogram is recommended for children with high-grade (Society of Fetal Urology grade 3 and 4) hydronephrosis, hydroureter or an abnormal bladder on ultrasound (late term prenatal or postnatal), or who develop a urinary tract infection on observation.
Option: An observational approach without screening for VUR, with prompt treatment of any urinary tract infection, may be taken for children with prenatally detected hydronephrosis (SFU grade 1 or 2), given the unproven value of identifying and treating VUR. It is also considered an option to perform a voiding cystourethrogram in these patients to screen for VUR.
http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/vur2010/ScreenNeonateinfantWithPrenatalHydronephrosis.pdf (for complete article).
Summary:In screened populations with prenatal hydronephrosis the prevalence of vesicoureteral reflux is 16.2%. Reflux in the contralateral nondilated kidney accounted for a mean of 25.2% of detected cases for a mean prevalence of 4.1%. In patients with a normal postnatal renal ultrasound the prevalence of reflux is 17%. The prenatal anteroposterior renal pelvic diameter was not predictive of reflux prevalence.

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