Affiliations: [a] Department of Obstetrics and Gynecology, Prenatal Diagnosis Unit, ASST Spedali Civili Brescia, University of Brescia, Italy
| [b]
Department of Pediatric Surgery, ASST Spedali Civili Brescia, University of Brescia, Italy
| [c] Department of Neonatology, ASST Spedali Civili Brescia, University of Brescia, Italy
| [d] Department of Obstetrics and Gynecology, ASST Spedali Civili Brescia, University of Brescia, Italy
Correspondence:
[*]
Address for correspondence: Chiara Loardi, Department of Obstetrics and Gynecology, ASST Spedali Civili Brescia, University of Brescia, Piazzale Spedali Civili 1, 25123 (Brescia) Italy. Tel.: + 39 0303995340; E-mail: [email protected].
Abstract: BACKGROUND:Renal pelvic dilatation (RPD) is a frequent finding in fetal ultrasound. The aim of the study is to correlate the prenatally detected moderate and severe pyelectasis with the postnatal outcome. METHODS:A retrospective analysis involving 90 cases of prenatally detected moderate and severe RPD referred to our prenatal diagnosis centre with 18 months of urological follow-up. Prenatal ultrasound was correlated with postnatal renal function, assessed by plasmatic creatinine and/or renal scintigraphy performed before surgery. RESULTS:Cases were divided between two groups according to postnatal management: group A including 35 newborns (38.9%) that needed surgical treatment and group B with 55 patients (61.1%) who were managed conservatively. The group A presented higher median RPD (18 mm, IQR 12–25 mm) compared to the group B (11 mm, IQR 10–14 mm). The most common anomaly detected within group A was pelvi-ureteric junction (PUI) obstruction (43%). Within group B 32 cases (58%) showed spontaneous resolution of hydronephrosis during postnatal follow up. In case of moderate pyelectasis the risk of postnatal surgery was 25% and raised to 60% for severe RPD. In our study, 29 newborns showed pathologic scintigraphies: 25 required surgery while 4 did not find indication for surgery due to ipsilateral renal function irreversible damage. 6 patients had high creatinine level (>0.6 mg/dl). 35 cases out of 90 (39%) developed monolateral irreversible renal function impairment. CONCLUSION:Moderate and severe RPD are often correlated with postnatal renal damage, therefore a close multidisciplinary follow-up is required. Prenatal scanning is highly predictive of postnatal outcome and can address properly the prenatal counseling.
Keywords: Fetal, severe pyelectasis, prenatal ultrasound, postnatal outcome, renal
function
