ANTENATAL HYDRONEPHROSIS - FETAL AND NEONATAL MANAGEMENT

As many as 1% of newborn infants have a prenatal diagnosis of hydronep hrosis or significant renal pelvic dilation. Hydronephrosis often is c aused by nonobstructive conditions. The likelihood of significant urol ogic pathology is directly related to the size of the fetal renal pelv is, and 90% with an anteroposterior diameter more than 2 cm need surge ry or long-term urologic medical care. Following delivery, antibiotic prophylaxis should be administered, and a renal sonogram and voiding c ystourethrogram should be obtained. If there is grade 3 or 4 hydroneph rosis, usually a diuretic renogram is recommended also. Pediatric urol ogic or pediatric nephrologic consultation usually is helpful in plann ing evaluation and treatment. Prenatal recognition of hydronephrosis a llows neonatal diagnosis and treatment of urologic pathology, preventi ng complications of pyelonephritis and obstruction.