The 4 year outcome following the demonstration of bilateral renal pelvic dilatation on pre-natal renal ultrasound

There is little in the literature regarding long-term prognosis in cases of fetal pyelectasis and calyceal dilatation. The aim of this study was to co rrelate antenatal ultrasound findings with outcome in a large group of chil dren, most of whom had routine antenatal mid-trimester scans. 75 babies wit h bilateral pyelectasis and calyceal dilatation in the pre-natal period and complete radiological and clinical data were identified over a 3 year peri od. Pre-natal ultrasound was correlated with results of post-natal investig ation and the frequency of post-natal surgery was established. Follow-up wa s documented to discharge or to at least 4 years of age. Prognosis was rela ted to the degree of pelvic dilatation, but neonatal morbidity was much mor e likely to be associated with prenatal calyceal dilatation and/or hydroure ter. 68% (51 of 75) of babies had insignificant abnormalities on post-natal investigation, defined as either transient fetal pyelectasis and calyceal dilatation, extrarenal pelves, or transient neonatal pyelectasis and calyce al dilatation. Five babies died in the neonatal period, all classified as e ither moderate or severe disease. Of the surviving 70 cases (93.3%), 27% ha d renal anomalies that required treatment by prophylactic antibiotics or su rgery. The remaining babies were conservatively managed and followed as out patients. One child required transplantation and a further two had a severe degree of chronic renal failure by the age of 4 years. These data will be of value in prospective counselling.