Postnatal outcome and natural history of antenatally-detected hydronephrosis

Routine maternal ultrasonography (US) has revealed a very high incidence of fetal hydronephrosis (HDN), the postnatal outcome and management protocols of which are replete with controversies. Pelviureteric junction (PUJ) obst ruction is the commonest postnatal diagnosis, and its management has no con sensus to date. This study was carried out to define the postnatal outcome and natural history of fetal HDN and to identify the mode of management to be adopted to the best advantage. All patients were subjected to US 48 h po stnatally or at first presentation and isotope renography (DTPA) with nucle ar glomerular filtration rate (GFR) was carried out at 3-4 weeks of age or at presentation. Micturating cystourethrography (MCU) and/or direct radionu clide cystography (DRCG) were done in cases with bilateral HDN, nonobstruct ive HDN, dilated ureter on US, and recurrent urinary tract infection. Patie nts were then grouped for surgical intervention or conservative follow-up. Investigations were repeated periodically. A total of 56 patients were regi stered for the study (78 renal units) with a mean follow-up period of 14.6 months; 37 renal units were operated upon or scheduled for surgery and 67 h ad some organic pathology, of which PUJ obstruction was the commonest. Amon g patients with PUJ obstruction, indications for surgery included symptoms, a palpable mass, poor or deteriorating function, and a solitary functionin g kidney. Patients operated upon showed improvement in function and/or drai nage, while those followed conservatively remained stable or improved. Cont roversy still exists as to the optimal management of PUJ obstruction detect ed antenatally. While it is the commonest postnatal diagnosis, many other p athologies are now being encountered. In antenatally-diagnosed HDN, there i s a good scope for conservative management provided rigid follow-up can be ensured, especially because a good recovery potential exists followed surge ry whenever indicated.