Correlation between anteroposterior renal pelvic diameter and vesicoureteral reflux in congenital hydronephros

authors:

avatar Mostafa SharifianDorche , avatar Nasrin Esfandiar ORCID , * , avatar Mohamad Rahdar , avatar Shamsollah Noripour ORCID

Koomesh: Vol.23, issue 2; 227-232
published online: May 01, 2021
article type: issue_documents_importer
received: December 01, 2019
accepted: September 01, 2020

how to cite: SharifianDorche M, Esfandiar N, Rahdar M, Noripour S . Correlation between anteroposterior renal pelvic diameter and vesicoureteral reflux in congenital hydronephros. koomesh. 2021;23(2):e153260. 

Abstract

Introduction: One of the most common findings in prenatal evaluation is congenital hydronephrosis. The correct diagnosis is of great value. This study was conducted to find the correlation between Anteroposterior Renal Pelvic Diameter (APD), which is detected by postnatal ultrasonography, and Vesicoureteral Reflux (VUR) in neonates and infants with congenital hydronephrosis. Therefore, this study was accompolish to determine whether invasive imaging such as voiding cystourethrography (VCUG) can be avoided especially in mild hydronephrosis. This imaging causes concern and anxiety for parents because of insertion of urinary catheter and radiation exposure of patients. Materials and Methods: In this study, neonates or infants with postnatally confirmed congenital hydronephrosis, referred to nephrology clinic during 2016-2018, were included. They were examined by ultrasonography, and their APD was measured. Infants with hydronephrosis persisting after birth underwent VCUG. Results: Out of 122 cases, 99 cases (81.1%) were male. Thirty-four cases with VUR (28 male) were detected. Mean APD in patients with VUR and without VUR was 19.51±12.50 and 12.15±5.68 respectively, which showed a significant difference between two groups (P value of 0.012). No correlation between grade of VUR and APD was found (P = 0.301). In addition, ROC curve showed that APD could be an acceptable variable for predicting VUR in male cases (AUC: 0.738 and P = 0.003). The best cut-of-point for APD predicting VUR in male cases was 10.5 mm (sensitivity: 76.8% and specificity: 52.9%). Conclusion: Postnatal APD in ultrasonography has a significant correlation with the presence of the VUR in male cases.  

References

  • 1.

    Shokeir A, Nijman R. Antenatal hydronephrosis: changing concepts in diagnosis and subsequent management. Br Urol Int 2000; 85: 987-994.

  • 2.

    Sharifian M, Esfandiar N, Mohkam M, Dalirani R, BabanTaher E, Akhlaghi A. Diagnostic accuracy of renal pelvic dilatation in determining outcome of congenital hydronephrosis. Iran J Kidney Dis 2014; 8: 26-30.##.

  • 3.

    Woodward M, Frank D. Postnatal management hydronephrosis. BJU Int 2002; 89: 149-156.

  • 4.

    Fernbach SK, Maizels M, Conway JJ. Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr Radiol 1993; 23: 478-480.

  • 5.

    Toiviainen-Salo S, Garel L, Grignon A, Dubois J, Rypens F, Boisvert J, et al. Fetal hydronephrosis: is there hope for consensus? Pediatr Radiol 2004; 34: 519-529.

  • 6.

    Diamond DA. Lee RS. Clinical perinatal urology. Pediatr Nephrol 2016; 97-112.

  • 7.

    Cordero K, Nankervis CA, oshaughnessy RW, Koff SA, Giannome PJ. Postnatal follow up of antentalhydronephrosis: a health care challenge. J Perinatol 2009; 29: 382-387.

  • 8.

    Lee RS, Cendron M, Kinnamon DD, Nguyen HT. Antenatal hydronephrosis as a predictor of postnatal outcome: a meta-analysis. Pediatrics 2006; 118: 586-593.

  • 9.

    Ylinen E, Ala-Houhala M, Wikstrom S. Outcome of patients with antenatally detected pelviureteric junction obstruction. Pediatr Nephrol 2004; 19: 880-887.

  • 10.

    Ismaili K, Avni FE, Wissing KM, Hall M. Long-term clinical outcome of infants with mild and moderate fetal pyelectasis: validation of neonatal ultrasound as a screening tool to detect significant nephrouropathies. J Pediatrics 2004; 144: 759-765.

  • 11.

    Yalcinkaya F, Ozcakar ZB. "Management of antenatal hydronephrosis". Pediatr Nephrol 2020; 35: 2231-2239.

  • 12.

    Lidefelt KJ, Herthelius M, Soeria-Atmadja S. Antenatal renal pelvis dilatation: 2-year follow-up with DMSA scintigraphy. Pediatr Nephrol 2009; 24: 533-536.

  • 13.

    Asl AS, Maleknejad S. "Clinical outcome and follow-up of prenatal hydronephrosis." Saudi J Kidney Dis Transpl 2012; 23: 526-531.

  • 14.

    Becker AM. Postnatal evaluation of infants with an abnormal antenatal renal sonogram. Curr Opin Pediatr 2009; 21: 207-213.

  • 15.

    Ebrahimi S. Comparison of renal ultrasound and voiding cystourethrography (VCUG) in the detection of vesicoureteral reflux. Galen Med J 2013; 2: 54-59.

  • 16.

    Frimberger D, Mercado-Deane MG. "Establishing a standard protocol for the voiding cystourethrography". Pediatrics 2016; 138: 2016-2590.

  • 17.

    Alsaef A, Alsadoun F, Alsaif A, Masudi E, Ali K, Alsaif S, Ahmed E. "Value of screening for vesicoureteral reflux in infants with antenatal hydronephrosis in king abdulaziz medical city-Riyadh". J Clin Neonatol 2019; 8: 24-27.##https://doi.org/10.4103/jcn.JCN_75_18.

  • 18.

    Sadeghi-Bojd S, Kajbafzadeh AM, Ansari-Moghadam A, Rashidi S. "Postnatal evaluation and outcome of prenatal hydronephrosis". Iran J Pediatr 2016; 26: e3667.

  • 19.

    Phan V, Traubici J, Hershenield B, Stephens D, Rosenblum ND, Geary DF. Vesicoureteral reflux in infants with isolated antenatal hydronephrosis. Pediatr Nephrol 2003; 18: 1224-1228.

  • 20.

    Ismaili K, Avni FE, Hall M. Results of systematic voiding cystourethrography in infants with antenatally detected renal pelvic dilation. J Pediatr 2002; 141: 21.

  • 21.

    Brophy MM, Austin PF, Yan Y, Coplen DE. Vesicoureteral reflux and clinical outcomes in infants with prenatally detected hydronephrosis. J Urol 2002; 168: 1716.

  • 22.

    Grazioli S1, Parvex P, Merlini L, Combescure C, Girardin E. Antenatal and postnatal ultrasound in the evaluation of the risk of vesicoureteral reflux. Pediatr Nephrol 2010; 25: 1687-1692.

  • 23.

    Passerotti CC, Kalish LA, Chow J, Passerotti AM, Recabal P, Cendron M, et al. "The predictive value of the first postnatal ultrasound in children with antenatal hydronephrosis". J Pediatr Urol 2011; 7: 128-136.

  • 24.

    Lee NG, Rushton G, Peters CA, Groves DS, Pohl HG. "Evaluation of prenatal hydronephrosis: novel criteria for predicting vesicoureteral reflux on ultrasonography". J Urol 2014; 192: 914-918.

  • 25.

    Arlen AM, Cooper CS. "New trends in voiding cystourethrography and vesicoureteral reflux: Who, when and how?" Int J Urol 2019; 26: 440-445.