Fetal Hydronephrosis

With the pervasive use of fetal ultrasound, hydronephrosis is more often diagnosed prenatally. A dilated renal collecting system is often the only indication of a number of congenital uropathies (Ismaili et al., 2004). Two processes cause hydronephrosis, reverse urine flow (vesicoureteral reflux, VUR) and impaired forward urine flow (obstruction). VUR occurs as an isolated entity or can be associated with a more complicated uropathy, such as bladder outlet obstruction with VUR. Obstructive uropathy may occur at different sites along the urinary tract, most often the ureteropelvic junction

Infants with fetal hydronephrosis need an ultrasound in the first week of life. If normal, a repeat ultrasound should be done in 2 to 4 weeks because of the possibility of a false-negative study in the low urine flow state characteristic of the newborn (Becker and Avner, 1995). Once the diagnosis is confirmed, evaluation includes a urinalysis, urine culture, basic metabolic panel (if bilateral), and a VCUG. If the VCUG is normal, a furosemide renogram is needed to determine the presence and degree of obstruction.

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