eMedicine Specialties > Pediatrics: Surgery > Urology

Antenatal Hydronephrosis: Follow-up

Author: Dennis B Liu, MD, Assistant Professor of Urology and Pediatrics, University of Toledo College of Medicine
Coauthor(s): John D Edmondson, MD, Consulting Staff, Virginia Urology Center
Contributor Information and Disclosures

Updated: Dec 11, 2008

Follow-up

Further Inpatient Care

  • A detailed description of situations that require further inpatient care is provided in Surgical Care. Briefly, fetuses with bilateral hydronephrosis, a distended bladder, and oligohydramnios require further evaluation in a tertiary care center.
  • Personnel and technology should be available to perform the necessary workup and offer intervention if this course of action is deemed appropriate.
  • Fetuses with milder forms of antenatal hydronephrosis (but still suggestive of a significant underlying pathologic cause) require immediate neonatal consultation with a pediatric urologist. This consultation can direct further inpatient workup or provide an outlet for outpatient monitoring.

Further Outpatient Care

  • Most neonates with antenatal hydronephrosis can be discharged to home provided that the inpatient evaluation does not preclude further evaluation or intervention in a hospital setting. Outpatient follow-up with the pediatric urologist depends on the diagnosis, which is summarized in Differentials. Evaluation and management of the neonate or infant in the outpatient setting is directed by the underlying cause of antenatal and postnatal hydronephrosis. Arranging appropriate follow-up with other subspecialties may also be necessary if the prenatal and postnatal evaluation warrants this type of management.
  • Typically, neonates with antenatal hydronephrosis are evaluated with postnatal ultrasonography.The optimal timing of the initial postnatal ultrasound is not important as long as repeat serial imaging is done. This is done to avoid underestimating the degree of hydronephrosis in a relatively dehydrated neonate.44 Postnatal ultrasonography 1-4 weeks after birth is recommended.

Inpatient & Outpatient Medications

  • The most common inpatient and/or outpatient medication prescribed in the setting of antenatally detected hydronephrosis persisting in the postnatal period is a prophylactic antibiotic against urinary tract infection. This medication is required to prevent urinary tract infections and possible renal damage that may result from pyelonephritis. This medication is not prescribed to all patients with hydronephrosis and is administered to patients based on the underlying cause of their hydronephrosis. Generally, a penicillin-based antibiotic is appropriate in this age group.

Transfer

Deterrence/Prevention

  • No identifiable prevention techniques are recognized for antenatal hydronephrosis.

Complications

  • Fetuses at highest risk of neonatal demise or pulmonary complications are those with bilateral hydronephrosis, a distended bladder, and oligohydramnios. These patients should be referred to a tertiary care center early in gestation. These neonates may require extensive cardiopulmonary support, as well as interventional support from a pediatric urologist early in the neonatal period.

Prognosis

  • Most neonates with antenatal hydronephrosis have an excellent prognosis. Prognosis is largely dependent on the underlying etiology of the dilated collecting system. Severe bilateral hydronephrosis that is associated with obstruction and oligohydramnios detected early in gestation is the best predictor of an adverse outcome.

Patient Education

  • Many fetuses have an excellent prognosis, and this should be communicated to the parents. If a fetus has ultrasonographic findings suggestive of an adverse outcome, discussing the implications and providing the parents with information regarding further evaluation and management of their pregnancy is important.

Miscellaneous

Medicolegal Pitfalls

  • Antenatal hydronephrosis is caused by physiologic and pathologic conditions that may or may not warrant close medical attention. The practitioner must make the appropriate decisions regarding evaluation and treatment of these underlying conditions. The medical field is well aware of the legal ramifications of missed diagnoses that result in harmful outcomes for patients, and this condition is no different.
 


More on Antenatal Hydronephrosis

Overview: Antenatal Hydronephrosis
Differential Diagnoses & Workup: Antenatal Hydronephrosis
Treatment & Medication: Antenatal Hydronephrosis
Follow-up: Antenatal Hydronephrosis
References
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Further Reading

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Keywords

antenatal hydronephrosis, congenital hydronephrosis, fetal hydronephrosis, urinary tract, ultrasonography, ultrasound, oligohydramnios, pyelonephritis, symptomatic flank pain, abdominal pain, renal calculi, hypertension, renal failure, pulmonary hypoplasia, nonrefluxing nonobstructed megaureter, prune belly syndrome, isolated antenatal hydronephrosis, IAHN

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Contributor Information and Disclosures

Author

Dennis B Liu, MD, Assistant Professor of Urology and Pediatrics, University of Toledo College of Medicine
Dennis B Liu, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Urological Association, Ohio Urological Society, Society for Fetal Urology, and Society for Pediatric Urology
Disclosure: Nothing to disclose.

Coauthor(s)

John D Edmondson, MD, Consulting Staff, Virginia Urology Center
John D Edmondson, MD is a member of the following medical societies: American College of Surgeons, American Urological Association, and Endourological Society
Disclosure: Nothing to disclose.

Medical Editor

Martin David Bomalaski, MD, FAAP, Pediatric Urologist, Alpine Urology
Martin David Bomalaski, MD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, and American Urological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Harry P Koo, MD, Chairman of Urology Division and Director of Pediatric Urology, Virginia Commonwealth University; Professor of Surgery, VCU School of Medicine, Medical College of Virginia; Director of Urology, Children's Hospital of Richmond
Harry P Koo, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, and American Urological Association
Disclosure: Nothing to disclose.

CME Editor

Paul D Petry, DO, FACOP, FAAP, Consulting Staff, Freeman Pediatric Care, Freeman Health System
Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association
Disclosure: Nothing to disclose.

Chief Editor

Marc Cendron, MD, Associate Professor of Surgery, Harvard School of Medicine; Consulting Staff, Department of Urological Surgery, Children's Hospital Boston
Marc Cendron, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, European Society for Paediatric Urology, Johns Hopkins Medical and Surgical Association, New Hampshire Medical Society, Society for Fetal Urology, and Society for Pediatric Urology
Disclosure: Nothing to disclose.

 
 
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