Moderate and severe fetal pyelectasis: Correlation between prenatal aspects and postnatal outcome.
BACKGROUND
Renal pelvic dilatation (RPD) is a frequent finding in fetal ultrasound. The aim of the study is to correlate the prenatally detected moderate and severe pyelectasis with the postnatal outcome.


METHODS
A retrospective analysis involving 90 cases of prenatally detected moderate and severe RPD referred to our prenatal diagnosis centre with 18 months of urological follow-up. Prenatal ultrasound was correlated with postnatal renal function, assessed by plasmatic creatinine and/or renal scintigraphy performed before surgery.


RESULTS
Cases were divided between two groups according to postnatal management: group A including 35 newborns (38.9%) that needed surgical treatment and group B with 55 patients (61.1%) who were managed conservatively. The group A presented higher median RPD (18 mm, IQR 12-25 mm) compared to the group B (11 mm, IQR 10-14 mm). The most common anomaly detected within group A was pelvi-ureteric junction (PUI) obstruction (43%). Within group B 32 cases (58%) showed spontaneous resolution of hydronephrosis during postnatal follow up. In case of moderate pyelectasis the risk of postnatal surgery was 25% and raised to 60% for severe RPD. In our study, 29 newborns showed pathologic scintigraphies: 25 required surgery while 4 did not find indication for surgery due to ipsilateral renal function irreversible damage. 6 patients had high creatinine level (>0.6 mg/dl). 35 cases out of 90 (39%) developed monolateral irreversible renal function impairment.


CONCLUSION
Moderate and severe RPD are often correlated with postnatal renal damage, therefore a close multidisciplinary follow-up is required. Prenatal scanning is highly predictive of postnatal outcome and can address properly the prenatal counseling.
['Loardi|C|C|', 'Signorelli|M|M|', 'Gregorini|M|M|', 'Marella|D|D|', 'Torri|F|F|', 'Zambelloni|C Mario|CM|', 'Omodei|U|U|', 'Odicino|F|F|']
D000072700:Conservative Treatment D003404:Creatinine D005260:Female D006801:Humans D006869:Hydronephrosis D007231:Infant, Newborn D007682:Kidney Pelvis D008297:Male D011247:Pregnancy D058536:Pyelectasis D011877:Radionuclide Imaging D012075:Remission, Spontaneous D051437:Renal Insufficiency D012189:Retrospective Studies D012720:Severity of Illness Index D000075529:Solitary Kidney D016216:Ultrasonography, Prenatal D014513:Ureter D014517:Ureteral Obstruction D014525:Urethral Stricture D014564:Urogenital Abnormalities D013520:Urologic Surgical Procedures D014718:Vesico-Ureteral Reflux
Fetal postnatal outcome severe pyelectasis prenatal ultrasound renal 
function