The shape of the kidney pelvis in the fetus with hydronephrosis grade III as a predictor of surgical treatment in postnatal period

Abstract

BACKGROUND: Fetal hydronephrosis is one of the most common malformations of the urinary system. The main goal of prenatal diagnostics is to identify a risk group with a dilatation of the renal collecting system due to mechanical obstruction of the pelvic-ureteral segment.

AIM: The aim of the study is to definition of a prenatal risk group with a high probability of early surgical intervention in the postnatal period based on an assessment of the predictor properties of the pelvis shape in hydronephrosis grade III.

MATERIALS AND METHODS: A prospective analysis of the results of prenatal ultrasound examination of 77 fetuses (82 renal units) with grade III hydronephrosis (SFU classification) was carried out. The anteroposterior diameter of the pelvis was measured in millimeters at the level of the kidney gate. With the ellipsoid shape of the pelvis, the compression ratio of the ellipse was calculated as the ratio of the small semi-axis of the ellipse to its large semi-axis. All parameters were recorded in the third trimester of pregnancy. The study included cases of hydronephrosis with parenchymal thickness not differing by more than two sigma deviations from the standard value. The first ultrasound examination in the postnatal period was performed during the first month of life and then at 3, 6 and 12 months.

RESULTS: Prenatally, 57 kidneys had an elliptical pelvis and 25 funnel-shaped. The anteroposterior diameter of ellipsoid (16.5 [13; 20]) and funnel-shaped pelvis (15.0 [13; 17.8]) did not differ statistically significantly (p = 0.39). 36 (43.9%) patients were operated on, 29 of them were operated at the age of 1–3 months, due to the increase in APD from 17.5±6.0 to 27.9±8.2 (p = 0.001) and the transition of hydronephrosis to the IV degree by 1 month of life. The remaining 7 children had gradual progression of hydronephrosis and were operated at the age of 12 months and older. In 56.1%, resolution, regression or stabilization of hydronephrosis were noted during dynamic observation lasting 1 year. With a single-variant analysis, it was found that the configuration of the pelvis and the compression ratio of the ellipse statistically significantly correctly predicted the progression of hydronephrosis and the probability of surgery at 69.5% and 80.5%, respectively. At the same time, the compression ratio had a higher sensitivity and specificity.

CONCLUSIONS: Fetal hydronephrosis with a funnel-shaped configuration of the pelvis, has a functional nature and regresses after birth during the first year of life. The antenatal ellipsoid configuration of the pelvis, approaching the circumference, is a statistically significant predictor of surgical intervention due to the progression of hydronephrosis due to external causes of obstruction.

Keywords

hydronephrosis / prenatal diagnosis / predictors of surgical treatment / children

References

[1] Livera LN, Brookfield DS, Egginton JA, Hawnaur JM. Antenatal ultrasonography to detect fetal renal abnormalities: a prospective screening programme. BMJ. 1989;298(6685):1421–1423. DOI: 10.1136/bmj.298.6685.1421

[2] Livera L.N., Brookfield D.S., Egginton J.A., Hawnaur J.M. Antenatal ultrasonography to detect fetal renal abnormalities: a prospective screening programme // BMJ. 1989. Vol. 298, No. 6685. P. 1421–1423. DOI: 10.1136/bmj.298.6685.1421

[3] Zhang D, Sun X, Chen X, et al. Ultrasound evaluation for prediction of outcomes and surgical decision in fetal hydronephrosis. Exp Ther Med. 2019;18(2):1399–1406. DOI: 10.3892/etm.2019.7683

[4] Zhang D., Sun X., Chen X., et al. Ultrasound evaluation for prediction of outcomes and surgical decision in fetal hydronephrosis // Exp Ther Med. 2019. Vol. 18, No. 2. P. 1399–1406. DOI: 10.3892/etm.2019.7683

[5] Babu R, Rathish VR, Sai V. Functional outcomes of early versus delayed pyeloplasty in prenatally diagnosed pelvi-ureteric junction obstruction. J Pediatr Urol. 2015;11(2):63.e1–e5. DOI: 10.1016/j.jpurol.2014.10.007

[6] Babu R., Rathish V.R., Sai V. Functional outcomes of early versus delayed pyeloplasty in prenatally diagnosed pelvi-ureteric junction obstruction // J Pediatr Urol. 2015. Vol. 11, No. 2. P. 63.e1–e5. DOI: 10.1016/j.jpurol.2014.10.007

[7] Yudina EV, Gel’dt VG, Kuzovleva GI. Znachenie kompleksnogo ul’trazvukovogo obsledovaniya v otsenke krovoobrashcheniya pochek ploda v norme i pri obstruktivnykh uropatiyakh. Prenatal’naya Diagnostika. 2007;(4):291–296. (In Russ.)

[8] Юдина Е.В., Гельдт В.Г., Кузовлева Г.И. Значение комплексного ультразвукового обследования в оценке кровообращения почек плода в норме и при обструктивных уропатиях // Пренатальная диагностика. 2007. № 4. С. 291–296.

[9] Sairam S, Al-Habib A, Sasson S, Thilaganathan B. Natural history of fetal hydronephrosis diagnosed on mid-trimester ultrasound. Ultrasound Obstet Gynecol. 2001;17(3):191–196. DOI: 10.1046/j.1469-0705.2001.00333.x

[10] Sairam S., Al-Habib A., Sasson S., Thilaganathan B. Natural history of fetal hydronephrosis diagnosed on mid-trimester ultrasound // Ultrasound Obstet Gynecol. 2001. Vol. 17, No. 3. P. 191–196. DOI: 10.1046/j.1469-0705.2001.00333.x

[11] Zhan X, Tao G, Cheng L, et al. Ultrasound score: a new method to differentiate fetal physiological and pathological hydronephrosis. Eur J Obstet Gynecol Reprod Biol. 2010;151(1):26–32. DOI: 10.1016/j.ejogrb.2010.02.046

[12] Zhan X., Tao G., Cheng L., et al. Ultrasound score: a new method to differentiate fetal physiological and pathological hydronephrosis // Eur J Obstet Gynecol Reprod Biol. 2010. Vol. 151, No. 1. P. 26–32. DOI: 10.1016/j.ejogrb.2010.02.046

[13] Bassanese G, Travan L, D’Ottavio G, et al. Prenatal anteroposterior pelvic diameter cutoffs for postnatal referral for isolated pyelectasis and hydronephrosis: more is not always better. J Urol. 2013;190(5):1858–1863. DOI: 10.1016/j.juro.2013.05.038

[14] Bassanese G., Travan L., D’Ottavio G., et al. Prenatal anteroposterior pelvic diameter cutoffs for postnatal referral for isolated pyelectasis and hydronephrosis: more is not always better // J Urol. 2013. Vol. 190, No. 5. P. 1858–1863. DOI: 10.1016/j.juro.2013.05.038

[15] Johnston JH. The pathogenesis of hydronephrosis in children. Br J Urol. 1969;41(6):724–734. DOI: 10.1111/j.1464-410x.1969.tb09985.x

[16] Johnston J.H. The pathogenesis of hydronephrosis in children // Br J Urol. 1969. Vol. 41, No. 6. P. 724–734. DOI: 10.1111/j.1464-410x.1969.tb09985.x

[17] Koff SA, Hayden LJ, Cirulli C, Shore R. Pathophysiology of ureteropelvic junction obstruction: experimental and clinical observations. J Urol. 1986;136(1 Pt 2):336–338. DOI: 10.1016/s0022-5347(17)44859-2

[18] Koff S.A., Hayden L.J., Cirulli C., Shore R. Pathophysiology of ureteropelvic junction obstruction: experimental and clinical observations // J Urol. 1986. Vol. 136, No. 1 Pt 2. P. 336–338. DOI: 10.1016/s0022-5347(17)44859-2

[19] Babu R, Vittalraj P, Sundaram S, Shalini S. Pathological changes in ureterovesical and ureteropelvic junction obstruction explained by fetal ureter histology. J Pediatr Urol. 2019;15(3):240.e1–240.e7. DOI: 10.1016/j.jpurol.2019.02.001

[20] Babu R., Vittalraj P., Sundaram S., Shalini S. Pathological changes in ureterovesical and ureteropelvic junction obstruction explained by fetal ureter histology // J Pediatr Urol. 2019. Vol. 15, No. 3. P. 240.e1–240.e7. DOI: 10.1016/j.jpurol.2019.02.001

[21] Kiener TA, Wohlmuth C, Schimke C, et al. Ultrasound markers in fetal hydronephrosis to predict postnatal surgery. Ultraschall Med. 2020;41(3):278–285. DOI: 10.1055/a-0591-3303

[22] Kiener T.A., Wohlmuth C., Schimke C., et al. Ultrasound markers in fetal hydronephrosis to predict postnatal surgery // Ultraschall Med. 2020. Vol. 41, No. 3. P. 278–285. DOI: 10.1055/a-0591-3303

[23] Sidhu G, Beyene J, Rosenblum ND. Outcome of isolated antenatal hydronephrosis: a systematic review and meta-analysis. Pediatr Nephrol. 2006;21(2):218–224. DOI: 10.1007/s00467-005-2100-9

[24] Sidhu G., Beyene J., Rosenblum N.D. Outcome of isolated antenatal hydronephrosis: a systematic review and meta-analysis // Pediatr Nephrol. 2006. Vol. 21, No. 2. P. 218–224. DOI: 10.1007/s00467-005-2100-9

[25] Chalmers DJ, Meyers ML, Brodie KE, et al. Inter-rater reliability of the APD, SFU and UTD grading systems in fetal sonography and MRI. J Pediatr Urol. 2016;12(5):305.e1–305.e5. DOI: 10.1016/j.jpurol.2016.06.012

[26] Chalmers D.J., Meyers M.L., Brodie K.E., et al. Inter-rater reliability of the APD, SFU and UTD grading systems in fetal sonography and MRI // J Pediatr Urol. 2016. Vol. 12, No. 5. P. 305.e1–305.e5. DOI: 10.1016/j.jpurol.2016.06.012

[27] Rickard M, Easterbrook B, Kim S, et al. Six of one, half a dozen of the other: A measure of multidisciplinary inter/intra-rater reliability of the society for fetal urology and urinary tract dilation grading systems for hydronephrosis. J Pediatr Urol. 2017;13(1):80.e1–80.e5. DOI: 10.1016/j.jpurol.2016.09.005

[28] Rickard M., Easterbrook B., Kim S., et al. Six of one, half a dozen of the other: A measure of multidisciplinary inter/intra-rater reliability of the society for fetal urology and urinary tract dilation grading systems for hydronephrosis // J Pediatr Urol. 2017. Vol. 13, No. 1. P. 80.e1–80.e5. DOI: 10.1016/j.jpurol.2016.09.005

[29] Lee RS, Cendron M, Kinnamon DD, Nguyen HT. Antenatal hydronephrosis as a predictor of postnatal outcome: a meta-analysis. Pediatrics. 2006;118(2):586–593. DOI: 10.1542/peds.2006-0120

[30] Lee R.S., Cendron M., Kinnamon D.D., Nguyen H.T. Antenatal hydronephrosis as a predictor of postnatal outcome: a meta-analysis // Pediatrics. 2006. Vol. 118, No. 2. P. 586–593. DOI: 10.1542/peds.2006-0120

[31] Duin LK, Willekes C, Koster-Kamphuis L, et al. Fetal hydronephrosis: does adding an extra parameter improve detection of neonatal uropathies? J Matern Fetal Neonatal Med. 2012;25(7):920–923. DOI: 10.3109/14767058.2011.600365

[32] Duin L.K., Willekes C., Koster-Kamphuis L., et. al. Fetal hydronephrosis: does adding an extra parameter improve detection of neonatal uropathies? // J Matern Fetal Neonatal Med. 2012. Vol. 25, No. 7. P. 920–923. DOI: 10.3109/14767058.2011.600365

[33] Elmaci AM, Dönmez Mİ. Time to resolution of isolated antenatal hydronephrosis with anteroposterior diameter ≤20 mm. Eur J Pediatr. 2019;178(6):823–828. DOI: 10.1007/s00431-019-03359-y

[34] Elmaci A.M., Dönmez M.İ. Time to resolution of isolated antenatal hydronephrosis with anteroposterior diameter ≤20 mm // Eur J Pediatr. 2019. Vol. 178, No. 6. P. 823–828. DOI: 10.1007/s00431-019-03359-y

[35] Wollenberg A, Neuhaus TJ, Willi UV, Wisser J. Outcome of fetal renal pelvic dilatation diagnosed during the third trimester. Ultrasound Obstet Gynecol. 2005;25(5):483–488. DOI: 10.1002/uog.1879

[36] Wollenberg A., Neuhaus T.J., Willi U.V., Wisser J. Outcome of fetal renal pelvic dilatation diagnosed during the third trimester // Ultrasound Obstet Gynecol. 2005. Vol. 25, No. 5. P. 483–488. DOI: 10.1002/uog.1879

[37] Kim HJ, Jung HJ, Lee HY, et al. Diagnostic value of anteroposterior diameter of fetal renal pelvis during second and third trimesters in predicting postnatal surgery among Korean population: useful information for antenatal counseling. Urology. 2012;79(5):1132–1137. DOI: 10.1016/j.urology.2012.01.007

[38] Kim H.J., Jung H.J., Lee H.Y., et al. Diagnostic value of anteroposterior diameter of fetal renal pelvis during second and third trimesters in predicting postnatal surgery among Korean population: useful information for antenatal counseling // Urology. 2012. Vol. 79, No. 5. P. 1132–1137. DOI: 10.1016/j.urology.2012.01.007

[39] Nguyen HT, Benson CB, Bromley B, et al. Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). J Pediatr Urol. 2014;10(6):982–998. DOI: 10.1016/j.jpurol.2014.10.002

[40] Nguyen H.T., Benson C.B., Bromley B., et al. Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system) // J Pediatr Urol. 2014. Vol. 10, No. 6. P. 982–998. DOI: 10.1016/j.jpurol.2014.10.002

[41] Obukhov NS, Voronina EA, Danilyuk SA. Prenatal diagnosis and postnatal verification of obstructive uropathy among children in the first year of life. Vestnik Ural’skoi Meditsinskoi Akademicheskoi Nauki. 2016;(2):24–29. (In Russ.) DOI: 10.22138/2500-0918-2016- 14-2-24-29

[42] Обухов Н.С., Воронина Е.А., Данилюк С.А. Пренатальная диагностика и постнатальная верификация обструктивных уропатий у детей первого года жизни // Вестник уральской медицинской академической науки. 2016. № 2. C. 24–29. DOI: 10.22138/2500-0918-2016- 14-2-24-29

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