Hydronephrosis
What is it?
Dilatation of the collecting system of the kidney observed in the standard transverse view of the abdomen. Ureters and bladder are normal.
On the basis of the anteroposterior diameter of the pelvis the condition is divided into:
Mild (only renal pelvis): 4-7 mm in the 2nd trimester; 7-9 mm in the 3rd.
Moderate (pelvis and calyces): 8-10 mm in the 2nd trimester; 10-15 mm in the 3rd.
Severe (cortical thinning): >10 mm in the 2nd trimester; >15 mm in the 3rd. Associated abnormalities:
Chromosomal defects: low risk in isolated forms.
Abnormalities of the contralateral kidney: multicystic kidney, ectopia, renal agenesis.
Associated syndromes are found in 5% of cases.
Which are the symptoms?
This isolated foetal pathological condition is not associated with maternal morbid conditions.
How is it diagnosed?
Investigations:
Detailed ultrasound examination (especially of the contralateral kidney).
Karyotyping should be offered only if other markers are present.
Suggested exams
How is it treated?
Prognosis:
In the majority of cases, the condition remains stable or resolves in the neonatal period. In about 20% of cases, there may be an underlying ureteropelvic junction obstruction or vesicoureteric reflux that requires postnatal follow-up and possible surgery. Moderate hydronephrosis is usually progressive and in more than 50% of cases surgery is necessary during the first 2 years of life.
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