What is included in the long-term monitoring of hydronephrosis and hydroureter?

Updated: Dec 16, 2020
  • Author: Dennis G Lusaya, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Once the diagnosis is made and treatment is performed, follow-up imaging studies are necessary to assess for resolution of the hydronephrosis and hydroureter. Additionally, laboratory studies of renal function should be performed, to assess the recovery of renal function.

For ultrasonography follow-up, fetuses with mild hydronephrosis should have follow-up ultrasonography in the third trimester (32-34 wk gestation). The interval for follow-up examination and management is dictated by the initial findings and the amount of amniotic fluid. Those with resolution have a low risk of clinically significant pathology and do not need further antenatal or postnatal evaluation. Serial follow-up ultrasonography is indicated for fetuses with the following:

  • Moderate or severe hydronephrosis

  • Bilateral involvement

  • Progression and/or persistence of hydronephrosis

  • Normal amniotic fluid volume: Fetuses with unilateral involvement and normal amniotic fluid volume should have repeat prenatal ultrasonography examination at 32-34 weeks of gestation to evaluate and guide postnatal evaluation.

  • Bilateral hydronephrosis and normal amniotic fluid volume: These patients should have repeat ultrasonography examination 2-3 weeks after diagnosis to evaluate for progression and amniotic fluid volume. Follow-up examinations are determined according to the serial ultrasonography results.

For follow-up in older children with hydronephrosis, most protocols recommend serial monitoring with ultrasound and diuretic renography. Indications for surgery include worsening of hydronephrosis, lithiasis, recurrent infections, or deterioration of renal function. Although diuretic renography remains the gold standard for the diagnosis of obstructive hydronephrosis, the use of color Doppler ultrasound to determine hydronephrosis grading and the absence of ureteral jets offers an accurate and noninvasive option that can limit the need for renography. [43]


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