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Title

Antenatal and postnatal ultrasound in the evaluation of the risk of vesicoureteral reflux

Authors
Parvex, Paloma
Published in Pediatric Nephrology. 2010, vol. 25, no. 9, p. 1687-1692
Collection Open Access - Licence nationale Springer
Abstract Antenatal hydronephrosis (ANH) is a frequent anomaly detected on fetal ultrasound scans. There is no consensus recommendation for the postnatal follow-up and/or the necessity to perform a voiding cystourethrography (VCUG) to diagnose vesicoureteral reflux (VUR). We conducted a cohort/non-randomized trial of 121 patients with ANH, defined as an anterior posterior diameter (APD) ≥ 5 mm after the 20th week of gestation, to evaluate the ability of the antenatal and postnatal ultrasonography results to predict VUR. All infants had two successive ultrasounds at 5 days and 1 month, respectively, after birth. A VCUG was performed at 6 weeks in children with a persistent APD ≥ 5 mm and/or an ureteral dilatation observed on at least one of two postnatal ultrasounds. In total, 88 patients had VCUG and nine had VUR, with five having high-grade reflux (>grade II). The risk of VUR increased significantly with the degree of APD detected on the postnatal ultrasound scan (p = 0.03). The odds ratios were 5.0 [95% confidence interval (CI) 0.5-51.2] for APD = 7-9 mm and 9.1 (95% CI 1.0-80.9) for APD ≥ 10 mm. The results of this study show that among our patient cohort antenatal ultrasound was not predictive of reflux. There was, however, a relation between the importance of the postnatal renal pelvis diameter and the risk of VUR. A cut-off of 7 mm showed a fair ability of ultrasonography to predict VUR and a cut-off of 10 mm enabled all severe refluxes in the 88 patients who had a VCUG to be diagnosed.
Keywords Disease ProgressionFemaleGestational AgeHumansHydronephrosis/complications/*ultrasonographyInfantInfant, NewbornMaleOdds RatioPredictive Value of TestsPregnancyProspective StudiesRisk AssessmentRisk FactorsSeverity of Illness IndexSwitzerland*Ultrasonography, PrenatalVesico-Ureteral Reflux/*etiology/radiography/ultrasonography
Identifiers
PMID: 20524012
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Structures
Research groups Pathogénèse du syndrome néphrotique idiopathique de l'enfant (180)
Groupe Hanquinet Sylviane (radiologie neuro-diagnostique et neuro-interventionnelle en pédiatrie) (842)
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GRAZIOLI, Serge et al. Antenatal and postnatal ultrasound in the evaluation of the risk of vesicoureteral reflux. In: Pediatric Nephrology, 2010, vol. 25, n° 9, p. 1687-1692. https://archive-ouverte.unige.ch/unige:20979

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Deposited on : 2012-05-23

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