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

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
PMID: 20524012
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Research groups Epidémiologie clinique (115)
Groupe Hanquinet Sylviane (radiologie neuro-diagnostique et neuro-interventionnelle en pédiatrie) (842)
Pathogénèse du syndrome néphrotique idiopathique de l'enfant (180)
(ISO format)
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. doi: 10.1007/s00467-010-1543-9 https://archive-ouverte.unige.ch/unige:20979

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Deposited on : 2012-05-23

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