Evaluation of infants with prenatally diagnosed hydronephrosis: Determining timing of postnatal ultrasound and need for prophylactic antibiotics

This figure summarizes our suggested approach to the initial evaluation and management of infants with prenatally diagnosed hydronephrosis. Postnatal evaluation is generally warranted if the prenatal ultrasound (performed in the 3^rd trimester) had a minimum RPD of 10 mm. RPDs below this level are unlikely to be associated with CAKUT. For additional details, including the subsequent steps in the evaluation based on the findings of the postnatal ultrasound, refer to separate UpToDate content on hydronephrosis and CAKUTs.

CAKUT: congenital anomalies of the kidney and urinary tract; RPD: renal pelvic diameter; UPJ: ureteral pelvic junction.

* The role of prophylactic antibiotics in infants undergoing diagnostic evaluation for prenatally diagnosed hydronephrosis remains uncertain. In our practice, we reserve antibiotic prophylaxis for patients with bilateral ureteral dilation, an enlarged or thickened bladder, bilateral UPJ obstruction, or giant hydronephrosis (massively enlarged kidney with RPD >30 mm). We do not administer antibiotic prophylaxis if the hydronephrosis is low to moderate grade or if the ultrasound findings suggest classic unilateral UPJ-type obstruction (unilateral hydronephrosis with nondilated ureter, normal bladder, and normal contralateral kidney). Other centers provide prophylactic antibiotics for moderate hydronephrosis (ie, RPD between 10 to 15 mm).

Graphic 69172 Version 15.0

خرید پکیج

Evaluation of infants with prenatally diagnosed hydronephrosis: Determining timing of postnatal ultrasound and need for prophylactic antibiotics