Document Detail


Mild fetal renal pelvis dilatation: much ado about nothing?
MedLine Citation:
PMID:  18987299     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Renal pelvis dilatation (RPD) occurs in 1% of fetuses. Severe RPD (>15 mm) is frequently associated with urinary tract pathology. For the majority with mild (5 to 9 mm) to moderate (10 to 15 mm) RPD, however, there is uncertainty about the risk of abnormalities and how much postnatal investigation is required. Study design: Systematic review of cohort studies of fetuses with RPD < or = 15 mm and metaregression to estimate risks of postnatal RPD, obstruction, and VUR.
RESULTS: Of 506 potentially relevant papers, 18 met the inclusion criteria. Risk of postnatal RPD increased with fetal RP size and earlier gestation. Odds ratios for postnatal RPD doubled per millimeter increase in fetal RP size: At 20 wk gestation, for example, 18% of fetuses with mean RP of 6 mm were estimated to have persistent postnatal RPD, compared with 95% of fetuses with 12 mm RPD, but risks were decreased by 16% to 18% per week of presentation gestation. Estimated risks of obstruction and VUR were substantially lower, particularly in the mild group such as the 6 mm example above: obstruction 2%, VUR 4%.
CONCLUSIONS: Our novel risk estimates are useful for antenatal counseling at presentation. The low frequency of obstruction/VUR in mild RPD raises questions over the most appropriate investigation of these cases but further data are required before establishing definitive postnatal management pathways. We suggest the need for a large prospective multicenter study to collect individual patient parameters/results and search for additional prognostic indicators.
Authors:
Daljit K Hothi; Angie S Wade; Ruth Gilbert; Paul J D Winyard
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review     Date:  2008-11-05
Journal Detail:
Title:  Clinical journal of the American Society of Nephrology : CJASN     Volume:  4     ISSN:  1555-905X     ISO Abbreviation:  Clin J Am Soc Nephrol     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-01-14     Completed Date:  2009-04-10     Revised Date:  2013-06-04    
Medline Journal Info:
Nlm Unique ID:  101271570     Medline TA:  Clin J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  168-77     Citation Subset:  IM    
Affiliation:
Nephro-Urology Unit, University College London Institute of Child Health, London, UK.
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MeSH Terms
Descriptor/Qualifier:
Counseling
Dilatation, Pathologic
Female
Gestational Age
Humans
Kidney Diseases / embryology*
Kidney Pelvis / embryology*,  ultrasonography
Odds Ratio
Pregnancy
Risk Assessment
Risk Factors
Severity of Illness Index
Ultrasonography, Prenatal
Ureteral Obstruction / embryology*,  ultrasonography
Vesico-Ureteral Reflux / embryology*,  ultrasonography
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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