HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) All Versions of this Article: CJN.00810208v1 4/1/168    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hothi, D. K. Articles by Winyard, P. J. D. Search for Related Content PubMed PubMed Citation Articles by Hothi, D. K. Articles by Winyard, P. J. D.

Mild Fetal Renal Pelvis Dilatation—Much Ado About Nothing?

Daljit K. Hothi^*, Angie S. Wade, Ruth Gilbert, and Paul J. D. Winyard^*

^* Nephro-Urology Unit, Centre for Paediatric Epidemiology and Biostatistics, and Centre for Evidence-Based Child Health, University College London Institute of Child Health, London, United Kingdom

Correspondence: Paul Winyard, Nephro-Urology Unit, Institute of Child Health, UCL, 30 Guilford Street, London, WC1N 1EH, United Kingdom, Phone: 020 7905 2116; Fax: 020 7905 2133; E-mail: pwinyard{at}ich.ucl.ac.uk

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 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.