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CUA: Antenatal hydronephrosis (2017): Difference between revisions

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==== Renal-bladder US (RBUS) ====
==== Renal-bladder US (RBUS) ====
* '''<span style="color:#ff0000">Verbatim (summary section): All significant AHN should be investigated with a postnatal RBUS. Most centres define significant AHN in the third trimester as APD ≥7 mm'''
* '''<span style="color:#ff0000">Indications (1)'''
** ''Verbatim (RBUS section): All children with AHN should have a complete abdominopelvic US, with particular attention to both the kidneys and bladder. [likely meant “significant” ANH rather than "all" patients]''
*#'''<span style="color:#ff0000">APD ≥7 mm in third trimester'''
* The RBUS should include assessment of cranio-caudal length of the kidneys, degree of echogenicity and corticomedullary differentiation, SFU grade of hydronephrosis, maximal APD on transverse axial view of the renal pelvis, diameter of both proximal and distal ureter if dilated, the degree of bladder filling, the detrusor thickness or presence of bladder trabeculation, diverticula, ureterocele, and posterior urethral dilation in males.
*#*'''<span style="color:#ff0000">Verbatim (summary section): All significant AHN should be investigated with a postnatal RBUS. Most centres define significant AHN in the third trimester as APD ≥7 mm'''
* '''A full bladder should prompt a period of observation with re-imaging post-void to assess for the capability to empty the bladder and to assess whether the HN improves post-void.'''
*#** ''Verbatim (RBUS section): All children with AHN should have a complete abdominopelvic US, with particular attention to both the kidneys and bladder. [likely meant “significant” ANH rather than "all" patients]''
* RBUS should include assessment of  
**Cranio-caudal length of the kidneys
**Degree of echogenicity and corticomedullary differentiation
**SFU grade of hydronephrosis
**Maximal APD on transverse axial view of the renal pelvis
**Diameter of both proximal and distal ureter if dilated
**Degree of bladder filling
**Detrusor thickness or presence of bladder trabeculation
**Diverticula
**Ureterocele
**Posterior urethral dilation in males.
* '''A full bladder should prompt a period of observation with re-imaging post-void to assess for the capability to empty the bladder and to assess whether the hydronephrosis improves post-void'''
* Fasting for a RBUS is unnecessary.
* Fasting for a RBUS is unnecessary.
* '''Timing (see below):'''
* '''Timing (see below):'''
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==== Voiding cysto-urethrography (VCUG) [or nuclear cystography] ====
==== Voiding cysto-urethrography (VCUG) [or nuclear cystography] ====
* '''The clinical utility of a VCUG in HGHN is to distinguish an obstructive cause of AHN from one due to VUR, not due to concern over UTI'''
* '''Goal is to distinguish an obstructive cause of AHN from VUR''', not due to concern over UTI
** '''On average, 16% of infants with ANH are found to have VUR, with 25% of such cases occurring in the non-dilated, contralateral renal unit.'''
** ≈'''16% of infants with ANH are found to have VUR, with 25% of such cases occurring in the non-dilated, contralateral renal unit.'''
* '''Steps to VCUG'''
*# '''A scout view''' for assessment of spine anomalies, presence of significant constipation or urinary stones
*# '''Catheter is inserted'''
*#* '''A balloon catheter should not be used''', as the balloon can obscure the filling defect characteristic of a ureterocele.
*#* The amount of urine removed should be recorded and the urine sent for analysis and culture as indicated.
*#* The bladder should be gravity filled until the first void occurs, with recording of the bladder capacity.
*# '''Voiding views''' of the urethra with post-void views of the bladder.
*# '''Delayed imaging''' after the post-void image may be required if there is VUR into a dilated renal pelvis or ureter so as to assess for concomitant UPJO and UVJO
** '''A cyclical study with at least two fill and void cycles will increase the detection of VUR.'''
* '''Nuclear cystography is more sensitive than VCUG for VUR with less radiation exposure'''
* '''Nuclear cystography is more sensitive than VCUG for VUR with less radiation exposure'''
* '''Indications'''
* '''Indications'''
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**# '''Increased renal cortical echogenicity''' (hyper-echogenicity)
**# '''Increased renal cortical echogenicity''' (hyper-echogenicity)
**# '''Renal cortical cysts'''
**# '''Renal cortical cysts'''
*'''Steps to VCUG'''
*# '''A scout view''' for assessment of spine anomalies, presence of significant constipation or urinary stones
*# '''Catheter is inserted'''
*#* '''A balloon catheter should not be used''', as the balloon can obscure the filling defect characteristic of a ureterocele.
*#* The amount of urine removed should be recorded and the urine sent for analysis and culture as indicated.
*#* The bladder should be gravity filled until the first void occurs, with recording of the bladder capacity.
*# '''Voiding views''' of the urethra with post-void views of the bladder.
*# '''Delayed imaging''' after the post-void image may be required if there is VUR into a dilated renal pelvis or ureter so as to assess for concomitant UPJO and UVJO
** '''A cyclical study with at least two fill and void cycles will increase the detection of VUR.'''
*
**#


==== Diuretic renography ====
==== Diuretic renography ====
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