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Abstract
Objectives Antenatal renal pelvis dilatation (ARPD) occurs in 1–2% of pregnancies,1 most cases resolving spontaneously without complications.2 Postnatal interventions are costly and time-consuming for healthcare professionals and families, not to mention the psychological burden of a baby with the label of a congenital malformation. We aim to assess current management practices across the UK and potential over-investigation of low-risk cases. Results would also be used as a scoping exercise for development of a standardised national guideline.
Methods We created a survey to evaluate practice in diagnosis, investigation and management of ARPD across UK neonatal units. Questions included thresholds for renal ultrasounds, scan timings, indications for radioisotope scans and use of antibiotic prophylaxis.
We disseminated the survey via network links and group emails to Paediatricians across the UK.
Results 31 responses covered the practice of 48 UK neonatal units, as some were regional guidelines. All units used departmental or regional guidelines.
41% of units (n=13) use all available antenatal scans from 20 weeks gestation, 31% (n=10) focus solely on 20-week scans, and 19% (n=5) use 32-week scans to guide postnatal management. 2 units use most recent scans and one uses the highest value of ARPD. 2 responders highlighted the value of serial scanning and rate of progression in determining postnatal investigations.
A 10mm unilateral renal pelvis is the threshold for initiation of postnatal investigations in 59% (n=17) of units, 24% (n=7) have a 7mm cut-off, with the remaining 17% (n=5) using 5–8mm.
In bilateral ARPD, 43% (n=13) use 10mm, 37% (n=11) use 7mm and the remaining 17% (n=5) use a 5–8mm cut-off (Chart 1). One unit investigates all bilateral involvement regardless of diameter.
Unilateral vs. Bilateral ARPD thresholds for postnatal investigation
50% of units (n=13) scan within 4 weeks for unilateral ARPD, whilst 32% (n=9) scan at 4–6 weeks. Bilateral ARPD scans are mostly <1 week (86%, n=18/21), with 48% (n=10/21) scanned <72hrs.
Most units (46%, n=12) discontinue surveillance <10mm, whilst 35% (n=9) use a 7mm cut-off. Antibiotic discontinuation was similar, though many units (29%, n=8) only give prophylaxis in high risk (Chart 2).
Value of RPD at which prophylactic antibiotics and monitoring are discontinued
Conclusion Our survey highlights huge variations in defining ARPD, thresholds and timeframes for investigation and use of antibiotics. This study underscores the need for standardisation to reduce unnecessary interventions, enhance focus on high-risk cases, and relieve outpatient and radiological pressures. We propose the development of a unified national guideline, in collaboration with nephro-urological networks, to establish safe thresholds for the management of infants with uncomplicated ARPD.
References
Gomella TL, Eyal FG, Bany-Mohammed F. Gomella’s Neonatology, 8th ed. McGraw Hill Professional, 2020.
Sidhu G, Beyene J, Rosenblum ND. Outcome of isolated antenatal hydronephrosis: A systematic review and meta-analysis. Pediatr. Nephrol 2006;21(2):218–224. doi: 10.1007/s00467-005-2100-9.