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Congenital hydronephrosis

Key sources
The following summarized guidelines for the evaluation and management of congenital hydronephrosis are prepared by our editorial team based on guidelines from the Pathway (Pathway 2023), the American College of Radiology (ACR 2023; 2020), the European Association of Urology (EAU/ESPU 2023), the Canadian Urological Association (CUA/PUC 2018), the American Urological Association (AUA 2017), and the American Academy of Pediatrics (AAP 2016).
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Guidelines

1.Classification and risk stratification

Assessment of antenatal hydronephrosis: classify the severity of antenatal hydronephrosis based on anteroposterior renal pelvic diameter:
Situation
Guidance
Mild
4-7 mm in the second trimester
7-9 mm in the third trimester
Moderate
7-10 mm in the second trimester
9-15 mm in the third trimester
Severe
7-10 mm in the second trimester
> 15 mm in the third trimester
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2.Diagnostic investigations

Renal and bladder ultrasound: as per ACR 2023 guidelines, obtain renal and bladder ultrasound to evaluate for renal anomalies and hydronephrosis in patients aged < 2 months presenting with a first episode of febrile UTI with an appropriate response to medical management.
B

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  • Voiding cystourethrography

  • Diuretic renography

3.Medical management

Continuous antibiotic prophylaxis: as per EAU 2023 guidelines, initiate continuous antibiotic prophylaxis to the subgroup of infants with antenatal hydronephrosis at high risk of developing UTIs, such as uncircumcised infants, as well as in case of hydroureteronephrosis and high-grade hydronephrosis.
B

4.Surgical interventions

Indications for surgery: decide on surgical intervention based on the time course of the hydronephrosis and the impairment of renal function.
B
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5.Follow-up and surveillance

Serial imaging assessment: obtain a follow-up renal and bladder ultrasound in 1-6 months in infants with a normal postnatal ultrasound and an antenatal diagnosis of hydronephrosis.
B
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