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Objective To investigate the long-term natural history of fetal hydronephrosis (FH) in a Chinese population, identify key prognostic factors, and optimize evidence-based postnatal management strategies using the Urinary Tract Dilation (UTD) classification system. Methods A hybrid retrospective-prospective cohort study was conducted among 49,097 pregnant women who received prenatal screening at Beijing Children’s Hospital Shunyi Women’s and Children’s Hospital between January 2010 and March 2020. A total of 2,263 fetuses were diagnosed with hydronephrosis and followed for 5 years. Prenatal ultrasound parameters (anteroposterior renal pelvic diameter [APD], renal parenchymal thickness, and A/R ratio) and postnatal outcomes (surgery, urinary tract infections, hypertension) were analyzed. Cases were stratified into UTD A1 (low-risk) and A2 ~ 3 (high-risk) groups. Statistical analyses included generalized linear mixed-effects models (GLMM), cumulative link mixed models (CLMM), and generalized linear models (GLM). Results The incidence of fetal hydronephrosis was 4.61% (2,263/49,097). Among these, 9.01% (204/2,263) were confirmed postnatally, and only 0.75% (17/2,263) required surgery. By the final assessment at the 5-year follow-up, hydronephrosis had resolved spontaneously in 97.39% (2,204/2,263) of cases, with persistence in only 59 (2.61%). Multivariate analysis identified left renal APD (OR = 22.05, 95% CI: 21.99–22.11, p  < 0.001) and left A/R ratio (OR = 22.39, 95% CI: 1.31–383.89, p  = 0.03) as independent predictors for surgery. All surgical cases were in the UTD A2 ~ 3 group, which showed significantly higher risks of postnatal hydronephrosis (OR = 8.26, p  < 0.001), persistence at 5 years (OR = 8.30, p  < 0.001), and clinical symptoms (OR = 20.57, p  < 0.001) compared to the UTD A1 group. Conclusion Most cases of fetal hydronephrosis resolve spontaneously without intervention. The UTD system effectively stratifies postnatal risk. For asymptomatic infants in the UTD A1 group, routine ultrasound within the first year of life is sufficient, reducing unnecessary early imaging and family anxiety. APD and A/R ratio are critical imaging predictors for surgical decision-making.

The aim of this study was to assess the efficacy of GFR measured using ROI from ultrasound technique in diuretic renography for evaluating postoperative outcomes in infants under one year old with congenital hydronephrosis. A retrospective analysis was conducted on thirty infants who underwent abdominal ultrasound and diuretic renography before and after surgery, obtaining preoperative and postoperative gGFRs and uGFRs (measured using ROI from ultrasound technique) determined using the Gates method and ultrasonic-assisted drawing ROI technique, respectively. A comparative study was performed on total GFR as well as individual kidney GFR before and after intervention. The preoperative and postoperative total and single uGFRs were significantly lower than gGFRs, while the postoperative total and single renal function, along with relative renal function in the hydronephrotic kidneys, were also significantly higher than the preoperative results ( p  < 0.05). Among 30 infants, 23 cases exhibited substantial recovery of renal function in their hydronephrotic kidneys after surgery, 2 cases did not show significant improvement, while 5 cases continued to experience deterioration in renal function. The GFR measured using ROI from ultrasound technique provides a more accurate assessment of renal function changes before and after surgery in infants under one year old with congenital hydronephrosis, facilitating an effective evaluation of postoperative treatment efficacy.

Knowledge about the prognosis for children born with congenital anomalies is important for counselling parents after a prenatal diagnosis. Nine population-based European Congenital Anomaly registries provided data on all children born 1995–2014 diagnosed with congenital hydronephrosis, multicystic kidney disease (MCKD), or posterior urethral valves (PUV) and on reference children from the same populations. Data up to 2015 on prescriptions, hospital diagnosis, and surgical procedures up to the 10th birthday were obtained by linkage to prescription and hospital databases. The study included 5624 children diagnosed with congenital hydronephrosis, 1314 with MCKD, and 414 with PUV. Children with hydronephrosis or MCKD were 13 times more likely to have prescriptions for antihypertensives compared to reference children before 10 years of age. Around 3% of children with congenital hydronephrosis or MCKD had a diagnosis of kidney failure at the age of 5 years; however, only 1% had a kidney transplantation by the age of 5 years. For children with PUV, 18.3% had a diagnosis of kidney failure and 5% had a kidney transplantation by the age of 5 years. Conclusion : Children born with congenital hydronephrosis and MCKD generally have a low absolute risk of developing kidney failure. Children with PUV have much higher morbidity, with 1 in 5 (18.3%) being diagnosed with kidney failure before the age of 5 years. It is important to monitor these children closely in early childhood in order to prevent or delay kidney failure. What is Known: • Congenital kidney anomalies are a leading cause of pediatric end-stage kidney disease. Children with hydronephrosis, MCKD, and PUV have increased morbidity, but long-term data on medication use and kidney outcomes are limited. What is New: • This population-based study shows a low absolute risk of kidney failure in children born with hydronephrosis or MCKD but a high relative risk. PUV has high morbidity, with 1 in 4 developing kidney failure by age 10. Antibiotic use is high in early childhood, and antihypertensive use increases with age.

Over recent years routine ultrasound scanning has identified increasing numbers of neonates as having hydronephrosis and pelvi-ureteric junction obstruction (PUJO). This patient group presents a diagnostic and management challenge for paediatric nephrologists and urologists. In this review we consider the known molecular mechanisms underpinning PUJO and review the potential of utilising this information to develop novel therapeutics and diagnostic biomarkers to improve the care of children with this disorder.

To discuss the application value of technologies such as chromosome microarray analysis (CMA) in fetuses with hydronephrosis and pyelectasis. Retrospectively collected the prenatal diagnostic data of 83 fetuses with hydronephrosis from January 2020 to July 2024. The positive rate of chromosomal abnormalities detected by different ultrasound abnormalities was statistically analyzed. Among the 83 pregnant women, 10 cases of abnormal karyotypes were detected by invasive prenatal diagnosis, with an abnormality rate of 12.05%. Numerical chromosomal abnormalities accounted for 90%, mainly trisomy 21 and 13. In the fetuses with normal karyotype/no abnormality, CMA additionally detected 15 copy number variations (CNVs) in 12 cases. Divided into isolated hydronephrosis and non-isolated hydronephrosis groups, the detection rates of fetuses carrying pathogenic CNVs were 5.56% and 12.77% respectively, and the detection rates of fetuses carrying variants of uncertain significance (VUS) were 19.44% and 8.51% respectively. Still, the differences between the two groups were not statistically significant (P > 0.05). Divided into moderate to severe hydronephrosis group and mild hydronephrosis group, the detection rate of pathogenic abnormalities by CMA was 10% and 37.21% respectively, and the difference between the two groups was statistically significant (P < 0.05). Hydronephrosis is associated with chromosomal abnormalities, and the rate of chromosomal abnormalities increases significantly as the degree of hydronephrosis increases. The combined use of CMA technology can detect abnormalities caused by chromosomal microdeletions and/or microduplications, which is of great value for clinical prenatal consultation.

PurposeTo investigate the puncture accuracy and feasibility of contrast-enhanced ultrasound (CEUS) guided percutaneous nephrolithotomy (PCNL) in flank position for patients with no apparent hydronephrosis.MethodsBetween May 2018 and June 2020, 72 kidney stone patients with no or mild hydronephrosis were randomized into two groups: a CEUS-guided PCNL group and a conventional ultrasound (US)-guided group. Patients’ demographics and perioperative outcomes were compared, including the success rate of puncture via calyceal fornix, the success rate of a single-needle puncture, puncture time, operative time, postoperative hemoglobin loss, stone-free rate, incidence of complications and postoperative stay.ResultsThe success rate of puncture via calyceal fornix for CEUS-guided group was significantly higher than that for conventional US-guided group (86.1 vs. 47.2%, p = 0.002). Patients performed with CEUS-guided PCNL required shorter renal puncture time than those guided with conventional US (36.5 s vs. 61.0 s, p < 0.001). The median postoperative hemoglobin loss in the CEUS-guided group was significantly lower than that in conventional US-guided group (2.5 vs. 14.5 g/L, p < 0.01). There was no statistically significant difference in the success rate of a single-needle puncture, operative time, stone-free rate, incidence of complications and postoperative stay between the two groups.ConclusionCEUS guidance facilitates identification of the renal calyx fornix, and benefits more precise renal puncture and less hemoglobin loss in PCNL. CEUS-guided PCNL in flank position is a feasible approach to the treatment of kidney stone patients with no apparent hydronephrosis. Trial registration number: ChiCTR1800015417.

Primary non-refluxing megaureter (PMU) is a congenital dilation of the ureter which is not related to vesicoureteral reflux, duplicated collecting systems, ureterocele, ectopic ureter, or posterior urethral valves and accounts for 5 to 10% of all prenatal hydronephrosis (HN) cases. The etiology is a dysfunction or stenosis of the distal ureter. Most often PMU remains asymptomatic with spontaneous resolution allowing for non-operative management. Nevertheless, in selective cases such as the development of febrile urinary tract infections, worsening of the ureteral dilatation, or reduction in relative renal function, surgery should be considered. Conclusion : Ureteral replantation with excision of the dysfunctional ureteral segment and often ureteral tapering is the gold-standard procedure for PMU, although endoscopic treatment has been shown to have a fair success rate in many studies. In this review, we discuss the natural history, follow-up, and treatment of PMU. What is Known: • PMU is the result of an atonic or stenotic segment of the distal ureter, resulting in congenital dilation of the ureter, and is frequently diagnosed on routine antenatal ultrasound. What is New: • Most often, PMU remains asymptomatic and clinically stable, allowing for non-operative management. • Nevertheless, since symptoms can appear even after years of observation, long-term ultrasound follow-up is recommended, even up to young adulthood, if hydroureteronephrosis persists. • Ureteral replantation is the gold standard in case surgery is needed. In selected cases, however, HPBD could be a reasonable alternative.