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Antenatal and postnatal ultrasound in the evaluation of the risk of vesicoureteral reflux

Grazioli, Serge ; Parvex, Paloma ; Merlini, Laura ; Combescure, Christophe ; Girardin, Eric

In: Pediatric Nephrology, 2010, vol. 25, no. 9, p. 1687-1692

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    Titre
    • Antenatal and postnatal ultrasound in the evaluation of the risk of vesicoureteral reflux
    Auteur
    • Grazioli, Serge. Department of Pediatric, Pediatric Nephrology Unit, University Hospital of Geneva, University of Geneva, 6 Willy-Donzé Street, 1211, Geneva, Switzerland
    • Parvex, Paloma. Department of Pediatric, Pediatric Nephrology Unit, University Hospital of Geneva, University of Geneva, 6 Willy-Donzé Street, 1211, Geneva, Switzerland
    • Merlini, Laura. Department of Pediatric, Pediatric Radiology Unit, University Hospital of Geneva, University of Geneva, Geneva, Switzerland
    • Combescure, Christophe. Division of Clinical Epidemiology, University Hospital of Geneva, University of Geneva, Geneva, Switzerland
    • Girardin, Eric. Department of Pediatric, Pediatric Nephrology Unit, University Hospital of Geneva, University of Geneva, 6 Willy-Donzé Street, 1211, Geneva, Switzerland
    Type de document
    • Postprint
    Identifiant OAI-PMH
    • oai:doc.rero.ch:311347
    Summary
    Antenatal hydronephrosis (ANH) is a frequent anomaly detected on fetal ultrasound scans. There is no consensus recommendation for the postnatal follow-up and/or the necessity to perform a voiding cystourethrography (VCUG) to diagnose vesicoureteral reflux (VUR). We conducted a cohort/non-randomized trial of 121 patients with ANH, defined as an anterior posterior diameter (APD) ≥5mm after the 20th week of gestation, to evaluate the ability of the antenatal and postnatal ultrasonography results to predict VUR. All infants had two successive ultrasounds at 5days and 1month, respectively, after birth. A VCUG was performed at 6weeks in children with a persistent APD ≥5mm and/or an ureteral dilatation observed on at least one of two postnatal ultrasounds. In total, 88 patients had VCUG and nine had VUR, with five having high-grade reflux (>grade II). The risk of VUR increased significantly with the degree of APD detected on the postnatal ultrasound scan (p = 0.03). The odds ratios were 5.0 [95% confidence interval (CI) 0.5-51.2] for APD = 7-9mm and 9.1 (95% CI 1.0-80.9) for APD ≥10mm. The results of this study show that among our patient cohort antenatal ultrasound was not predictive of reflux. There was, however, a relation between the importance of the postnatal renal pelvis diameter and the risk of VUR. A cut-off of 7mm showed a fair ability of ultrasonography to predict VUR and a cut-off of 10mm enabled all severe refluxes in the 88 patients who had a VCUG to be diagnosed