ASSESSING OUTCOME OF ANTENATAL HYDRONEPHROSIS- AN INTEGRATED CLINICAL APPROACH

BACKGROUND The widespread use of ultrasonography during pregnancy has resulted in a higher detection rate of congenital malformations. Out of these antenatally detected congenital malformations Antenatal Hydronephrosis (ANH) is the commonest one. The diagnosis of ANH causes significant distress to the parents. There always remains a probability of the neonate having complete resolution to undergoing surgery based on the degree of hydronephrosis measured primarily with AP diameter of renal pelvis. MATERIALS AND METHODS A total of 94 patients were enrolled (Excluding 16) and their complete profile with clinical, radiological imaging and renal scan details were taken as per Study Performa and were followed up and outcomes were assessed for complete resolution, partial resolution with non-obstructive drainage and cases requiring surgical intervention. RESULTS The incidence of ANH in our study was 2.14% and M:F ratio was 2.13:1. The distribution of mild, moderate and severe ANH was at 58.51, 31.92 and 9.57% respectively. The relative risk of surgery for cases with APD > 10 mm, (moderate and severe ANH) was 15.511 with Odds ratio of 21.21. The 95% Confidence interval was from 2.6 to 172.79. Hence a statistically significant association (for a 95% confidence interval p <.05) exists between the APD >10 mm and the risk of surgery. Only one case in mild ANH underwent surgical intervention and the association was not statistically significant. CONCLUSION The result of our study show that Mild ANH runs a benign course and chances of spontaneous resolution are high. Those cases which failed to resolve need follow up and further detailed investigation (MCU & Radionuclide scan), only if there was increase in severity of hydronephrosis, urinary tract infection or thinning of renal cortex. However, cases of moderate ANH have specific postnatal pathology and may undergo surgical intervention while in cases of severe ANH all have significant postnatal pathology and majority may have to undergo surgical intervention. This study brings about the relevant data for a better and sequential counselling of worried parents and also adds to the literature to draw various centres to a consensus on management of these foetus/neonates