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Antenatal Hydronephrosis as a Predictor of Postnatal Outcome: A Meta-analysis
Richard S. Lee, Marc Cendron, Daniel D. Kinnamon and Hiep T. Nguyen
Pediatrics 2006;118;586
DOI: 10.1542/peds.2006-0120

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ARTICLE

Antenatal Hydronephrosis as a Predictor of Postnatal
Outcome: A Meta-analysis
Richard S. Lee, MDa, Marc Cendron, MDa, Daniel D. Kinnamon, MSb, Hiep T. Nguyen, MDa
a

Department of Urology, Children’s Hospital Boston, Boston, Massachusetts; bDepartment of Pediatrics,Division of Pediatric Clinical Research, University of Miami Miller
School of Medicine, Miami, Florida

The authors have indicated they have no financial relationships relevant to this article to disclose.

ABSTRACT
OBJECTIVE. Antenatal hydronephrosis is diagnosed in 1% to 5% of all pregnancies;
however, the antenatal and postnatal management of hydronephrosis varies
widely. No previousstudies define the risk of postnatal pathology in infants with
antenatal hydronephrosis. Our objective was to review the current literature to
determine whether the degree of antenatal hydronephrosis and related antenatal
ultrasound findings are associated with postnatal outcome.
METHODS. We searched Medline (1966 –2005), Embase (1991–2004), and the Cochrane Library databases for articles onantenatal hydronephrosis. We required
studies to have subjects selected on the basis of documented measurements of
antenatal hydronephrosis and followed to a postnatal diagnosis. We excluded case
reports, review articles, and editorials. Two independent investigators extracted
data.
RESULTS. We screened 1645 citations, of which 17 studies met inclusion criteria. We

created a data set of 1308subjects. The risk of any postnatal pathology per degree
of antenatal hydronephrosis was 11.9% for mild, 45.1% for moderate, and 88.3%
for severe. There was a significant increase in risk per increasing degree of
hydronephrosis. The risk of vesicoureteral reflux was similar for all degrees of
antenatal hydronephrosis.

www.pediatrics.org/cgi/doi/10.1542/
peds.2006-0120doi:10.1542/peds.2006-0120
Key Words
hydronephrosis, renal, kidney disease,
prenatal, outcome
Abbreviations
ANH—antenatal hydronephrosis
VCUG—voiding cystourethrogram
APD—anterior posterior diameter
UPJ— ureteropelvic junction obstruction
VUR—vesicoureteral reflux
CI— confidence interval
Accepted for publication Mar 8, 2006
Address correspondence to Richard S. Lee,
MD, Children’s Hospital Boston, Department ofUrology, 300 Longwood Ave, Hunn-390,
Boston, MA 02115. E-mail: richard.lee@
childrens.harvard.edu
PEDIATRICS (ISSN Numbers: Print, 0031-4005;
Online, 1098-4275). Copyright © 2006 by the
American Academy of Pediatrics

CONCLUSIONS. The findings of this meta-analysis can potentially be used for prenatal
counseling and may alter current postnatal management of children with antenatalhydronephrosis. Overall, children with any degree of antenatal hydronephrosis are at greater risk of postnatal pathology as compared with the normal
population. Moderate and severe antenatal hydronephrosis have a significant risk
of postnatal pathology, indicating that comprehensive postnatal diagnostic management should be performed. Mild antenatal hydronephrosis may carry a risk for
postnatal...