Antenatal Hydronephrosis in a Cohort of 187 Congenital Birth Defects over 2 Years in a Tertiary Care Hospital in Bangladesh

Abstract

Background: Antenatal hydronephrosis (ANH) is one of the most common birth defects. Postnatal ultrasonogram (USG) evaluation is essential to preserve renal function, prevent urinary infection, and decide surgical management. Objective: This study aims to estimate the frequency of ANH among a cohort of newborns with birth defects, observe maternal and neonatal characteristics in hydronephrotic babies, and perform postnatal radiological evaluation of newborns to observe the anatomical status of the kidney. Materials and Methods: This was a prospective analytical study conducted over 2 years in the Department of Neonatology, Bangabandhu Sheikh Mujib Medical University (BSMMU). Inborn and outborn newborns of any gestational age in the postnatal ward or admitted at neonatal intensive care unit BSMMU, with antenatal sonographic diagnosis of unilateral or bilateral hydronephrosis of any grade, who completed radiologic evaluation at 1 month of age, were included in the study. The study group was evaluated postnatally by using an USG. The first USG was done 3 days after birth by a radiologist in the Department of Radiology and Imaging, and the second USG was advised for all cases at 1 month of age. Result: The frequency of ANH was 28.3% among the studied cohort. Forty-four of them completed the second USG at 1 month of age. Involvement was bilateral in most (65.9%) of the affected babies, and moderate to severe hydronephrosis outnumbered the mild variety. In follow-up radiology, 43.2% underwent gradual regression. The frequency of postnatal diagnosis of different anomalies of the kidney and urinary tract was ureteropelvic junction obstruction (27.3%), hypoplastic/ dysplastic kidney (9.1%), vesicoureteral reflux (15.9%), pelvic kidney (2.3%), and single kidney (2.3%). Conclusion: A moderate number of ANH cases undergo spontaneous resolution. Permanent or obstructive hydronephrosis is associated with ureteropelvic junction obstruction, hypoplastic/dysplastic kidney, vesicoureteral reflux, pelvic kidney, and single kidney.