Clinical Pathway for Evaluation/Management of Neonates Presenting with Findings of Perinatal Urinary Tract Dilation
PRENATAL Ultrasound Risk Stratification
for Postnatal Intervention
for Postnatal Intervention
Low Risk (A1)
- ≥ 28 weeks AP RPD 7 to < 10 mm
- or
- 16-27 weeks AP RPD 4 to 6.9 mm and no imaging/measurements ≥ 28 weeks
- or
- Central calyceal dilation with all other US findings normal
Increased Risk (A2-3)
- ≥ 28 weeks AP RPD ≥ 10 mm
- or
- 16-27 weeks AP RPD ≥ 7 mm
- or
- Any additional abnormal ultrasound finding (except central calyceal dilation)
Obtain POSTNATAL US per recommendations
POSTNATAL Ultrasound Risk Stratification
Low Risk (P1)
- AP RPD 10 to < 15 mm
- and/or
- Central calyceal dilation with all other US findings normal
Intermediate Risk (P2)
- AP RPD ≥ 15 mm
- and/or
- Any of the following:
- Peripheral calyceal dilation
- Abnormal ureters
High Risk (P3)
- AP RPD ≥ 15 mm
- and/or
- Any of the following:
- Abnormal parenchymal thickness
- Abnormal parenchymal appearance
- Abnormal bladder
- Abnormal urethra
UTD | Urinary tract dilation |
---|---|
A | Antenatal |
P | Postnatal |
AP RPD | Anterior-posterior renal pelvic diameter |
VCUG | Voiding cystourethrogram |
CeVUS | Contrast-enhanced voiding urosonography |
RBUS | Renal and bladder ultrasound |
MAG 3 | Lasix (nuclear medicine) renal scan |
fMRU | Functional MR urography |
VUR | Vesicoureteral reflux |
UPJ | Ureteropelvic junction |
- Ultrasound Findings of UTD
- Central or peripheral calyceal dilation
- Abnormal parenchymal thickness
- Abnormal parenchymal appearance
- Abnormal ureters
- Abnormal bladder
- Abnormal urethra
Discharge Planning Considerations
If ultrasound is obtained at outside hospital, obtain CD of images and bring to PCP and/or urology follow-up.
Reinforce importance of continued antibiotics (if prescribed) until follow-up with urology to avoid complications.
Inform family to refill and continue amoxicillin every 2 weeks until follow-up with PCP or urology.
CHOP Urology strongly recommends obtaining VCUG at CHOP to ensure reduced radiation exposure and quality images.
Do not discharge patient until imaging findings are resulted.
Call CHOP Urology with any questions at 215-590-2754.
Posted: May 2019
Revised: January 2021
Authors: D. Weiss, MD, K. Mckenna, MD, H. Otero, MD, D. Kaiser, CRNP, J. Ko, MD
Revised: January 2021
Authors: D. Weiss, MD, K. Mckenna, MD, H. Otero, MD, D. Kaiser, CRNP, J. Ko, MD
Evidence
- The Society for Fetal Urology Consensus Statement on the Evaluation and Management of Antenatal Hydronephrosis
- The Antenatal Urinary Tract Dilation Classification System Accurately Predicts Severity of Kidney and Urinary Tract Abnormalities
- Society for Fetal Urology Classification vs Urinary Tract Dilation Grading System for Prognostication in Prenatal Hydronephrosis: A Time to Resolution Analysis
- The Association Between Continuous Antibiotic Prophylaxis and UTI from Birth Until Initial Postnatal Imaging Evaluation Among Newborns with Antenatal Hydronephrosis
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