Perinatal Urinary Tract Dilation Clinical Pathway — Inpatient, Outpatient Specialty Care and Primary Care

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Patients presenting with ultrasound findings of perinatal urinary tract dilation (UTD)

Initial Patient Assessment

PRENATAL Ultrasound Risk Stratification
for Postnatal Intervention

Low Risk (A1)

16-27 weeks AP RPD 4 to 6.9 mm
OR
≥ 28 weeks AP RPD 7 to < 10 mm
AND/OR
Central calyceal dilation with all other US findings normal

Increased Risk (A2-3)

16-27 weeks AP RPD ≥ 7 mm
OR
≥ 28 weeks AP RPD ≥ 10 mm
AND/OR
Any abnormal ultrasound finding (except central calyceal dilation)

Management Based on PRENATAL Ultrasound Risk Stratification

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

Management based on POSTNATAL Ultrasound Risk Stratification

Legend
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
Authors: D. Weiss, MD, K. Mckenna, MD, H. Otero, MD, D. Kaiser, CRNP, J. Ko, MD

Evidence

Related CHOP Programs

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway please contact us.

©2019 by Children's Hospital of Philadelphia, all rights reserved.
Use of this site is subject to the Terms of Use.

The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.