Fetal hydronephrosis

Changed by Joshua Yap, 8 May 2023
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Disclosures - updated 15 Jul 2022: Nothing to disclose

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Fetal hydronephrosis represents the abnormal dilatation of the fetal renal collecting system, with pelviureteric junction obstruction the most commonly encountered cause. 

Please, refer to the article on fetal pyelectasis for a dedicated discussion on this relatively common and usually benign form of mild hydronephrosis. 

Terminology 

Although there is an overlap of definition between pyelectasis and hydronephrosis, the former has been widely used instead of mild hydronephrosis given that the great majority of the cases represent only a physiological incidental finding that resolves spontaneously, while the latter tends to be reserved for cases where a pathological obstruction is suspected. 

Epidemiology

Depending on its definition, the estimated prevalence may range between 1-3% of pregnancies.

Associations

Pathology

Aetiology

Marked hydronephrosis (particularly in the 3rd trimester) can result from a number of pathologies, which include:

Associations

Radiographic features

The degree of fetal hydronephrosis can be graded by urinary tract dilatation classification.

Antenatal ultrasound

In the second trimester, the severity of fetal hydronephrosis may be graded as 1,2.

  • mild hydronephrosis: anteroposterior renal pelvic diameter measures ≥5mm (≥4mm at 16-20 weeks)

  • moderate/severe hydronephrosis: anteroposterior renal pelvic diameter measures ≥7 mm or if there is associated calyceal dilatation

  • persistent hydronephrosis: ≥10 mm in the 3rdthird trimester

Ancillary sonographic features:

  • dilatation of the renal calyces

  • dilated ureter if the obstruction is distal

  • concurrent oligohydramnios if there is a bilateral obstruction (or unilateral obstruction with significantly impaired renal function in the other kidney)

Treatment and prognosis

Management will depend on the underlying pathology. The degree of renal pelvic dilatation correlates with the outcome. A renal pelvic anteroposterior diameter of 9 mm or more, and a pelvic-to-renal anteroposterior diameter ratio of 0.45 before 32 weeks of gestation and 0.52 thereafter are considered to be useful for the detection of a severe outcome postnatally 3.

  • -<p><strong>Fetal hydronephrosis</strong> represents the abnormal dilatation of the fetal renal collecting system, with <a href="/articles/pelviureteric-junction-obstruction-1">pelviureteric junction obstruction</a> the most commonly encountered cause. </p><p>Please, refer to the article on <a href="/articles/fetal-pyelectasis">fetal pyelectasis</a> for a dedicated discussion on this relatively common and usually benign form of mild hydronephrosis. </p><h4>Terminology </h4><p>Although there is an overlap of definition between pyelectasis and hydronephrosis, the former has been widely used instead of mild hydronephrosis given that the great majority of the cases represent only a physiological incidental finding that resolves spontaneously, while the latter tends to be reserved for cases where a pathological obstruction is suspected. </p><h4>Epidemiology</h4><p>Depending on its definition, the estimated prevalence may range between 1-3% of pregnancies.</p><h4>Pathology</h4><p>Marked hydronephrosis (particularly in the 3<sup>rd</sup> trimester) can result from a number of pathologies, which include:</p><ul>
  • -<li>
  • -<a href="/articles/posterior-urethral-valves">posterior urethral valves</a>: in males</li>
  • -<li>congenital <a href="/articles/pelviureteric-junction-obstruction-1">pelviureteric junction obstruction</a>:  the commonest cause of fetal hydronephrosis <sup>8</sup>
  • -</li>
  • -<li>congenital <a href="/articles/vesico-ureteric-junction-obstruction">vesicoureteric junction obstruction</a>
  • -</li>
  • -<li><a href="/articles/ureterocele-1">ureterocoele(s)</a></li>
  • -<li><a href="/articles/urethral-agenesis">urethral agenesis</a></li>
  • -<li><a href="/articles/congenital-megaloureter">congenital megaloureter</a></li>
  • -<li><a href="/articles/megacystis-microcolon-intestinal-hypoperistalsis-syndrome">megacystis microcolon syndrome</a></li>
  • -<li>
  • -<a href="/articles/megacystis-megaureter-syndrome">megacystis megaureter syndrome</a> <sup>7</sup>
  • -</li>
  • -<li>fetal <a href="/articles/vesicoureteric-reflux">vesicoureteric reflux</a>
  • -</li>
  • -<li>
  • -<a href="/articles/prune-belly-syndrome">prune-belly syndrome</a> (rare)</li>
  • -</ul><h5>Associations</h5><ul><li>
  • -<a href="/articles/down-syndrome">Down syndrome</a>: more so with <a href="/articles/fetal-pyelectasis">mild renal pelvic dilatation</a> (low association)</li></ul><h4>Radiographic features</h4><p>The degree of fetal hydronephrosis can be graded by <a href="/articles/urinary-tract-dilatation-classification-1">urinary tract dilatation classification</a>.</p><h5>Antenatal ultrasound</h5><p>In the second trimester, the severity of fetal hydronephrosis may be graded as <sup>1,2</sup>.</p><ul>
  • -<li>
  • -<strong>mild hydronephrosis: </strong>anteroposterior renal pelvic diameter measures ≥5<sup> </sup>mm (≥4<sup> </sup>mm at 16-20 weeks)</li>
  • -<li>
  • -<strong>moderate/severe hydronephrosis:</strong> anteroposterior renal pelvic diameter measures ≥7 mm or if there is associated calyceal dilatation</li>
  • -<li>
  • -<strong>persistent hydronephrosis:</strong> ≥10 mm in the 3<sup>rd</sup> trimester</li>
  • +<p><strong>Fetal hydronephrosis</strong> represents the abnormal dilatation of the fetal renal collecting system, with <a href="/articles/pelviureteric-junction-obstruction-1">pelviureteric junction obstruction</a> the most commonly encountered cause. </p><p>Please, refer to the article on <a href="/articles/fetal-pyelectasis">fetal pyelectasis</a> for a dedicated discussion on this relatively common and usually benign form of mild hydronephrosis. </p><h4>Terminology </h4><p>Although there is an overlap of definition between pyelectasis and hydronephrosis, the former has been widely used instead of mild hydronephrosis given that the great majority of the cases represent only a physiological incidental finding that resolves spontaneously, while the latter tends to be reserved for cases where a pathological obstruction is suspected. </p><h4>Epidemiology</h4><p>Depending on its definition, the estimated prevalence may range between 1-3% of pregnancies.</p><h5>Associations</h5><ul><li><p><a href="/articles/down-syndrome">Down syndrome</a>: more so with <a href="/articles/fetal-pyelectasis">mild renal pelvic dilatation</a> (low association)</p></li></ul><h4>Pathology</h4><h5>Aetiology</h5><p>Marked hydronephrosis (particularly in the 3<sup>rd</sup> trimester) can result from a number of pathologies, which include:</p><ul>
  • +<li><p><a href="/articles/posterior-urethral-valves">posterior urethral valves</a>: in males</p></li>
  • +<li><p>congenital <a href="/articles/pelviureteric-junction-obstruction-1">pelviureteric junction obstruction</a>: the most common cause of fetal hydronephrosis <sup>8</sup></p></li>
  • +<li><p>congenital <a href="/articles/vesico-ureteric-junction-obstruction">vesicoureteric junction obstruction</a></p></li>
  • +<li><p><a href="/articles/ureterocele-1">ureterocele(s)</a></p></li>
  • +<li><p><a href="/articles/urethral-agenesis">urethral agenesis</a></p></li>
  • +<li><p><a href="/articles/congenital-megaloureter">congenital megaloureter</a></p></li>
  • +<li><p><a href="/articles/megacystis-microcolon-intestinal-hypoperistalsis-syndrome">megacystis microcolon syndrome</a></p></li>
  • +<li><p><a href="/articles/megacystis-megaureter-syndrome">megacystis megaureter syndrome</a> <sup>7</sup></p></li>
  • +<li><p>fetal <a href="/articles/vesicoureteric-reflux">vesicoureteric reflux</a></p></li>
  • +<li><p><a href="/articles/prune-belly-syndrome">prune-belly syndrome</a> (rare)</p></li>
  • +</ul><h4>Radiographic features</h4><p>The degree of fetal hydronephrosis can be graded by <a href="/articles/urinary-tract-dilatation-classification-1">urinary tract dilatation classification</a>.</p><h5>Antenatal ultrasound</h5><p>In the second trimester, the severity of fetal hydronephrosis may be graded as <sup>1,2</sup>.</p><ul>
  • +<li><p><strong>mild hydronephrosis: </strong>anteroposterior renal pelvic diameter measures ≥5<sup> </sup>mm (≥4<sup> </sup>mm at 16-20 weeks)</p></li>
  • +<li><p><strong>moderate/severe hydronephrosis:</strong> anteroposterior renal pelvic diameter measures ≥7 mm or if there is associated calyceal dilatation</p></li>
  • +<li><p><strong>persistent hydronephrosis:</strong> ≥10 mm in the third trimester</p></li>
  • -<li>dilated ureter if the obstruction is distal</li>
  • -<li>concurrent <a href="/articles/oligohydramnios-1">oligohydramnios</a> if there is a bilateral obstruction (or unilateral obstruction with significantly impaired renal function in the other kidney)</li>
  • +<li><p>dilated ureter if the obstruction is distal</p></li>
  • +<li><p>concurrent <a href="/articles/oligohydramnios-1">oligohydramnios</a> if there is a bilateral obstruction (or unilateral obstruction with significantly impaired renal function in the other kidney)</p></li>

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