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ANTENATALLY DETECTED HYDRONEPHROSIS (ANH): What to Remember?(WTR?)


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When to Worry?

  • APD ≥4 mm in 2nd trimester and ≥7 mm in 3rd trimester.
  • ANH with oligohydramnios
  • ANH with extra-renal anomalies and soft markers
  • ANH with any calyceal dilatation, renal parenchymal changes, bladder wall abnormalities.

When to do a post-natal scan?

  • USG KUB after adequate hydration, 3-7 days.
  • MCU after 4-6 weeks
  • USG KUB and MCU within 48 hours, if lower urinary tract obstruction.

When to treat?

  • Severe hydronephrosis- APD > 10mm - peripheral calyceal dilatation, renal parenchymal changes, bladder wall abnormalities, ureter abnormalities.
  • PUV or lower urinary tract obstruction - Surgical approach
  • VUR - Antibiotic Prophylaxis
  • Normal MCU - Diuretic venography (after 4-6 weeks) to differentiate obstructive and non-obstructive hydronephrosis and for assessment of renal function.
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