Antenatal Hydronephrosis

Antenatal hydronephrosis is classified according to severity based on antero-posterior diameter (APD) of fetal renal pelvis in USG. Antenatal hydronephrosis is present if the APD is ≥4 mm in second trimester and ≥7 mm in the third trimester.

These patients need to be evaluated further with a post natal USG, preferably after 48 hrs of life and another between 4-6 weeks of age to individualize management

Postnatal follow up of neonates with antenatal hydronephrosis

  • Mild Hydronephrosis (7-10 mm APD) : Monitor with serial ultrasounds every 3 months till resolution. Identify and treat any Urinary Tract Infection(UTI) promptly.
  • Moderate to Severe unilateral or bilateral hydronephrosis ( > 10 mm APD) :  Refer to a Pediatric Nephrologist. Evaluation and management needs to be individualized.

Antibiotic prophylaxis for Urinary Tract Infection(UTI)

Antibiotic Prophylaxis is recommended in following situations :

  • All cases of Moderate to severe hydronephrosis
  • Dilated ureters pending evaluation
  • All children with Vescio Ureteral  Reflux through first year of life and
  • Any patient who develops UTI in first year of life.

Cephalexin ( 10mg/kg) once daily at bed time is the prefered drug in first 3-6 months of life. Beyond this we may use Septran ( 1-2mg/kg) or Nitrofurantoin (1-2 mg/kg) once daily for prophylaxis.

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