Antenatal and postnatal ultrasound in the evaluation of the risk of vesicoureteral reflux

Pediatr Nephrol. 2010 Sep;25(9):1687-92. doi: 10.1007/s00467-010-1543-9. Epub 2010 Jun 4.


Antenatal hydronephrosis (ANH) is a frequent anomaly detected on fetal ultrasound scans. There is no consensus recommendation for the postnatal follow-up and/or the necessity to perform a voiding cystourethrography (VCUG) to diagnose vesicoureteral reflux (VUR). We conducted a cohort/non-randomized trial of 121 patients with ANH, defined as an anterior posterior diameter (APD) >or=5 mm after the 20th week of gestation, to evaluate the ability of the antenatal and postnatal ultrasonography results to predict VUR. All infants had two successive ultrasounds at 5 days and 1 month, respectively, after birth. A VCUG was performed at 6 weeks in children with a persistent APD >or=5 mm and/or an ureteral dilatation observed on at least one of two postnatal ultrasounds. In total, 88 patients had VCUG and nine had VUR, with five having high-grade reflux (>grade II). The risk of VUR increased significantly with the degree of APD detected on the postnatal ultrasound scan (p = 0.03). The odds ratios were 5.0 [95% confidence interval (CI) 0.5-51.2] for APD = 7-9 mm and 9.1 (95% CI 1.0-80.9) for APD >or=10 mm. The results of this study show that among our patient cohort antenatal ultrasound was not predictive of reflux. There was, however, a relation between the importance of the postnatal renal pelvis diameter and the risk of VUR. A cut-off of 7 mm showed a fair ability of ultrasonography to predict VUR and a cut-off of 10 mm enabled all severe refluxes in the 88 patients who had a VCUG to be diagnosed.

MeSH terms

  • Disease Progression
  • Female
  • Gestational Age
  • Humans
  • Hydronephrosis / complications
  • Hydronephrosis / diagnostic imaging*
  • Infant
  • Infant, Newborn
  • Male
  • Odds Ratio
  • Predictive Value of Tests
  • Pregnancy
  • Prospective Studies
  • Radiography
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Switzerland
  • Ultrasonography, Prenatal*
  • Vesico-Ureteral Reflux / diagnostic imaging
  • Vesico-Ureteral Reflux / etiology*