Antenatal Urinary Tract Dilation*

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Presentation transcript:

Antenatal Urinary Tract Dilation* 08/06/15 Pediatrics Urology Nephrology DRAFT Antibiotic prophylaxis until radiologic studies completed** Urology consult as required ANTENATAL SEVERITY Unilateral A1 Unilateral A2-3 Bilateral A1 Bilateral A2-3 Continue ppx UTI ssx teaching At 2 weeks old --Urology f/u --Ultrasound (US) Before discharge --US > 48H old*** At 24-48 hours of age --Urology consult --US & VCUG --Weigh diapers --BMP at 24H --Neph consult if Cr >1mg/dL; UOP <2 or >5 ml/kg/hr POSTNATAL SEVERITY Normal Unilateral P1 Unilateral P2 or P3 Bilateral Stop ppx No f/u No VCUG Continue ppx UTI ssx teaching 4 weeks old --Urology f/u --US Before discharge --Urology consult --VCUG --Circumcision recommended --BMP > 48H old**** --Nephrology consult if Cr >1mg/dL *Severity of urinary tract dilation (UTD) based on AP renal-pelvic diameter, peripheral vs central calyceal dilation, parenchymal thickness, parenchymal appearance, ureter, and bladder. Antenatal risk stratification: normal: normal,; A1: low risk; A2-3: increased risk. Postnatal: normal: normal;P1: low risk;P2,:mod; P3: high5 --UTD found on a prenatal US but resolved on 3rd trimester US does not need a postnatal workup. --If oligo/polyhydramnios present on prenatal u/s, monitor urine output. Obtain chem 10 panel if excessive or decreased UOP. ** Antibiotic prophylaxis (Amoxicillin 10MG/KG QHS) ***To avoid underestimation of the UTD ****To better reflect newborn’s Cr instead of Mom’s

References Baskin, L. (2013, July 15). Postnatal management of antenatal hydronephrosis. Retrieved October 22, 2013, from UpToDate: http://www.uptodate.com/contents/postnatal-management-of-antenatal-hydronephrosis Braga, L., Mijovic, H., Farrokhyar, F., Pemberton, J., DeMaria, J., & Lorenzo, A. (2013). Antibiotic prophylaxis for urinary tract infections in antenatal hydronephrosis. Pediatrics , e251-e261. Davenport, M., Merguerian, P., & Koyle, M. (2013). Antenatally diagnosed hydronephrosis: current postnatal management. Pediatric Surgery International , 207-214. Nguyen, H., Herndon, A., Cooper, C., Gatti, J., Kirsch, A., Kokorowski, P., et al. (2010). The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. Journal of Pediatric Urology , 212-231. Nguyen H. et al (2014). Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). Journal of Pediatric Urology, 982-998.