1. 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 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

2. References
Baskin, L. (2013, July 15). Postnatal management of antenatal hydronephrosis. Retrieved October 22, 2013, from UpToDate:
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 ,
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 ,
Nguyen H. et al (2014). Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). Journal of Pediatric Urology,