Simplified Diagnostic Algorithm for Evaluation of Neonates With Prenatally Detected Hydronephrosis
Simplified Diagnostic Algorithm for Evaluation of Neonates With Prenatally Detected Hydronephrosis
Patients with congenital hydronephrosis will be identified by inpatient consultations
 performed by Dr. Assadi for congenital hydronephrosis and by outpatient problem lists with
 congenital hydronephrosis of Dr. Assadi's existing patients. Given standard evaluation will
 be evaluated to determine if based on initial ultrasound classification an algorithm can be
 developed to target evaluation studies for the initial evaluation. With a goal of targeting
 the few children that have need of additional intervention and minimizing the studies
 performed on children who will spontaneously resolve.
Patients with congenital hydronephrosis will be identified by inpatient consultations
 performed by Dr. Assadi for congenital hydronephrosis and by outpatient problem lists with
 congenital hydronephrosis of Dr. Assadi's existing patients. Once identified, the patient's
 grade of hydronephrosis will be recorded from initial ultrasound based on Society of Fetal
 Urology (SFU) classification. If no initial SFU classification was assigned to the
 hydronephrosis a pediatric radiologist will review the initial ultrasound images and classify
 the grade of hydronephrosis based upon SFU criteria. The patients ensuing evaluation of their
 hydronephrosis that took place will then be recorded and de-identified. Data to be collected
 will include: Ultrasound evaluations of the abdomen, retroperitoneum, or renal system,
 Voiding Cysto-Urethrogram (VCUGs), nuclear studies: diuretic enhanced technetium-99m
 dietylene triamine penta-acetic acid renogram (DTPA) or technetium-99m
 Mercapto-acetyl-triglycine renogram (MAG3), referral to pediatric urology for pyeloplasty,
 serum electrolytes, Blood Urea Nitrogen (BUN) and creatinine, urinalysis, urinary tract
 infections, and placement on long-term antibiotic prophylaxis.

 The follow up evaluation that took place for each patient will then be compared to our
 proposed algorithm for congenital hydronephrosis evaluation and treatment. This algorithm
 will be designed based on clinical experience of expert opinion and literature review of each
 step in the evaluation and treatment. Primary outcomes will be progressive renal function
 decline and progression to referral to a pediatric urologist for pyeloplasty. Secondary
 outcomes will be incidence of urinary tract infections and placement on long term antibiotic
 prophylaxis for urinary tract infection prophylaxis.
Inclusion Criteria:

 -  Inclusion criteria for the study were confirmation of the diagnosis of prenatal
 hydronephrosis by postnatal renal ultrasound

 Exclusion Criteria:

 -  prior history of UTI

 -  diagnosis of cystic renal dysplasia with poorly functioning kidney

 -  previous operation on the urinary tract system

 -  and other deformities of the external genital organs or anomalies in cardiopulmonary
 and central nervous system