Korean Journal of Pediatrics 2009;52(8):917-921.
Published online August 15, 2009.
Clinical study of urinary tract infection, natural courses, and prenatal ultrasonographic results according to the grades of hydronephrosis
Jee-Hee Lee, Jun-Woo Kim, Ji-Eun Yoon, Tae-Sun Ha
Department of Pediatrics, Chungbuk National University College of Medicine, Cheongju, Korea
수신증의 정도와 요로감염 및 자연경과, 산전초음 수신증 여부와의 관련성에 대한 임상적 고찰
이지희, 김준우, 윤지은, 하태선
충북대학교 의과대학 소아과학교실
Correspondence: 
Tae-Sun Ha, Email: tsha@chungbuk.ac.kr
Abstract
Purpose
Although renal ultrasonography (USG) has improved the detection rate of hydronephrosis (HN), its clinical courses and postnatal management remains controversial. Here, we reviewed the clinical features of patients with HN according to the grades.
Methods
We retrospectively studied 207 patients who were regularly followed-up among 367 patients with HN detected by renal USG postnatally between April 1998 and December 2007. These patients were grouped into four groups, grades 1-4, according to renal pelvic diameter (RPD). For analysis, each group was merged into two categories (mild: grade 1, 2; severe: grade 3, 4).
Results
During follow-up, 128 episodes of urinary tract infection (UTI) occurred in 91 patients. According to grades from 1 to 4, 35/89 (39.3%), 41/88 (46.5%), 11/22 (50%), and 4/8 (50%), respectively, had UTI, without any significance between the mild and severe groups. However, the severe group presented a higher risk in cumulative episodes of UTI per year (P=0.041). The spontaneous resolution of HN was observed in 103 (58.8%) of the 175 mild group patients and in 3 (10.7%) of the 28 severe group patients (P<0.001). Furthermore, the detection rate of prenatal HN by prenatal USG was much higher in patients with severe RPD (P<0.001).
Conclusion
We found that the severer the grade of HN, the lower was the rate of spontaneous resolution and higher was the frequency of UTI. Therefore, the establishment of guidelines for managing treatments such as antibiotic prophylaxis for patients with HN is needed to improve renal prognosis.
Key Words: Hydronephrosis, Grade, Renal pelvic diameter, Urinary tract infection, Prenatal ultrasono


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