MAG3 Renal Scan There is no relevant literature to support the routine use of Tc-99m mercaptoacetyltriglycine (MAG3) diuretic renal scan in the initial postnatal evaluation of antenatal hydronephrosis. MRI Abdomen and Pelvis There is no relevant literature to support the routine use of MR urography (MRU) in the initial postnatal evaluation of antenatal hydronephrosis. Fluoroscopic Voiding Cystourethrography There is controversy regarding whether all children with antenatal hydronephrosis should undergo VCUG. A meta- analysis by the American Urology Association found that on average, approximately 16% of neonates and infants with antenatal hydronephrosis will have VUR. The incidence of VUR was independent of degree of antenatal hydronephrosis, and a quarter of these were found to have no hydronephrosis on postnatal US [31]. There is disagreement over whether this VUR is clinically significant and therefore over the need for diagnosis. Some authors advocate VCUG for all infants with antenatal hydronephrosis, to guide treatment with prophylactic antibiotics [20,27,32,33]. However, currently, most authors (including the 2010 SFU consensus statement) recommend against routine VCUG for antenatal hydronephrosis [2,12,29,34,35]. This is largely because the benefit of prophylactic antibiotic in children with UTI has not been clearly demonstrated [36]. The efficacy of prophylactic antibiotics in preventing UTIs or renal damage in patients with antenatal hydronephrosis, with or without VUR, is difficult to determine because of variability in methods and results [39]. In addition, most of the VUR spontaneously resolves [40]. One of the potential risks of VCUG is iatrogenic UTI. This was reported in about 2% of VCUG studies performed for evaluation of antenatal hydronephrosis [39].
Antenatal Hydronephrosis Infant. MAG3 Renal Scan There is no relevant literature to support the routine use of Tc-99m mercaptoacetyltriglycine (MAG3) diuretic renal scan in the initial postnatal evaluation of antenatal hydronephrosis. MRI Abdomen and Pelvis There is no relevant literature to support the routine use of MR urography (MRU) in the initial postnatal evaluation of antenatal hydronephrosis. Fluoroscopic Voiding Cystourethrography There is controversy regarding whether all children with antenatal hydronephrosis should undergo VCUG. A meta- analysis by the American Urology Association found that on average, approximately 16% of neonates and infants with antenatal hydronephrosis will have VUR. The incidence of VUR was independent of degree of antenatal hydronephrosis, and a quarter of these were found to have no hydronephrosis on postnatal US [31]. There is disagreement over whether this VUR is clinically significant and therefore over the need for diagnosis. Some authors advocate VCUG for all infants with antenatal hydronephrosis, to guide treatment with prophylactic antibiotics [20,27,32,33]. However, currently, most authors (including the 2010 SFU consensus statement) recommend against routine VCUG for antenatal hydronephrosis [2,12,29,34,35]. This is largely because the benefit of prophylactic antibiotic in children with UTI has not been clearly demonstrated [36]. The efficacy of prophylactic antibiotics in preventing UTIs or renal damage in patients with antenatal hydronephrosis, with or without VUR, is difficult to determine because of variability in methods and results [39]. In addition, most of the VUR spontaneously resolves [40]. One of the potential risks of VCUG is iatrogenic UTI. This was reported in about 2% of VCUG studies performed for evaluation of antenatal hydronephrosis [39].