Diagnosis and treatment of infants with severe hydronephrosis (literature review)

Introduction. An assessment of the effectiveness of antenatal diagnosis and postnatal management of infants and infants with grade IV hydronephrosis was performed based on the analysis of domestic and foreign literature.

Literature review. In the literature analysis, we used the databases СlinicalKey, Web of Science, Cyberleninka, PubMed, and Medline. The search was not limited by the publication date; instead, the search’s emphasis was placed on publications of the last 10 years.

Classification. Several classification systems have been developed to assess the severity of hydronephrosis in infants. However, none of them describes the degree of expansion of the PCS and the functional state of the renal parenchyma. This work shows the stages of embryogenesis of the obstruction of the pyelourethral segment.

Diagnosis. The issues of antenatal diagnostics and prognostically significant outcome criteria for an intrauterine malformation of the fetal urinary system are considered. The main diagnostic methods in the postnatal period are described.

Morphological changes. Variants of pathomorphological changes in the renal parenchyma, the pelvic wall, and ureter in prolonged obstruction conditions are described. The role and variability of the number of Cajal interstitial cells in the pelvic wall and ureter in hydronephrosis have been analyzed.

Treatment. Particular attention is paid to nephroprotective therapy and surgical treatment tactics of the defect. Questions regarding the timing and choice of treatment methods, the need and duration of preliminary urine diversion in infants and children with grade IV hydronephrosis remain open.

Conclusion. Analysis of the world literature shows that there is no single protocol for intrauterine diagnosis and postnatal management of children with grade IV hydronephrosis. The functional state of the parenchyma is possible only with a comprehensive examination to assess the degree of hydronephrosis. Improving antenatal and postnatal diagnostics, therapeutic and surgical treatment of children with severe hydronephrosis should be based on a doctor’s cooperation, a specialist in ultrasound diagnostics, a nephrologist, and a pediatric surgeon.