Neonatal hydronephrosis

Last revised by Henry Knipe on 3 Jan 2023

Neonatal hydronephrosis is most commonly diagnosed antenatally as fetal pylectasis, and in the majority of cases is due to pelviureteric junction (PUJ) obstruction.  

The degree of neonatal hydronephrosis can be classified by urinary tract dilatation classification.

Renal pelvis AP diameter of >7-10 mm is considered significant 3,4; this is not absolute and varies by institution. It can be classified according to severity of hydronephrosis 7:

  • grade 1: mildly dilated renal pelvis without calyceal dilatation

  • grade 2: further dilation of renal pelvis with dilatation of some calyces

  • grade 3: renal pelvis and calyces are dilated, however, the renal parenchymal thickness is normal

  • grade 4: all features of grade 3, together with thinning of renal parenchyma

The estimated incidence of neonatal hydronephrosis that has clinical significance is 1 in 600 and most cases will resolve without intervention 5

  • normal physiologic filling of the renal collecting system 6

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