Evaluation and Management of Hydronephrosis in Pediatrics

Hydronephrosis, particularly when detected prenatally, represents one of the most frequent conditions encountered in pediatric urology and nephrology. The condition encompasses a broad spectrum of underlying pathologies, including pelvi‑ureteric junction obstruction, primary and secondary megaureter, ectopic ureter, and ureterocele. Postnatal follow‑up and management remain complex because hydronephrosis may reflect transient or physiologically benign dilatation in some infants, while in others it may signify clinically significant obstruction with potential for renal functional deterioration. Despite widespread availability of ultrasonography and nuclear medicine studies, clinical decision making continues to vary considerably across centers. Uncertainties remain in identifying which infants will stabilize spontaneously and which will require early surgical intervention, as well as in determining the optimal imaging follow‑up interval, drainage parameters, and unified definitions of obstruction severity. Recent research has underscored the limitations of traditional qualitative grading systems and has highlighted the need for quantitative, standardized, and physiology‑based assessment methods that can lead to more individualized, evidence‑driven management pathways in children with hydronephrosis.This Research Topic aims to advance understanding and harmonization of postnatal evaluation and management strategies for infants and children with hydronephrosis, including those with prenatally detected pelvi‑ureteric junction–like obstruction. The overarching goal is to promote high‑quality research that refines imaging‑based diagnostic criteria, validates relevant quantitative parameters, and improves the predictive accuracy of clinical decision tools. It seeks to stimulate collaboration among pediatric urologists, nephrologists, nuclear medicine specialists, and radiologists to define standardized protocols for postnatal surveillance and intervention thresholds. Studies addressing how ultrasound metrics, diuretic renography indices, and magnetic resonance–based functional imaging can be combined to guide clinical management will be particularly welcome. By aligning methodology and outcome assessment across centers, this Research Topic strives to enhance consensus and reproducibility in evaluating and managing hydronephrosis from birth through later childhood.The scope of this Research Topic covers all aspects of the diagnosis, follow‑up, and management of hydronephrosis in children, including methodological and clinical research, imaging innovations, and outcome studies. To gather further insights in this field, we welcome submissions addressing, but not limited to, the following themes:• Postnatal follow‑up and risk‑stratification pathways for infants and children with prenatally detected hydronephrosis• Quantitative and comparative evaluation of diuretic renogram drainage metrics, including half‑time and normalized residual activity, for predicting surgical need• Integration of ultrasonographic parameters with diuretic renography, magnetic resonance urography, or other advanced imaging modalities• Longitudinal outcomes of conservative management versus early intervention, with a focus on renal function preservation, urinary tract infection, symptom progression, and growth• Timing and indications for pyeloplasty and predictors of postoperative functional recovery• Inter‑observer variability and efforts toward reproducibility and standardization of imaging protocols across institutions• Application of predictive analytics and machine learning for assessing obstruction severity and long‑term outcomes• Management considerations for complex cases such as solitary kidneys, bilateral disease, or multiple congenital urinary tract anomaliesWe invite the submission of many article types, including original research, systematic review, methods, review, clinical trial, study protocol, mini review, perspective, brief research report, case report, and opinion articles. This Research Topic welcomes contributions that help establish data‑driven and consensus‑based approaches to evaluation and management, promoting collaboration across disciplines and enhancing evidence‑based pediatric urinary tract care. Topic editors: Gyanendra Sharma, Pankaj N Maheshwari Source: https://www.frontiersin.org/research-topics/80537/evaluation-and-management-of-hydronephrosis-in-pediatrics