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Approach To Fetuses With A Diagnosis Of Urinary System Abnormality

Year 2015, Volume: 12 Issue: 4, 135 - 139, 01.07.2015

Abstract

Aim: The aim of this prospective study was to demonstrate the management of the cases diagnosed as fetal urinary malformation at antenatal period and to compare findings to their neonatal findings.Material and Methods: This study included 57 cases who were diagnosed with antenatal ultrasound at Ministry of Health Aegean Obstetrics and Gynecology Teaching Hospital between January 2004 and January 2005. Cases were divided into group 1 with no functional kidney , group 2 with at least one functional kidney , group 3 with pyelectasia . Pyelectasia was described as anterior posterior diameter of renal pelvis to ≥5mm. Renal pelvis diameter was evaluated before and after 30 gestational week in respect to progression of pyelectasia. The data of cases who had urinary system anomalies diagnosed at postpartum period were collected retrospectively from hospital records.Results: Three of group 1’cases were aborted. Other 5 fetus died after partution. One case in group 2 was operated after partution. Urinary system abnormality was seen in 15 of 48 cases Group 3 at neonatal period. Four of them were operated. 28 cases with pyelectasia got antibiotic threapy due to urinar tract infection. Three cases underwent amniocentesis and one of them was terminated due to Down Syndrome. Chromosomal inversion was determined in other one. 8 of 57 cases 14% had anhydramnios and 4 of them 7% had polyhydramnios.Conclusion: Prenatal diagnosis of urinary system anomalies is so important for termination of pregnancy, consideration of amniocentesis for ongoing and planning neonatal follow up. The moderate pyelectasia due to organic lesion should be counselled to pediatric urology specialist for preventing kindney loss.

References

  • Helin I, Persson PH. Prenatal diagnosis of urinary tract abnormalities by ultrasound. Pediatrics. 1986;78:879-83.
  • Mathieu H, Loirat C, Macher MA, Weisgerber G, Guedeney J, Pillion G, Guesnu M. Long-term outcome of children with malformative uropathies. Int J Pediatr Nephrol 1985;6: 3-12.
  • Freedman AL, Bukowski TP, Smith CA, Evans MI, Quintero R, Gonzales R, Johnson MP. Fetal therapy for obstructive uropathy: diagnosis specific outcomes. Urology 1996;156:720-24.
  • Gunn TR,Mora D, Pease P. Antenatal diagnosis of urinary tract abnormalities by ultrasonography after 28 weeks’ gestation: incidence and outcome. Am J Obstet Gynecol 1995; 172: 479–486.
  • Sairam S, Al-Habib A, Sasson S, Thilaganathan B. Natural history of fetal hydronephrosis diagnosed on mid-trimester ultrasound. Ultrasound Obstet Gynecol 2001; 17: 191–196.
  • Herndon CD. Antenatal hydronephrosis: differential diagnosis, evaluation, and treatment options Scientific World Journal. 2006; 6: 2345-65
  • Bois E, Feingold J, Benmaiz H, Briard ML. Congenital urinary tract malformations: epidemiologic and genetic aspects. Clin Genet. 1975; 8: 37-47.
  • Cocchi G, Magnani C, Morini MS, Garani GP, Milan M, Calzolari E. Urinary tract abnormalities (UTA) and associated malformations: data of the Emilia-Romagna Registry. IMER Group. Eur J Epidemiol. 1996;12: 493- 7.
  • Nicolaides KH, Cheng HH, Snijders RJ, Moniz CF.Fetal urine biochemistry in the assessment of obstructive uropathy. Am J Obstet Gynecol. 1992 ;166: 932-7
  • Blyth B, Snyder HM, Duckett JW. Antenatal diagnosis and subsequent management of hydronephrosis. J Urol 1993; 149: 693–698.
  • Peters CA, Carr MC, Lais A, Retik AB, Mandell J. The response of the fetal kidney to obstruction. J Urol 1992; 148: 503–509.
  • Scott JE. Fetal, perinatal, and infant death with congenital renal anomaly. Arch Dis Child. 2002; 87: 114-7
  • Qin P, Ma XQ, Xie YX, Hou DM, Qian M. Prenatal ultrasonography for fetus with hydronephrosis. Zhonghua Yi Xue Za Zhi. 2007 18;87:2481-3.
  • Ismaili K, Hall M, Donner C, Thomas D, Vermeylen D, Avni FE; Results of systematic screening for minor degrees of fetal renal pelvis dilatation in an unselected population.Am J Obstet Gynecol. 2003; 188: 242-6.
  • Lepercq J, Beaudoin S, Bargy F. Outcome of 116 moderate renal pelvis dilatations at prenatal ultrasonography. Fetal Diagn Ther. 1998; 13: 79-81
  • Broadley P, McHugo J, Morgan I, Whittle MJ, Kilby MD.The 4 year outcome following the demonstration of bilateral renal pelvic dilatation on pre-natal renal ultrasound. Br J Radiol. 1999; 72: 265-70.
  • Wollenberg A, Neuhaus TJ, Willi UV, Wisser J Outcome of fetal renal pelvic dilatation diagnosed during the third trimester. Ultrasound Obstet Gynecol. 2005; 25: 483-8.
  • Anderson NG, Abbott GD, Mogridge N, Allan RB, Maling TM, Wells JE Vesicoureteric reflux in the newborn: relationship to fetal renal pelvic diameter.Pediatr Nephrol. 1997 ; 11: 610-6.
  • McIlroy PJ, Abbott GD, Anderson NG, Turner JG, Mogridge N, Wells JE.Outcome of primary vesicoureteric reflux detected following fetal renal pelvic dilatation. J Paediatr Child Health 2000;36:569-73.
  • Reddy PP, Mandell J. Prenatal diagnosis. Therapeutic implications. Urol Clin North Am. 1998; 25: 171-80
  • Thomas DF. Fetal uropathy. Br J Urol. 1990; 66: 225-31
  • Gotoh H, Masuzaki H, Fukuda H, Yoshimura S, Ishimaru T. Detection and assessment of pyelectasis in the fetus: relationship to postnatal renal function. Obstet Gynecol. 1998;92: 226-31.
  • Kurjak A, Latin V, Mandruzzato G, D’Addario V, Rajhvajn B. Ultrasound diagnosis and perinatal management of fetal genito-urinary abnormalities. J Perinat Med. 1984; 12: 291-312.
  • Dungan SJ, Fernandez TM, Abbott LP et al. Multicystic dysplastic kidney: natural history of prenatally detected cases. Prenatal diagnosis 1990; 10: 175-82.
  • Aubertin G, Cripps S, Coleman G, McGillivray B, Yong SL, Van Allen M, Shaw D, Arbour L. Prenatal diagnosis of apparently isolated unilateral multicystic kidney: implications for counselling and management Prenat. Diagn. 2002; 22: 388-94.
  • Hains DS, Bates CM, Ingraham S, Schwaderer AL Management and etiology of the unilateral multicystic dysplastic kidney: a review. Pediatr Nephrol. Hains DS, Bates CM, Ingraham S, Schwaderer AL Management and etiology of the unilateral multicystic dysplastic kidney: a review. Pediatr Nephrol. 2009 Feb;24(2):233-41
  • Nicolaides KH, Cheng HH, Abbas A, Snijders RJ, Gosden C. Fetal renal defects: associated malformations and chromosomal defects. Fetal Diagn Ther. 1992; 7: 1-11.
  • Oliveira EA, Diniz JS, Vilasboas AS, Rabêlo EA, Silva JM, Filgueiras MT. Multicystic dysplastic kidney detected by fetal sonography: conservative management and follow-up. Pediatr Surg Int. 2001; 17: 54-7.
  • Ylinen E, Ahonen S, Ala-Houhala M, Wikström S. Nephrectomy for multicystic dysplastic kidney: if and when? Urology. 2004; 63: 768-71
  • Mahony BS, Callen PW, Filly RA. Fetal urethral obstruction: US evaluation. Radiology. 1985; 157: 221-4.
  • Hayden SA, Russ PD, Pretorius DH, Manco-Johnson ML, Clewell WH Posterior urethral obstruction. Prenatal sonographic findings and clinical outcome in fourteen cases. J Ultrasound Med. 1988; 7: 371-5.
  • Coplen DE. Prenatal intervention for hydronephrosis J Urol. 1997;157:2270-7.
  • Zhu CP, Yi ZW.Expression of fibroblast growth factor receptor-4 in fetal kidneys and pathological kidneys of children. Zhongguo Dang Dai Er Ke Za Zhi. 2007; 9: 133-8.
  • Shima H, Tazawa H, Puri P. Increased expression of fibroblast growth factors in segmental renal dysplasia. Pediatr Surg Int. 2000; 16: 306-9.

Üriner Sistem Anomalisi Saptanan Fetuslara Yaklaşım

Year 2015, Volume: 12 Issue: 4, 135 - 139, 01.07.2015

Abstract

Amaç: Fetal üriner sistem anomalisi saptanan olguların antenatal takibi ile yönetiminin belirlenmesi ve neonatal sonuçlarını değerlendirmektir.Gereç ve Yöntemler: Çalışma Ocak 2004-Ocak 2005 yılları arasında Ege Doğumevi ve Kadın Hastalıkları Eğitim ve Araştırma Hastanesi’nde antenatal ultrason ile tespit edilen 57 olguyu içeriyordu. Olgular fonksiyonel böbreği olmayan Grup 1 en az bir fonksiyonel böbreği olan Grup 2 ve sadece pyelektazi izlenen Grup 3 fetuslar olmak üzere 3 gruba ayrılarak incelendi. Renal pelvis ön arka çapı ≥5 mm olan olgular pyelektazi olarak kabul edilerek çalışmaya dahil edildi. Renal pelvis ön arka çapları progresyon açısından 30. gebelik haftasından önce ve sonra değerlendirildi. Postpartum böbrek anomalili tanıları retrospektif olarak incelendi.Bulgular: Non-fonksiyonel böbrek Grup 1 nedeniyle 8 olgunun 3’ü abort ettirildi, diğer 5 fetus doğum sonrası exitus oldu. Grup 2’de yer alan 1 olgu doğum sonrası opere edildi. Unilateral ve/veya bilateral pyelektazi nedeniyle izlenen Grup 3 48 olgunun 15’inde postpartum incelemede üriner sistem anomalisi saptandı ve 11’ine operasyon uygulandı. 28 pyelektazi olgusu neonatal dönemde idrar yolu enfeksiyonu nedeniyle antibiyotik tedavisi aldı. Üç olguya prenatal dönemde amniosentez uygulandı. Bunlardan birinin gebeliği down sendromu nedeniyle sonlandırıldı. 57 olgunun 8’inde %14 anhidramniyos ve dört olguda %7 polihidramniyos tespit edildi.Sonuç: Üriner sistem anomalileri prenatal dönemde tespit edilmesi, gerek gebeliğin sonlandırılması gerekse gebeliği devam eden olgularda amniyosentez yapılması veya doğum sonrası yenidoğanın takibe alınmasında büyük öneme sahiptir. Özellikle prenatal dönemde masum gibi görünen, temelinde organik lezyon bulunan hafif renal pelvis dilatasyonları pastpartum dönemde kalıcı böbrek fonksiyon kaybı yaratmadan pediatrik üroloğa yönlendirilmelidir.

References

  • Helin I, Persson PH. Prenatal diagnosis of urinary tract abnormalities by ultrasound. Pediatrics. 1986;78:879-83.
  • Mathieu H, Loirat C, Macher MA, Weisgerber G, Guedeney J, Pillion G, Guesnu M. Long-term outcome of children with malformative uropathies. Int J Pediatr Nephrol 1985;6: 3-12.
  • Freedman AL, Bukowski TP, Smith CA, Evans MI, Quintero R, Gonzales R, Johnson MP. Fetal therapy for obstructive uropathy: diagnosis specific outcomes. Urology 1996;156:720-24.
  • Gunn TR,Mora D, Pease P. Antenatal diagnosis of urinary tract abnormalities by ultrasonography after 28 weeks’ gestation: incidence and outcome. Am J Obstet Gynecol 1995; 172: 479–486.
  • Sairam S, Al-Habib A, Sasson S, Thilaganathan B. Natural history of fetal hydronephrosis diagnosed on mid-trimester ultrasound. Ultrasound Obstet Gynecol 2001; 17: 191–196.
  • Herndon CD. Antenatal hydronephrosis: differential diagnosis, evaluation, and treatment options Scientific World Journal. 2006; 6: 2345-65
  • Bois E, Feingold J, Benmaiz H, Briard ML. Congenital urinary tract malformations: epidemiologic and genetic aspects. Clin Genet. 1975; 8: 37-47.
  • Cocchi G, Magnani C, Morini MS, Garani GP, Milan M, Calzolari E. Urinary tract abnormalities (UTA) and associated malformations: data of the Emilia-Romagna Registry. IMER Group. Eur J Epidemiol. 1996;12: 493- 7.
  • Nicolaides KH, Cheng HH, Snijders RJ, Moniz CF.Fetal urine biochemistry in the assessment of obstructive uropathy. Am J Obstet Gynecol. 1992 ;166: 932-7
  • Blyth B, Snyder HM, Duckett JW. Antenatal diagnosis and subsequent management of hydronephrosis. J Urol 1993; 149: 693–698.
  • Peters CA, Carr MC, Lais A, Retik AB, Mandell J. The response of the fetal kidney to obstruction. J Urol 1992; 148: 503–509.
  • Scott JE. Fetal, perinatal, and infant death with congenital renal anomaly. Arch Dis Child. 2002; 87: 114-7
  • Qin P, Ma XQ, Xie YX, Hou DM, Qian M. Prenatal ultrasonography for fetus with hydronephrosis. Zhonghua Yi Xue Za Zhi. 2007 18;87:2481-3.
  • Ismaili K, Hall M, Donner C, Thomas D, Vermeylen D, Avni FE; Results of systematic screening for minor degrees of fetal renal pelvis dilatation in an unselected population.Am J Obstet Gynecol. 2003; 188: 242-6.
  • Lepercq J, Beaudoin S, Bargy F. Outcome of 116 moderate renal pelvis dilatations at prenatal ultrasonography. Fetal Diagn Ther. 1998; 13: 79-81
  • Broadley P, McHugo J, Morgan I, Whittle MJ, Kilby MD.The 4 year outcome following the demonstration of bilateral renal pelvic dilatation on pre-natal renal ultrasound. Br J Radiol. 1999; 72: 265-70.
  • Wollenberg A, Neuhaus TJ, Willi UV, Wisser J Outcome of fetal renal pelvic dilatation diagnosed during the third trimester. Ultrasound Obstet Gynecol. 2005; 25: 483-8.
  • Anderson NG, Abbott GD, Mogridge N, Allan RB, Maling TM, Wells JE Vesicoureteric reflux in the newborn: relationship to fetal renal pelvic diameter.Pediatr Nephrol. 1997 ; 11: 610-6.
  • McIlroy PJ, Abbott GD, Anderson NG, Turner JG, Mogridge N, Wells JE.Outcome of primary vesicoureteric reflux detected following fetal renal pelvic dilatation. J Paediatr Child Health 2000;36:569-73.
  • Reddy PP, Mandell J. Prenatal diagnosis. Therapeutic implications. Urol Clin North Am. 1998; 25: 171-80
  • Thomas DF. Fetal uropathy. Br J Urol. 1990; 66: 225-31
  • Gotoh H, Masuzaki H, Fukuda H, Yoshimura S, Ishimaru T. Detection and assessment of pyelectasis in the fetus: relationship to postnatal renal function. Obstet Gynecol. 1998;92: 226-31.
  • Kurjak A, Latin V, Mandruzzato G, D’Addario V, Rajhvajn B. Ultrasound diagnosis and perinatal management of fetal genito-urinary abnormalities. J Perinat Med. 1984; 12: 291-312.
  • Dungan SJ, Fernandez TM, Abbott LP et al. Multicystic dysplastic kidney: natural history of prenatally detected cases. Prenatal diagnosis 1990; 10: 175-82.
  • Aubertin G, Cripps S, Coleman G, McGillivray B, Yong SL, Van Allen M, Shaw D, Arbour L. Prenatal diagnosis of apparently isolated unilateral multicystic kidney: implications for counselling and management Prenat. Diagn. 2002; 22: 388-94.
  • Hains DS, Bates CM, Ingraham S, Schwaderer AL Management and etiology of the unilateral multicystic dysplastic kidney: a review. Pediatr Nephrol. Hains DS, Bates CM, Ingraham S, Schwaderer AL Management and etiology of the unilateral multicystic dysplastic kidney: a review. Pediatr Nephrol. 2009 Feb;24(2):233-41
  • Nicolaides KH, Cheng HH, Abbas A, Snijders RJ, Gosden C. Fetal renal defects: associated malformations and chromosomal defects. Fetal Diagn Ther. 1992; 7: 1-11.
  • Oliveira EA, Diniz JS, Vilasboas AS, Rabêlo EA, Silva JM, Filgueiras MT. Multicystic dysplastic kidney detected by fetal sonography: conservative management and follow-up. Pediatr Surg Int. 2001; 17: 54-7.
  • Ylinen E, Ahonen S, Ala-Houhala M, Wikström S. Nephrectomy for multicystic dysplastic kidney: if and when? Urology. 2004; 63: 768-71
  • Mahony BS, Callen PW, Filly RA. Fetal urethral obstruction: US evaluation. Radiology. 1985; 157: 221-4.
  • Hayden SA, Russ PD, Pretorius DH, Manco-Johnson ML, Clewell WH Posterior urethral obstruction. Prenatal sonographic findings and clinical outcome in fourteen cases. J Ultrasound Med. 1988; 7: 371-5.
  • Coplen DE. Prenatal intervention for hydronephrosis J Urol. 1997;157:2270-7.
  • Zhu CP, Yi ZW.Expression of fibroblast growth factor receptor-4 in fetal kidneys and pathological kidneys of children. Zhongguo Dang Dai Er Ke Za Zhi. 2007; 9: 133-8.
  • Shima H, Tazawa H, Puri P. Increased expression of fibroblast growth factors in segmental renal dysplasia. Pediatr Surg Int. 2000; 16: 306-9.
There are 34 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Deniz Balsak This is me

Nurgül Başoğul This is me

Cihan Toğrul

Ömer Başoğul This is me

Kerem Doğa Seçkin This is me

Mehmet Onur Karaaltı This is me

Ali Emre Tahaoğlu This is me

Mehmet Şükrü Budak This is me

Ümit Görkem This is me

Publication Date July 1, 2015
Published in Issue Year 2015 Volume: 12 Issue: 4

Cite

Vancouver Balsak D, Başoğul N, Toğrul C, Başoğul Ö, Seçkin KD, Karaaltı MO, Tahaoğlu AE, Budak MŞ, Görkem Ü. Üriner Sistem Anomalisi Saptanan Fetuslara Yaklaşım. JGON. 2015;12(4):135-9.