UTD Sınıflamasının Antenatal Hidronefroz Prognozunu Tahmin Etmedeki Rolü

Year 2023, , 189 - 193, 25.12.2023

Sevgin Taner , Gunay Ekberli

https://doi.org/10.57221/izmirtip.1342217

Abstract

Amaç: Antenatal hidronefroz (HN), böbrek ve üriner systemin konjenital anomalilerinin (CAKUT) bir tezahürünün yanı sıra geçici bir durumu da gösterebilir. CAKUT vakalarını tanımak ve gerekli müdahaleyi zamanında yapabilmek için farklı skorlama sistemleri geliştirilmiştir. Bu çalışmanın amacı antenatal HN ile hastanemize başvuran hastaların takip sonuçlarını ‘Üriner Trakt Dilatasyonu’ (ÜTD) sınıflamasına göre yeniden değerlendirmek ve sınıflamanın prognostik öngörüsünü belirlemektir.
Gereç ve Yöntemler: Şubat 2020-Mart 2021 tarihleri arasında Adana Şehir Eğitim ve Araştırma Hastanesi Çocuk Nefroloji ve Üroloji polikliniklerine antenatal HN tanısı ile başvuran hastalar çalışmaya alındı. Hastalar UTD sınıflamasına göre gruplandırıldı.
Bulgular: Çalışmaya dahil edilen 132 hastanın (93 erkek/39 kadın) 84'ü (%64) geçici/fizyolojik hidronefroz, 48'i (%36) CAKUT tanısı aldı. Kırk yedi hastada izole pelvik dilatasyonu (pelvis ön-arka çapı <10 mm) saptandı. UTD sınıflamasına dahil edilmeyen (UTD-P0) bu hastaların dördü (%9) CAKUT tanısı aldı. CAKUT insidansı UTD-P1 grubunda %13, UTD-P2 grubunda %55 ve UTD-P3 grubunda %100 idi. UTD P3 grubunda CAKUT varlığı, böbrek fonksiyon kaybı ve cerrahi girişim gereksinimi daha sıktı.
Sonuç: UTD sınıflaması hastaların prognozunu tahmin etmede yardımcıdır. Ancak UTD sınıflamasına (P0) dahil olmayan grupta bile CAKUT olgularının varlığı bize tek bir US görüntülemenin yanıltıcı olabileceğini hatırlatmaktadır. UTD Sınıflamasına göre, herhangi bir derecede antenatal HN'si olan çocuklar, normal popülasyona kıyasla postnatal patoloji riski altındadır. Özellikle orta ve şiddetli antenatal HN, önemli bir patolojik sonuç riskine sahiptir. Bu hastaların kapsamlı doğum sonrası tanı yönetimini yürütmek önemlidir.

Keywords

hidronefroz, antenatal hidronefroz, CAKUT, UTD

The Role of UTD Classification in Predicting Prognosis of Antenatal Hydronephrosis

Abstract

Evaluation of Patients with Antenatal Hydronephrosis According to UTD Classification
Aim: Antenatal hydronephrosis (HN) may indicate a temporary benign condition, as well as a manifestation of congenital anomalies of the kidney and urinary system (CAKUT). Different scoring systems have been introduced to recognize CAKUT cases and to perform the necessary intervention in a timely manner. The aim of this study is to reevaluate the follow-up results of patients admitted to our hospital with antenatal HN according to the Urinary Tract Dilation (UTD) classification, and to determine the prognostic prediction of the classification in determining the presence of CAKUT and the need for surgery.
Materials and Methods: Patients admitted to Adana City Training and Research Hospital Pediatric Nephrology and Urology outpatient clinics with the diagnosis of antenatal HN between February 2020-March 2021 included in the study. Patients were grouped according to the UTD classification.
Results: Of the 132 patients (93 male/39 female), 84 (64%) of the patients were evaluated as transient/physiological hydronephrosis, 48 (36%) as CAKUT. Isolated pelvic dilatation (pelvis anteroposterior diameter <10 mm) was detected in 47 patients. These patients were not included in the UTD classification (P0). Four (9%) of the UTD-P0 patients were evaluated as CAKUT. The incidence of CAKUT was 13% in patients with UTD-P1, 55% in patients with UTD-P2 and 100% in patients with UTD-P3. The diagnosis of CAKUT, loss of kidney function, and the need for surgical intervention were more common in patients in the UTD P3 group, respectively.
Conclusion: UTD classification is helpful in predicting prognosis of the patient. However, the presence of CAKUT cases even in the group not included in the UTD classification (P0) reminds us that a single US imaging can be misleading. According to the UTD Classification, children with any degree of antenatal HN are at risk for postnatal pathology compared to the normal population. Particularly moderate and severe antenatal HN has a significant risk of pathologic outcome. It is important to carry out comprehensive postnatal diagnosis management of these patients.

Keywords

hydronephrosis, antenatal hydronephrosis, CAKUT, UTD

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