Abstract
Amaç: Çoğunlukla geçici olan, ancak böbrek ve idrar yolunun konjenital anomalileri (CAKUT) ile de birlikte olabilen ve aileleri endişelendiren antenatal hidronefroz (AH) konusundaki dokuz yıllık deneyimlerimizi okuyucularla paylaşmaktır.Gereç ve Yöntemler: Antenatal dönemde saptanan hidronefroz nedeniyle genel pediatri polikliniğinde Ocak 2005 ve Aralık 2013 tarihleri arasında izlenen 230 hasta retrospektif olarak değerlendirildi. Hastaların kilo, boy, kan basıncı değerleri ile laboratuvar, ultrasonografi, dimerkaptosüksinik asit, dietilentriamin pentaasetik asit, miksiyon sistoüreterografi sonuçları kaydedildi.Bulgular: Hastaların 200’ünde (% 87.0) sol böbrek, 11’inde (%4.8) sağ böbrek olmak üzere %91.8’unda tek taraflı AH ve 19’unda (%8.3) çift taraflı AH saptandı. Hidronefrozun derecesi 175 hastada (%76.1) hafif, 38 hastada (%16.5) orta ve 17 hastada (%7.4) ağır düzeydeydi. AH nedeniyle takip edilen hastaların 195’inde (%84.8) non-obstrüktif hidronefroz saptanırken 19’unda (%8.2) vezikoüreteral reflü, 14’ünde (%6.1) üreteropelvik bileşke darlığı ve 2’sinde (%0.9) posterior üretral valv saptandı. Hidronefroz derecesi arttıkça üriner sistem patolojisi saptanma riskinde artış gözlendi (p<0.001). Çift taraflı AH bulunan hastalarda üriner sistem patolojisi saptanma sıklığı tek taraflı AH bulunan hastalara göre anlamlı derecede yüksek bulundu (p=0.008). Non-obstrüktif AH tanısı alan hastalardan hafif düzeyde hidronefroz olanlarda birinci yılın sonunda spontan düzelme sıklığı %96.4 ve orta düzeyde hidronefroz olanlarda ise %78.6’di.Sonuç: AH nedeniyle takip edilen hastaların başlangıçta 3-7. günler ile 4-6. haftalarda ve daha sonra üç ayda bir olmak üzere en az 1 yıl süreyle takip edilmeleri gerektiği düşünülmektedir. Olguların büyük çoğunluğunda hayatın ilk yılında spontan düzelme gözlenmektedir. Çift taraflı AH veya 10 mm’den büyük renal pelvis çapı saptanan hastalar çocuk nefrologları ve/veya ürologlarına yönlendirilmelidir.
Keywords
References
- Livera LN, Brookfield DS, Egginton JA, Hawnaur JM. Antenatal ultrasonography to detect fetal renal abnormalities: A prospective screening programme. BMJ 1989;298:1421-3.
- Lee RS, Cendron M, Kinnamon DD, Nguyen HT. Antenatal hydronephrosis as a predictor of postnatal outcome: A meta- analysis. Pediatrics 2006;118:586-93.
- Rao PK, Palmer JS. Prenatal and postnatal management of hydronephrosis. Scientific World Journal 2009;9:606-14.
- Yamaçake KG, Nguyen HT. Current management of antenatal hydronephrosis. Pediatr Nephrol 2013;28:237-43.
- Berrocal T, Pinilla I, Gutiérrez J, Prieto C, De Pablo L, Del Hoyo ML. Mild hydronephrosis in newborns and infants: Can ultrasound predict the presence of vesicoureteral reflux. Pediatr Nephrol 2007;22:91-6.
- Valent-Moric B, Zigman T, Cuk M, Zaja-Franulovic O, Malenica M. Postnatal evaluation and outcome of infants with antenatal hydronephrosis. Acta Clin Croat 2011;50:451-5.
Abstract
Objective: To share our nine-year experience with antenatal hydronephrosis (AH), which is usually transient but may be associated with congenital anomalies of the kidney and urinary tract (CAKUT) and can therefore be worrisome for families. Material and Methods: 230 patients with AH who presented to general pediatrics outpatients between January 2005 and December 2013 were evaluated retrospectively. Each patient’s weight, height, blood pressure values and laboratory, ultrasound, dimercaptosuccinic acid, diethylenetriamine pentaacetic acid, and voiding cystourethrography results were recorded. Results: 91.8% of the patients had unilateral AH; 200 patients (87.0%) had left kidney AH, 11 (4.8%) had right kidney AH, and 19 (8.3%) had bilateral AH. The degree of hydronephrosis was mild in 175 patients (76.1%), moderate in 38 patients (16.5%), and severe in 17 patients (7.4%). Non-obstructive hydronephrosis was detected in 195 patients (84.8%), vesicoureteral reflux was detected in 19 patients (8.2%), pelvi-ureteric junction obstruction was detected in 14 patients (6.1%), and posterior urethral valve was detected in 2 patients (0.9%). An increased risk of urinary tract pathology was observed with increasing degrees of hydronephrosis (p<0.001). The detection rate of urinary tract pathology was significantly higher in the patients with bilateral AH compared with unilateral AH (p=0.008). The spontaneous recovery rates for the non-obstructive AH patients with mild and moderate dilatation were 96.4% and 78.6%, respectively
References
- Livera LN, Brookfield DS, Egginton JA, Hawnaur JM. Antenatal ultrasonography to detect fetal renal abnormalities: A prospective screening programme. BMJ 1989;298:1421-3.
- Lee RS, Cendron M, Kinnamon DD, Nguyen HT. Antenatal hydronephrosis as a predictor of postnatal outcome: A meta- analysis. Pediatrics 2006;118:586-93.
- Rao PK, Palmer JS. Prenatal and postnatal management of hydronephrosis. Scientific World Journal 2009;9:606-14.
- Yamaçake KG, Nguyen HT. Current management of antenatal hydronephrosis. Pediatr Nephrol 2013;28:237-43.
- Berrocal T, Pinilla I, Gutiérrez J, Prieto C, De Pablo L, Del Hoyo ML. Mild hydronephrosis in newborns and infants: Can ultrasound predict the presence of vesicoureteral reflux. Pediatr Nephrol 2007;22:91-6.
- Valent-Moric B, Zigman T, Cuk M, Zaja-Franulovic O, Malenica M. Postnatal evaluation and outcome of infants with antenatal hydronephrosis. Acta Clin Croat 2011;50:451-5.
Details
| Other ID | JA97CE83ES |
|---|---|
| Journal Section | Research Article |
| Authors | |
| Publication Date | June 1, 2016 |
| Submission Date | June 1, 2016 |
| Published in Issue | Year 2016 Volume: 10 Issue: 2 |
The publication language of Turkish Journal of Pediatric Disease is English.
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