Orta Anadolu’da Yaşamın İlk Yılında Hidronefrozun Değerlendirilmesi ve Yönetimi

Öz

Amaç: Bu çalışmanın amacı, hidronefroz tanısı alan hastaların yaşamının ilk yılında prognoz ve sonuçlarını değerlendirmekle birlikte büyüme, gelişme ve üriner sistem enfeksiyonu açısından takip etmektir. Gereç ve Yöntemler: Çalışma grubunu Üniversitemiz Çocuk Sağlığı ve Hastalıkları polikliniklerinde Antenatal Hidronefroz tanısı ile takip edilen 28 hasta oluşturmaktadır. Çalışmaya dahil edilen olguların dosyaları retrospektif olarak tarandı ve bir yıllık takipte hastaların demografik verileri, görüntüleme yöntemleri, geçirilmiş üriner sistem enfeksiyonu, büyüme gelişimi ve beslenme durumları değerlendirildi. Antenatal dönemde yapılan renal ultrasonografi bulguları pelvik anteroposterior çaplarına göre derecelendirildi. Bulgular: Antenatal dönemde ultrasonografi ile hidronefroz saptanan toplam 28 hasta çalışmamıza dahil edildi. Birinci postanatal ultrasonografi'de hastaların 14'ünde (%50) unilateral hidronefroz, 10'unda (%35,7) bilateral hidronefroz ve 4'ünde (%14,3) normal görüldü. Tez çalışması süresince takip edilen hastaların %71,4'ünde hafif hidronefroz, %14,3'ünde ağır hidronefroz ve %14,3'ünde normal saptandı. Hidronefroz tanısı alan hastaların tüm takiplerinde, hidronefrozun derecesi ile takip arasında hastaların büyüme ve gelişmesi üzerine olumsuz etki olmuş ve zıt bir ilişki gözlenmiştir. Bu sonuçlar istatistiksel olarak anlamlı bulundu (p<0.05). Sonuç: Antenatal hidronefroz etiyolojisinin birçok nedeni girişime gerek kalmadan kendiliğinden gerileyebilmekte olup, ileri tetkik gereken hastaların belirlenmesi, diğer hastalar için daha az tetkik ve prospektif takip planı ile takip edilmesinin uygun olduğu düşünülmektedir.

Anahtar Kelimeler

• Hidronefroz
• antenatal hidronefroz
• postnatal takip

Proje Numarası

10395689

Evaluation and Management of Hydronephrosis at First Year of Life in Central Anatolia

Öz

Objective: The aim of this study was to evaluate the prognosis and outcomes of patients diagnosed with hydronephrosis in the first year of life and to follow them in terms of growth, development and urinary tract infection. Material and Methods: The study group consists of the follow-up of 28 patients who were followed up with the diagnosis of Antenatal Hydronephrosis in the Pediatrics outpatient clinics of our University. The files of the cases included in the study were retrospectively scanned and demographic data, imaging methods, previous urinary tract infection, growth development and nutritional status of the patients were evaluated during the one-year follow-up. Renal ultrasonography findings performed in the antenatal period were graded according to pelvic anteroposterior diameters. Results: A total of 28 patients with hydronephrosis detected by ultrasonography during antenatal period were included in our study. Unilateral hydronephrosis in 14 (50%) of the patients in the first postanatal ultrasonography, bilateral hydronephrosis in 10 (35.7%) and 4 (14.3%) was seen as normal. In the first postnatal ultrasonography of the patients followed during the thesis study, 71.4% had mild hydronephrosis, 14.3% had severe hydronephrosis, and 14.3% was normal. In all follow-ups of patients with the diagnosis of hydronephrosis, there was a negative effect on the growth and development of the patients between the degree of hydronephrosis and the follow-up, and an opposite relationship was observed. These results were found to be statistically significant (p<0.05). Conclusion: Many causes of antenatal hydronephrosis etiology can regress spontaneously without the need for intervention, and it is considered appropriate to identify patients who need further examination and to follow up with less examination and prospective follow-up plan for other patients.

Anahtar Kelimeler

• Hydronephrosis
• antenatal hydronephrosis
• postnatal follow-up

Proje Numarası

10395689

Kaynakça

1. 1. Nguyen HT, Benson CB, Bromley B, Campbell JB, Chow J, Coleman B, et al. Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). J Pediatr Urol. 2014;10(6):982-8.
2. 2. Woodward M, Frank D. Postnatal management of antenatal hydronephrosis. BJU Int. 2002;89(2):149–56.
3. 3. Sidhu G, Beyene J, Rosenblum ND. Outcome of isolated antenatal hydronephrosis: a systematic review and meta-analysis. Pediatr Nephrol. 2016;21(2):218-24.
4. 4. Yavascan O, Aksu N, Anil M, Kara OD, Aydin Y, Kangin M, et al. Postnatal assessment of growth, nutrition, and urinary tract infections of infants with antenatally detected hydronephrosis. Int Urol Nephrol. 2010;42(3):781-8.
5. 5. Walsh TJ, Hsieh S, Grady R, Mueller BA. Antenatal hydronephrosis and the risk of pyelonephritis hospitalization during the first year of life. Urology. 2007;69(5):970-4.
6. 6. DiSandro MJ, Kogan BA. Neonatal management role for early intervention. Urol Clin North Am 1998;25(2):187-97.
7. 7. Nguyen HT, Herndon CD, Cooper C, Gatti J, Kirsch A, Kokorowski P, et al. The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol. 2010;6(3):212-31.
8. 8. Fernbach SK, Maizels M, Conway JJ. Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr Radiol. 1993;23(6):478-80.

9. 9. Persutte WH, Hussey M, Chyu J, Hobbins JC. Striking findings concerning the variability in the measurement of the fetal renal collecting system. Ultrasound Obstet Gynecol. 2000;15(3):186-90.
10. 10. Costers M, Van Damme-Lombaerts R, Levtchenko E, Bogaert G. Antibiotic prophylaxis for children with primary vesicoureteral reflux: where do we stand today? Adv Urol. 2008; 2008:217805.
11. 11. Dias CS, Silva JM, Pereira AK, Marino VS, Silva LA, Coelho AM, et al. Diagnostic accuracy of renal pelvic dilatation for detecting surgically managed ureteropelvic junction obstruction. J Urol. 2013;190(2):661-6.
12. 12. Nguyen HT, Benson CB, Bromley B, Campbell JB, Chow J, Coleman B, et al. Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). J Pediatr Urol. 2014;10(6):982-98.
13. 13. Lidefelt KJ, Herthelius M. Antenatal hydronephrosis: infants with minor postnatal dilatation do not need prophylaxis. Pediatr Nephrol. 2008;23(11):2021-4.
14. 14. Grazioli S, Parvex P, Merlini L, Combescure C, Girardin E. Antenatal and postnatal ultrasound in the evaluation of the risk of vesicoureteral reflux. Pediatr Nephrol. 2010;25(9):1687-92.
15. 15. Pattaragarn A, Alon US. Urinary tract infection in childhood. Review of guidelines and recommendations. Minerva Pediatr. 2002;54(5):401-13.
16. 16. Braga LH, Mijovic H, Farrokhyar F, Pemberton J, DeMaria J, Lorenzo AJ. Antibiotic prophylaxis for urinary tract infections in antenatal hydronephrosis. Pediatrics. 2013;131(1): e251-61.
17. 17. Kıllı İ, Avlan D, Taşkınlar H, Kara PP, Apaydın FD, Delibaş A et al. Effective predictors for surgical decision in antenatal hydronephrosis: a prospective multiparameter analysis. Turk J Urol. 2017;43(3):361– 5.
18. 18. Lim DJ, Park JY, Kim JH, Paick SH, Oh SJ, Choi H. Clinical characteristics and outcome of hydronephrosis detected by prenatal ultrasonography. J Korean Med Sci. 2003;18(6):859–62. 9
19. 19. Chertin B, Pollack A, Koulikov D, Rabinowitz R, Hain D, HadasHalpren I, et al. Conservative treatment of ureteropelvic junction obstruction in children with antenatal diagnosis of hydronephrosis: lessons learned after 16 years of follow-up. Eur Urol. 2006;49(4):734– 8.
20. 20. Nerli RB, Amarkhed SS, Ravish IR. Voiding cystourethrogram in the diagnosis of vesicoureteric reflux in children with antenatally diagnosed hydronephrosis. Ther Clin Risk Manag. 2009;5(1):35–9.
21. 21. Polito C, La Manna A, Capacchione A, Pullano F, Iovene A, Del Gado R. Height and weight in children with vesicoureteric reflux and renal scarring. Pediatr Nephrol. 1996;10(5):564–7.
22. 22. Seidel C, Schaefer F, Schärer K. Body growth in urinary tract malformations. Pediatr Nephrol. 1993;7(2):151–5.