Perinatal Hydronephrosis: Etiology and Effect to Renal Functions

Abstract

Objective: Hydronephrosis, which is characterized with the dilatation of renal pelvis and/or calix is the most frequent antenatal renal anomaly. It was evaluated causes of perinatal hydronephrosis and effect to the renal functions in our study. Materials and Methods: The study enrolled 65 patients with perinatal hydronephrosis diagnosed and followed in the department of pediatric nephrology. All patients were followed with ultrasonography (USG) after evaluated for the clinic and physic findings. Patients were assessed with voidingsistouretrography (VCUG) in terms of vesicoureteral reflux (VUR). Results: 46 of cases were males (%70,8) and 19 (%29,2) were females. 44 of patients had (%67,7) unilateral hydronephrosis and 21 of patients (%32,3) had bilateral hydronephrosis. It was assessed as physiological hydronephrosis the cases which hydronephrosis regressed in terms of USG in the monitoring and VUR was not detected in the VCUG. There were 27 (%41) patients in physiological hydronephrosis group. The rest of 38 patients (%59) were assessed as pathological hydronephrosis. In terms of renal functions, the rate of urine protein / urine creatine was higher in cases with pathological hydronephrosis according to the cases with physiological hydronephrosis. Conclusion: In the study, we come to conclusion that it is needed to define cases that are not constituted the problem in terms of diagnosis, monitoring and treatment for antenatal hydronephrosis and it is needed to abstain from unnecessary invasive procedure but on the other hand, it is should not be late for diagnosis of obstructive uropathy which could be caused the renal scar and it is needed dynamic approach to these cases.

Keywords

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Perinatal Hidronefroz: Etiyoloji ve Böbrek Fonksiyonlarına Etkisi

Öz

Amaç: Hidronefroz renal pelvis ve/veya kalikslerin dilatasyonu ile karakterize, en sık gözlenen antenatal renal anomalidir. Çalışmamızda perinatal hidronefroza yol açan nedenler ve böbrek fonksiyonlarına etkisi değerlendirildi. Gereç ve Yöntem: Pediatrik Nefroloji polikliniği tarafından perinatal hidronefroz tanısı ile izlenmekte olan 65 hasta çalışmaya alındı. Olgular klinik, fizik muayene bulguları yönünden değerlendirildikten sonra ultarasonografi (USG) ile takibe alındı. Hastalar vezikoüreteral reflü (VUR) yönünden voidingsistoüretrografi (VCUG) ile değerlendirildi. Bulgular: Olguların 46'sı erkek (%70,8), 19'u kızdı (%29,2). Hastaların 44'ünde (%67,7) unilateral hidronefroz, 21'inde (%32,3) bilateral hidronefroz vardı. İzlemlerinde USG'da hidronefrozu gerileyen, VCUG'de VUR saptanmayan olgular fizyolojik hidronefroz olarak değerlendirildi. Fizyolojik hidronefroz grubunda 27 hasta (%41) vardı. Geriye kalan 38 (%59) hasta patolojik hidronefroz olarak değerlendirildi. Böbrek fonksiyon parametrelerinden idrar protein/idrar kreatinin oranı patolojik hidronefroz olgularında fizyolojik hidronefroz olgularına göre daha yüksekti. Sonuç: Sonuç olarak çalışmamızda antenatal hidronefrozda tanı, takip ve tedavideki sorunsuz seyredilebilecek olguları tespit edip ve gereksiz invazif işlemlerden kaçınmak gerektiği, ancak diğer taraftan renal skara neden olabilen obstrüktif üropatilerin tanısı için geç kalmadan bu olgulara dinamik bir yaklaşım gerektiği kanaatine varıldı.

Anahtar Kelimeler

• Perinatal hidronefroz, Etiyoloji, Böbrek fonksiyonları

Kaynakça

1. Jaswon MS, Dibble L. Prospective study of outcome in ante- natally diagnosed renal pelvis dilatation. Arc Dis Fetal Neona- tal Ed 1999; 80: 135-8.
2. Woodward M, Frank D. Antenatal problems: management in the postnatal period. In: Webb JAN, Postethwaite RJ (eds). Clinical Pediatric Nephrology. 3rd Ed. UK: Oxford Unv Press, 2002; 270-82.
3. Olcay N, Türkan E. Üriner Sistem ve Hastalıkları. In: Şirin A, Emre S, Nayır A, Tanman F, Bilge I (editörler). Pediyatri. 4. Baskı, İstanbul: Nobel Matbaacılık, 2010; 1427-31.
4. Grignon A, Fitlion R. Urinary tract dilatation in utero: classifi- cation and clinical applications. Radiology 1986; 160: 645-7.
5. Dremsek PA, Gindl K. Renal pyelactasis in fetuses and neona- tes: diagnostic value of pelvis diameter in pre and postnatal sonografic screening. Am J Roentgenol 1997; 168: 1017-9.
6. 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: 1687-92.
7. Berrocal T, Pinilla I, Gutierrez J, Prieto C, Pablo L, Hoyo M. Mild hydronephrosis in newborns and infants: can ultrasound predict the presence of vesicoureteral reflux. Pediatr Nephrol 2007; 22: 91-6.
8. Apocalypse G, Oliveira E, Rabelo E, Diniz J, Marino V, Pereira A, et al. Outcome of apparent ureteropelvic junction obstruction identified by investigation of fetal hydronephrosis. Int Urol Nephrol 2003; 35: 441-8.

9. Oliveira EA, Diniz J, Silva J, Rabelo E, Pontes A, Souza M. Features of primary vesicoureteric reflux detected by investi- gation of fetal hydronephrosis. Int Urol Nephrol 1998; 30: 535-41.
10. Gunn TR, Mora JD, Pease P. Antenatal diagnosis of urinary tract abnormalities by ultrasonography after 28 weeks’ gesta- tion: incidence and outcome. Am J Obstet Gynecol 1995; 172; 479-80.
11. Dudley JA, Haworth JM, McGraw ME, Frank JD, Tizard EJ. Clinical relevance and implications of antenatal hydronephro- sis. Arch Dis Chil Fetal Neonatal Ed 1997; 76: 31–4.
12. Williams B, Tareen B, Resnick MI. Pathophysiology and treatment of ureteropelvic junction obstruction. Curr Urol Rep 2007; 8: 111-7.
13. Woodwark M, Frank D. Postnatal management of antenatal hydronephrosis. BJU International 2002; 89: 149-56.
14. Bruyn R, Gordon I. Postnatal investigation of fetal renal disease. J Prenat Diagn 2001; 21: 84-91.
15. Zerin JM, Ritchey ML, Chang ACH. Incidental vesicoureteral reflux in neonatas with antenatally detected hydronephrosis and other renal abnormalities. Radiology 1993; 187: 157-60.
16. Vanderheyden T, Kumar S, Fisk NM. Fetal renal impairment. Semin Neonatal 2003; 8: 279–89.
17. Gönderilme Tarihi: 21.05.2012