Antenatal Pelvik Dilatasyon Saptanan Bebeklerin Postnatal Değerlendirilmesi

Yıl 2012, , 177 - 181, 01.10.2012

Sevinç Emre Ilmay Bilge Zeynep Yürük Yıldırım Alev Yılmaz Haluk Ander Bağdagül Aksu Aydan Şirin

https://doi.org/10.5222/j.child.2012.177

Öz

Amaç: Antenatal ultrasonografi USG sırasında en sık olarak konjenital üriner sistem anomalileri görülür; bunlardan en sık saptananı ise antenatal pelvik dilatasyondur. Bu retrospektif çalışmanın amacı antenatal renal pelvik dilatasyon saptanan bebeklerin postnatal tanısı ve prognozunun değerlendirilmesidir. Gereç ve Yöntem: Çalışma grubu Ocak 1997 ve Aralık 2010 tarihleri arasında antenatal renal pelvik dilatasyon RPD tanısı almış 280 yenidoğandan oluşmaktaydı. Hastaların dosyaları tüm laboratuvar ve görüntüleme yöntemleri sonuçları ve prognozları retrospektif olarak değerlendirildi. Renal Pelvis antero-posterior çapı APD 20 mm olanlar ağır dilatasyon olarak kabul edildi. Fonksiyonel lateralizasyon, sintigrafide bir böbreğin total renal fonksiyona katkısının %44’ten az olması olarak tanımlandı. Bulgular: Hastaların 70 % 25 ’i kız, 210 % 75 ’u erkekti. Ortalama izlem süresi 16.3±18.6 aydı 6-127 ay . Postnatal olarak 350 renal ünitede RPD tespit edildi. Bunlardan 197 % 56,3 ’si hafif, 84 % 24 ’ü orta ve 69 % 19,7 ’u ağır olarak değerlendirildi. Hafif dilatasyonu olan hastalarda non-obstrüktif dilatasyon n= 95: % 70,4 , vesikoüreteral reflü VUR n= 14: % 10,4 üreteropelvik bileşke obstrüksiyonu UPBO n=12: % 8,9 , üreterovesikal bileşke obstrüksiyonu UVBO n= 3: % 2,2 ve posterior üretral valv PUV n= 1: % 0.7 saptandı.Orta dilatasyonu olan hastalarda ise non-obstrüktif dilatasyon n= 29: % 44.7 , VUR n= 15: % 23 , UPBO n=12: % 18,59, UVBO n=1: % 1,5 ve PUV n=3 görüldü. Ağır dilatasyonu olanlarda , non-obstrüktif dilatasyon n= 10: % 13,2 , VUR 5: % 9,6 , UPBO n=18: % 3 4,6 , UVBO n=1: % 1,9 ve PUV n=5: % 9,6 gözlendi. İzlemde hafif dilatasyonların % 34,9’u kayboldu, % 26,4’ü azaldı, % 9’unda artış görülürken, % 29,7’sinde stabil kaldı. VUR’un spontane düzelme oranı % 34 olarak saptandı. Renal fonksiyonlarda bozulma PUV tanısı olan 1 hastada saptandı. Sonuç: Hafif ve orta dereceli antenatal RPD’nin en sık nedenleri non-obstrüktif dilatasyon ve VUR olarak saptandı. Antenatal USG üriner sistem anomalilerini saptamada oldukça duyarlı olduğu görüldü, yanlış pozitiflik oranı yalnızca % 10’du.

Anahtar Kelimeler

Antenatal dilatasyon, antenatal ultrasonografi, üriner sistem anomali

Postnatal Assessment of the Infants with Antenally Detected Renal Pelvic Dilation

Öz

Aim: Congenital anomalies of the urinary system are the most common abnormalities detected during antenatal ultrasonografi US , and renal pelvic dilation RPD is the most common of these. The aim of this retrospective study was to evaluate the postnatal diagnosis and follow up of the infants with renal pelvic dilation. Material and Methods: The study group consisted of 280 newborn babies in whom RPD was diagnosed antenatally in our clinic between January 1997 and December 2010. The patients’ files were reviewed for laboratory findings and their prognosis, retrospectively. Mild dilation was defined as pelvic diameter pd of 20 mm. Functional lateralization in scintigraphy was Results: Of the 280 patients, 70 25 % were female and 210 75 % were male. Mean follow up duration was 16.3±18.6 months 6-127 months . Of the 350 renal units with RPD in postnatal USG, 197 56.3 % were mild, 84 24 % were moderate and 69 19.7 % were severe . Among the infants with mild dilation non-obstructive pelvic dilation n= 95: 70.4 % , vesicoureteral reflux VUR n= 14: 10.4 % , ureteropelvic junction obstruction UPJO n= 12: 8.9 % , ureterovesical junction obstruction UVJO n= 3: 2.2 % , and posterior ureteral valve PUV n=1: 0.7 % were detected. In the moderate dilation group, non-obstructive pelvic dilation n=29:44.7 % , VUR n=15: 23% , UPJO n=12: 18.5 % , UVJO n=1:1.5 % , and PUV n=3: 4.7 % were encountered. In the severe dilation group, were non-obstructive pelvic dilation n=10:13.2 % , VUR n=5 :9.6 % , UPJO n= 18: 34.6 % , UVJO 1:1.9 % , and PUV n= 5: 9.6 % were observed. RPD disappeared in 34.9 % of renal units with mild dilation on follow up and pd decreased in 26.4 %, was increased in 9% and remained stable in 29.7 % of the cases, respectively. The rate of spontaneous resolution of VUR was 34 %. Renal function deteriorated in 1 patient with PUV. Conclusion: Majority of mild or moderate antenatal RPD is due to non-obstructive pelvic dilation and VUR. Antenatal US is a sensitive method to detect urinary tract abnormalities with only 10 % false positive results.

Anahtar Kelimeler

Antenal dilation, antenatal ultrasonography, urinary tract abnormalities

Kaynakça

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