Hafif ve Orta Dereceli İzole Antenatal Hidronefrozlu Süt Çocuklarının Postnatal İzlem Sonuçlarının Değerlendirilmesi

Öz

Antenatal hidronefroz doğum öncesi yapılan ultrasonografik incelemede en sık saptanan konjenital ürolojik anomalilerden biridir. Hafif ve orta dereceli izole antenatal hidronefrozun doğum sonrası dönemdeki yönetimi hakkında çelişkili sonuçlar bulunmaktadır. Bu çalışmanın amacı hafif ve orta dereceli izole antenatal hidronefrozlu süt çocuklarında ilk bir yılda idrar yolu enfeksiyonu (İYE) sıklığını ve klinik seyri araştırmaktır. Bu çalışmaya doğum sonrası 7 gün ile 2 hafta arasında yapılan ilk böbrek ultrasonografisinde hafif ve orta dereceli hidronefrozu olan hastalar dahil edildi. Hidronefroz dışında böbrek anomalisi olan, üreteral dilatasyonu ya da mesane anomalisi bulunan hastalar çalışmaya dahil edilmedi. Hidronefroz ön-arka pelvis çapı ölçülerek hafif (5-9.9 mm) ve orta (10-14.9 mm) dereceli olarak sınıflandırıldı. Çalışmaya 140 hasta [96 erkek (%68.6), 44 kız (%31.4)] dahil edildi. Altmış hasta (%42.9) hafif dereceli, 80 hasta (%57.1) orta dereceli hidronefroza sahipti. Spontan gerileme oranı hafif hidronefrozlu hastalarda diğer gruptan daha yüksekti [sırası ile n=58 (%96.6), n=48 (%60), p<0.01]. Ortanca gerileme zamanı hafif hidronefrozlu hastalarda daha kısa idi [ortanca gerileme zamanı; sırası ile 4 (3-5.25); 6 (5-7) ay,  p<0.01]. İYE sıklığı hafif ve orta dereceli hidronefrozlu hastalar arasında farklı değildi (p>0.05). Hafif ve orta dereceli izole hidronefroz sıklıkla kendini sınırlayan bir durumdur. Hafif ve orta dereceli izole hidronefrozlu çocuklar antibiyotik profilaksisi başlanmadan izlenebilir.

 

Anahtar Kelimeler

• İdrar yolu enfeksiyonu,antibiyotik profilaksisi,izole antenatal hidronefroz

The Evaluation of Postnatal Follow-up Results of the İnfants with Mild and Moderate İsolated Antenatal Hydronephrosis

Öz

Antenatal hydronephrosis is one of the most common congenital urological anomalies identified on prenatal ultrasound. There are controversial results in the postnatal management of mild-moderate isolated antenatal hydronephrosis. The purpose of this study was to investigate the clinical outcome and the frequency of urinary tract infection in infants with mild-moderate isolated antenatal hydronephrosis during the first year of life. The patients with mild-moderate hydronephrosis on the first renal ultrasonography done between seven days and two weeks of age were included in this study. The patients with other kidney abnormalities other than hydronephrosis, ureteral dilatation or bladder abnormalities were not included in the study. Hydronephrosis was classified as mild (5-9.9 mm), moderate (10-14.9 mm) by anterior-posterior pelvic diameters.  140 patients [96 boys (68.6%), 44 girls (31.4%)] were included in the study. Sixty (42.9%) patients had mild hydronephrosis and 80 (57.1%) patients had moderate hydronephrosis. The rate of spontan resolution was higher in patients with mild hydronephrosis than other group [n=58 (96.6%), n=48 (60%), respectively, p<0.01]. The median regression time was shorter in patients with mild hydronephrosis [median regression time; 4 (3-5.25); 6 (5-7) months, respectively,  p<0.01]. The frequency of urinary tract infection did not differ between the patients with mild and moderate hydronephrosis patients (p>0.05). There was no evidence of acute pyelonephritis and obstructive or progressive hydronephrosis. Mild and moderate isolated antenatal hydronephrosis is often a self-limited condition. Children with mild and moderate isolated antenatal hydronephrosis might be followed without antibiotic prophylaxis.

Anahtar Kelimeler

• Urinary tract infection,antibiotic prophylaxis,isolated antenatal hydronephrosis

Kaynakça

1. Referans1 Bozacı AC, Doğan HS, Tekgül S. Antenatal Hidronefroz. Turkiye Klinikleri J Urology-Special Topics 2015;8(4):7-13.
2. Referans2 Lee RS, Cendron M, Kinnamon DD, Nguyen H T. Antenatal hydronephrosis as a predictor of postnatal outcome: A meta-analysis. Pediatrics. 2006;118 (2): 586–93.
3. Referans3 Sidhu G, Beyene J, Rosenblum ND. Outcome of isolated antenatal hydronephrosis: a systematic review and metaanalysis. Pediatr Nephrol. 2006; 21(2): 218e24.
4. Referans4 Homsy YL, Saad F, Laberge I, Williot P, Pison C. Transitional hydronephrosis of the newborn and infant. J Urol. 1990;144(2 Pt 2):579e83.
5. Referans5 Ismaili K, Avni FE, Piepsz A, Wissing KM, Cochat P, Aubert D, et al. Current management of infants with fetal renal pelvis dilation: a survey by French-speaking pediatric nephrologists and urologists. Pediatr Nephrol. 2004;19(9):966–971.
6. Referans6 Shaikh N, Ewing AL, Bhatnagar S, Hoberman A. Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics. 2010;126(6):1084-91.
7. Referans7 Williams GJ, Wei L, Lee A, Craig JC. Long-term antibiotics for preventing recurrent urinary tract infection in children. Cochrane Database Syst Rev. 2006;19(3):CD001534.
8. Referans8 Blachar A, Blachar Y, Livne PM, Zurkowski L, Pelet D, Mogilner B. Clinical outcome and follow-up of prenatal hydronephrosis. Pediatr Nephrol. 1994;8(1):30–35.

9. Referans9 Al-Shibli AI, Chedid F, Mirghani H, Al Safi W, Al-Bassam MK. The significance of fetal renal pelvic dilatation as a predictor of postnatal outcome. J Matern Fetal Neonatal Med. 2009; 22(9):797e800.
10. Referans10 Asl AS, Maleknejad S. Clinical outcome and follow-up of prenatal hydronephrosis. Saudi J Kidney Dis Transpl. 2012;23(3):526e31.
11. Referans11 Bak M, Tümay D, Serdaroğlu E. The postnatsl follow-up prenatally diagnosed diagnosed urinary anomalies cases. Turkiye Klinikleri J Pediatr 2007;16(4):255-63.
12. Referans12 Mami C, Paolata A, Palmara A, Marrone T, Berte LF, Marseglia L, et al. Outcome and management of isolated moderate renal pelvis dilatation detected at postnatal screening. Pediatr Nephrol. 2009;24(10):2005–2008.
13. Referans13 Sairam S, Al-Habib A, Sasson S, Thilaganathan B. Natural history of fetal hydronephrosis diagnosed on mid-trimester ultrasound. Ultrasound Obstet Gynecol. 2001;17(3):191–196.
14. Referans14 Mallik M, Watson AR. Antenatally detected urinary tract abnormalities: more detection but less action. Pediatr Nephrol. 2008;23(6):897–904.
15. Referans15 Tekin M, Gülyüz A, Özay C, Konca Ç. Postnatal Assessment and Outcome of Infants with Antenatal Hydronephrosis. Turkish J Pediatr Dis. 2016;2:96-100.
16. Referans16 Çamlar SA, Deveci N, Soylu A, Türkmen MA, Özmen D, Çapakaya G, et al. The role of dynamic renal scintigraphy on clinical decision making in hydronephrotic children. Saudi J Kidney Dis Transpl. 2017;28(1):76-80.
17. Referans17 Brenner DJ, Hall EJ. Computed tomography-An increasing source of radiation exposure. N Engl J Med. 2007;357(22):2277-84.
18. Referans18 Smith T, Gordon I. An update of radiopharmaceutical schedules in children. Nucl Med Communicat. 1998;19(11):1023-36.
19. Referans19 Easterbrook B, Capolicchio JP, Braga LH. Antibiotic prophylaxis for prevention of urinary tract infections in prenatal hydronephrosis: An updated systematic review. Can Urol Assoc J. 2017;11(1-2Suppl1): S3-11.
20. Referans20 Montini G, Tullus K, Hewitt I. Febrile urinary tract infections in children. N Engl J Med. 2011;365(3):239-50.
21. Referans21 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.
22. Referans22 Woodward M, Frank D. Postnatal management of antenatal hydronephrosis. BJU Int. 2002;89(2):149–156.
23. Referans23 Roth CC, Hubanks JM, Bright BC, Heinlen JE, Donovan BO, Kropp BP, et al. Occurrence of urinary tract infection in children with significant upper urinary tract obstruction. Urology 2009;73(1):74–78.
24. Referans24 Alconcher L, Tombesi M. Mild antenatal hydronephrosis: management controversies. Pediatr Nephrol. 2004;19(7):819–820.
25. Referans25 Lidefelt KJ, Herthelius M. Antenatal hydronephrosis: infants with minor postnatal dilatation do not need prophylaxis. Pediatr Nephrol. 2008;23(11):2021–2024.
26. Referans26 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.
27. Referans27 Elder JS. Commentary: importance of antenatal diagnosis of vesicoureteral reflux. J Urol. 1992(5 Pt 2);148:1750e4.
28. Referans28 Andrich M, Massoud M. Diagnostic imaging in the evaluation of first time urinary tract infection in infants and young children. Pediatrics 1992;90(3):436–41.
29. Referans29 Passerotti CC, Kalish LA, Chow J, Passerotti AM, Recabal P, Cendron M, et al. The predictive value of the first postnatal ultrasound in children with antenatal hydronephrosis. J Pediatr Urol. 2011;7(2):128-36.
30. Referans30 Yeung CK, Godley ML, Dhillon HK, Gordon I, Duffy PG, Ransley PG. The characteristics of primary vesico-ureteric reflux in male and female infants with pre-natal hydronephrosis. Br J Urol. 1997;80(2):319e27.