Süt Çocukluğu Döneminde Konjenital Hidronefrozun Seyri

Year 2021, Volume: 15 Issue: 3, 222 - 225, 25.05.2021

Serkan Tursun , Ayşegül Alpcan , Yaşar Kandur , Banu Acar

https://doi.org/10.12956/tchd.846393

Abstract

Amaç: Çalışmamızın amacı, konjenital hidronefroz vakalarında spontan düzelme oranlarını güncel bir bakış açısıyla incelemektir.

Gereç ve Yöntemler: Konjenital hidronefroz tanılı 69 hasta (E/K=46/23) çalışmaya dahil edildi.

Bulgular: Doğum sonrası ilk kontrolde bebeklerin ortalama yaşı 10.8 ± 7.6 gün iken çalışma sonunda yaşları 9.5±3.2 ay’dı. Takipte 48 (%69.5) hastanın renal pelvis anteriör-posteriör çapı düzelmişken, 8 (%11.6) hastanınki artmıştı. Ancak bu 8 hastanın MAG-3 görüntülemesi normaldi. Diğer 13 (%18.9) hastada, CAKUT (Böbrek ve üriner sistem konjenital anomalileri) tanılarından olan vezikoüretral reflü (n=8), üreteropelvik bileşke obstrüksyonu (n=5) saptandı. Ortalama başlangıç anteriör-posteriör çap ölçümü, çapı azalmış grupta 9.1±2.8 mm ve artmış grupta 9.7±2.8 mm’di (p=0.461). Son ölçümdeki ortalama anteriör-posteriör çapı ölçümü, çap ölçümü azalmış grupta, artmış gruba göre daha düşüktü (5.1±1.8 mm’ye karşılık 17.9±12.6 mm; p=0.001). Sol tarafta hidronefrozu olan hastaların yirmi altısında (%81.25) ve sağ tarafta hidronefrozu olan hastaların onunda (%71.4) anteriör-posteriör çapı ölçümü spontan olarak azaldı. Bilateral hidronefroz olan hastalarda spontan düzelme, tek taraflı olgulara göre daha düşük orandaydı (n=13; %56.5).

Sonuç: Çalışmamız şunu göstermiştir ki konjenital hidronefroz vakalarında, doğum sonrası yapılan ilk ultrason görüntülemede, hafif düzeydeki hidronefroz varlığı, patolojik seyri dışlamamaktadır. Bu nedenle bu hastalarda ultrason görüntüleme işlemine belli aralıklarla devam edilmelidir.

Keywords

Konjenital hidronefroz, süt çocuğu, antenatal, renal pelvis çapı

The Course of Congenital Hydronephrosis in Infancy

Abstract

Objective: The aim of our study is to examine the spontaneous resolution rates of congenital hydronephrosis from a recent perspective.

Material and Methods: Sixty-nine pediatric patients (M/F=46/23) with congenital hydronephrosis were enrolled in this study.

Results: The mean age at the first postnatal examination was 10.8±7.6 days, and the mean age at the time of the final examination was 9.5±3.2 months. Forty-eight patients’ renal anteroposterior diameters (APD) (69.5%) improved while 8 (11.6%) patients’ APDs worsened during the follow-up period. However, MAG3 of these 8 patients was normal. The remaining thirteen (18.9%) patients had congenital anomalies of the kidney and the urinary tract (8 vesicoureteral reflux, 5 cases of ureteropelvic junction obstruction). The mean baseline APD was 9.1±2.8 mm in the group with reduced APD, and 9.7±2.8 mm in the one with increased APD (p=0.461). The mean APD at the final visit was significantly lower in the group with reduced APD than that in the group with increased APD (5.1±1.8 mm vs 17.9±12.6 mm; p=0.001). The anteroposterior diameter of 26 (81.25%) patients with left-sided hydronephrosis and 10 (71.4%) patients with right-sided hydronephrosis regressed spontaneously. The rate of spontaneous resolution was relatively low in patients with bilateral hydronephrosis (n=13; 56.5%) compared to unilateral ones.

Conclusion: Our study indicates that an initially mild hydronephrosis does not exclude a pathological course in cases of congenital hyronephrosis. Therefore, in such patients, routine ultrasonography should be done regularly.

Keywords

Congenital hydronephrosis, infant, antenatal, renal pelvic diameter

References

• 1. Davenport MT, Merguerian PA, Koyle M. Antenatally diagnosed hydronephrosis: current postnatal management. Pediatr. Surg. Int 2013; 29: 207–14.
• 2. Phan V, Traubici J, Hershenfield B, Stephens D, Rosenblum ND, Geary DF. Vesicoureteral reflex in infants with isolated antenatal hydronephrosis. Pediatr.Nephrol 2003; 18: 1224–8.
• 3. Fernbach SK, Maizels M, Conway JJ (1993) Ultrasound grading of Hydronephrosis: introduction to the system used by the society for fetal urology. Pediatr Radiol 23: 478–480.
• 4. SinhaA, Bagga A, Krishna A, Bajpai M, Srinivas M, Uppal R, Agarwal I, Revised guidelines on management of antenatal hydronephrosis. Indian J Nephrol 2013; 23: 83–97.
• 5. Joan L Robinson, Jane C Finlay, Mia Eileen Lang, Robert Bortolussi, Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Community Paediatrics Committee. Urinary tract infections in infants and children: Diagnosis and management. Paediatr Child Health 2014; 19: 315–9
• 6. National Institute for Health and Clinical Excellence (2007) Urinary tract infection in children. National Institute for Health and Clinical Excellence, London. http://guida nce.nice.org.uk/cg054
• 7. Kazuyoshi Johnin Kenichi Kobayashi Teruhiko Tsuru Tetsuya Yoshida Susumu Kageyama Akihiro Kawauchi, Pediatric voiding cystourethrography: An essential examination for urologists but a terrible experience for children. International Journal of Urology 2019; 26: 160-71
• 8. Kristy VanDervoort, Stephanie Lasky, Christine Sethna, Rachel Frank, Suzanne Vento, Jeanne Choi-Rosen, Beatrice Goilav and Howard Trachtman. Hydronephrosis in Infants and Children: Natural History and Risk Factors for Persistence in Children Followed by a Medical Service. Clinical Medicine: Pediatrics 2009:1; 63-70.
• 9. Nguyen HT, Benson CB, Bromley B, Campbell JB, Chow J, Coleman B, Cooper C, Crino J, Darge K, Herndon CD, Odibo AO, Somers MJ, Stein DR. Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). J Pediatr Urol 2014; 10: 982–98.
• 10. Wiener JS, O’Hara SM. Optimal timing of initial postnatal ultrasonography in newborns with prenatal hydronephrosis. J Urol 2002; 168: 1826-9.
• 11. Yiee J, Wilcox D. Management of fetal hydronephrosis.Pediatr Nephrol 2008; 23: 347-53
• 12. de Bruyn R, Marks SD Postnatal investigation of fetal renal disease. Semin Fetal Neonatal Med 2008; 3: 133-41
• 13. Misra D, Kempley ST, Hird MF. Are patients with antenatally diagnosed hydronephrosis being over-investigated and overtreated? Eur J Pediatr Surg 1999; 5: 303-30
• 14. Arant BS Jr. Vesicoureteric reflux and renal injury. Am J Kidney Dis. 1991; 17: 491-511.
• 15. Piepsz A, Gordon I, Brock J, Koff S. Round table on management of renal pelvic dilatation in children. J Pediatr Urol 2009; 5: 437-44
• 16. Kandur Y, Salan A, Guler AG, Tuten F. Diuretic renography in hydronephrosis: a retrospective single-center study. Int Urol Nephrol 2018; 50:1199-204