Sairam S, Al-Habib A, Sasson S, Thilaganathan B
Feto-Maternal Medicine Unit, Homerton Hospital, Academic Unit of Obstetrics and Gynaecology, St Bartholomew's and The Royal London School of Medicine and Dentistry, London, UK.
Ultrasound Obstet Gynecol. 2001 Mar;17(3):191-6. doi: 10.1046/j.1469-0705.2001.00333.x.
Renal tract dilatation is a common finding in routine prenatal ultrasound. However, there is no consensus as to the criteria used for differentiating pathological from physiological dilatation. The aim of this study was to evaluate the natural history and postnatal outcome of fetal hydronephrosis in an unselected obstetric population.
This was a prospective study of fetal hydronephrosis, detected at 18-23 weeks' gestation, in a routine obstetric population. Fetal hydronephrosis was diagnosed as 'mild' if the antero-posterior renal pelvic diameter (APRPD) measured >or = 4 mm and as 'moderate/severe' if the APRPD measured > or = 7 mm or if there was associated calyceal dilatation. The postnatal outcome of fetuses with persistent hydronephrosis (> or = 10 mm in the third trimester) was determined from a postal questionnaire.
During the study period, 11 465 women underwent an anomaly scan at 18-23 weeks of gestation. Fetal hydronephrosis was identified in 2.3% (268/11 465) of women. Mild hydronephrosis was present in 80.6% (216/268) and moderate/severe hydronephrosis in 19.4% (52/268). The hydronephrosis resolved in the antenatal or early neonatal period in 88% of fetuses. None of the fetuses with mild hydronephrosis and approximately one in three fetuses with persistent moderate/severe hydronephrosis required postnatal surgery. Overall, only one in every 1000 total births in the study population required postnatal urological surgery.
The current study highlights the natural history of antenatally detected hydronephrosis. Mild fetal hydronephrosis appears to be associated with an excellent prognosis and probably represents the group with physiological renal pelvic dilatation. Moderate/severe fetal hydronephrosis is associated with poorer outcome and is perhaps the group that will need more intense follow up both antenatally and postnatally.
尿路扩张是常规产前超声检查中常见的发现。然而，对于区分病理性扩张和生理性扩张所使用的标准尚无共识。本研究的目的是评估未选择的产科人群中胎儿肾积水的自然病程及出生后结局。
这是一项对在妊娠18 - 23周时检测出胎儿肾积水的常规产科人群进行的前瞻性研究。如果肾盂前后径（APRPD）测量值≥4 mm，则胎儿肾积水被诊断为“轻度”；如果APRPD测量值≥7 mm或伴有肾盏扩张，则诊断为“中度/重度”。通过邮寄问卷确定持续性肾积水（孕晚期≥10 mm）胎儿的出生后结局。
在研究期间，11465名妇女在妊娠18 - 23周时接受了畸形扫描。2.3%（268/11465）的妇女被发现有胎儿肾积水。80.6%（216/268）为轻度肾积水，19.4%（52/268）为中度/重度肾积水。88%的胎儿肾积水在产前或新生儿早期消退。轻度肾积水的胎儿无一需要出生后手术，持续性中度/重度肾积水的胎儿约三分之一需要出生后手术。总体而言，研究人群中每1000例总出生中只有1例需要出生后泌尿外科手术。
本研究突出了产前检测到的肾积水的自然病程。轻度胎儿肾积水似乎预后良好，可能代表生理性肾盂扩张组。中度/重度胎儿肾积水与较差的结局相关，可能是产前和产后都需要更密切随访的群体。
