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单侧多囊性发育不良肾:产前与产后联合评估

Unilateral multicystic dysplastic kidney: a combined pre- and postnatal assessment.

作者信息

van Eijk L, Cohen-Overbeek T E, den Hollander N S, Nijman J M, Wladimiroff J W

机构信息

Department of Obstetrics and Gynaecology, University Hospital Rotterdam Dijkzigt, Rotterdam, The Netherlands.

出版信息

Ultrasound Obstet Gynecol. 2002 Feb;19(2):180-3. doi: 10.1046/j.0960-7692.2001.00497.x.

Abstract

OBJECTIVE

To review the prenatal assessment of associated renal pathology, non-renal pathology and renal biometry, fetal outcome and postnatal urological management in the presence of unilateral fetal multicystic dysplastic kidney.

METHODS

A total of 38 singleton pregnancies with fetal unilateral multicystic dysplastic kidney was studied over a 13-year period. Prenatally, fetal biometry, including head and abdominal circumferences and largest longitudinal diameter of the affected and contralateral kidneys, was performed. The amount of amniotic fluid was assessed. Fetal karyotyping was offered in cases of contralateral renal or non-renal pathology. A MAG 3 scan and voiding cystogram was performed approximately 4 weeks after delivery to establish renal function and to exclude urinary reflux.

RESULTS

Unilateral fetal multicystic dysplastic kidney was left-sided in 53% and right-sided in 47% of cases. The fetus was male in 63% and female in 37% of cases. Associated renal and non-renal pathology existed in 21% and 5% of cases, respectively. The fetal karyotype in these subsets was always normal. The longitudinal diameter of the multicystic dysplastic kidney was above the 95th centile in 87%. There was polyhydramnios in three cases and oligohydramnios in two cases. The prematurity rate was 16%. Postnatal examination revealed a non-functional multicystic kidney in 87% (33/38) of cases. Following surgical removal of the affected kidney, these infants progressed normally. Of the remaining five infants, four died because of associated anomalies and one infant developed normally without surgery.

CONCLUSIONS

Fetal outcome is determined by associated renal and/or non-renal structural pathology and not by the size/location of the unilateral multicystic dysplastic kidney or amniotic fluid volume.

摘要

目的

回顾单侧胎儿多囊性发育不良肾情况下相关肾脏病理、非肾脏病理及肾脏生物测量的产前评估、胎儿结局及产后泌尿外科处理。

方法

在13年期间对38例单胎妊娠合并胎儿单侧多囊性发育不良肾进行了研究。产前,进行胎儿生物测量,包括头围、腹围以及患侧和对侧肾脏的最大纵径。评估羊水量。在对侧肾脏或非肾脏有病理改变的情况下进行胎儿染色体核型分析。产后约4周进行MAG 3扫描和排尿性膀胱尿道造影,以确定肾功能并排除尿反流。

结果

单侧胎儿多囊性发育不良肾病例中,53%为左侧,47%为右侧。胎儿中63%为男性,37%为女性。分别有21%和5%的病例存在相关肾脏和非肾脏病理改变。这些亚组中的胎儿染色体核型均正常。87%的多囊性发育不良肾纵径高于第95百分位数。3例羊水过多,2例羊水过少。早产率为16%。产后检查发现87%(33/38)的病例中多囊肾无功能。手术切除患肾后,这些婴儿进展正常。其余5例婴儿中,4例因相关畸形死亡,1例未经手术正常发育。

结论

胎儿结局取决于相关的肾脏和/或非肾脏结构病理改变,而非单侧多囊性发育不良肾的大小/位置或羊水量。

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