Yoshida Junko, Tsuchiya Masami, Tatsuma Noriko, Murakami Mutsumi
Department of Pediatrics, Nippon Medical School Hospital, Sendagi, Bunkyo-ku, Tokyo, Japan.
Pediatr Int. 2003 Apr;45(2):142-9. doi: 10.1046/j.1442-200x.2003.01681.x.
Recent widespread use of ultrasound has led to new efforts at screening for congenital kidney and urinary tract abnormalities. However, a standard screening methodology, criteria defining abnormalities, and follow-up procedures remain to be established. In order to establish screening criteria for these abnormalities, we performed a preliminary study in 800 1-month-old infants using provisional methods and criteria.
Based on the results of preliminary study, we screened 2700 1-month-old infants in a prospective study using the criteria of renal size (longitudinal diameter <or=35 mm or >or=60 mm, or a difference between sides of >or=10 mm), and of pelvic dilatation (Society for Fetal Urology [SFU] grade 2 or higher) as positive at the first ultrasound screening. We used the SFU grading system instead of anteroposterior pelvic diameter measurements for pelvic dilatation.
One hundred and twelve (4.1%) of the 2700 infants had abnormalities at the first ultrasound screening, while 18 (0.67%) had congenital kidney and urinary tract abnormalities on further examination. Use of the SFU grading system enabled us to reduce the false-positive rate at first screening, while maintaining a high diagnostic rate. The abnormalities consisted of ureteropelvic junction obstruction in seven infants, megaureter in two, hypoplastic kidney in four, vesicoureteral reflux in six (three were accompanied by hypoplastic kidneys or multicystic dysplastic kidney), multicystic dysplastic kidney in one, and horseshoe kidney in one.
These results indicate that our screening methods and criteria are useful variables for detecting congenital kidney and urinary tract abnormalities.
近期超声的广泛应用促使人们在先天性肾脏和尿路异常筛查方面做出了新的努力。然而，标准的筛查方法、异常的定义标准以及后续的随访程序仍有待确立。为了建立这些异常的筛查标准，我们采用临时方法和标准对800名1月龄婴儿进行了初步研究。
基于初步研究结果，我们在一项前瞻性研究中对2700名1月龄婴儿进行了筛查，首次超声筛查时以肾脏大小标准（纵径≤35mm或≥60mm，或双侧差值≥10mm）以及肾盂扩张标准（胎儿泌尿学会[SFU]2级或更高）为阳性。对于肾盂扩张，我们使用SFU分级系统而非前后径测量。
2700名婴儿中，112名（4.1%）在首次超声筛查时有异常，而进一步检查后有18名（0.67%）患有先天性肾脏和尿路异常。使用SFU分级系统能够在首次筛查时降低假阳性率，同时保持较高的诊断率。异常情况包括7名婴儿的肾盂输尿管连接部梗阻、2名的巨输尿管、4名的肾发育不全、6名的膀胱输尿管反流（3名伴有肾发育不全或多囊性发育不良肾）、1名的多囊性发育不良肾以及1名的马蹄肾。
这些结果表明，我们的筛查方法和标准是检测先天性肾脏和尿路异常的有用变量。
