Katzir Ze'ev, Witzling Michaela, Nikolov Gallina, Gvirtz Gabriela, Arbel Eliana, Kohelet David, Boaz Mona, Smetana Shmuel, Lorberboym Mordechai
Institute of Nephrology, E. Wolfson Medical Center, Holon, Israel.
Pediatr Nephrol. 2005 Jun;20(6):763-7. doi: 10.1007/s00467-005-1851-7. Epub 2005 Apr 19.
Extra-renal pelvis (ERpel) is a common ultrasonographic finding among neonates who have undergone recurrent ultrasound examinations for a better definition of prenatal renal pelvic dilatation. This study tries to determine whether or not ERpel has important prognostic implications. Seventy-nine neonates (17 female) were examined. All had a diagnosis of prenatal renal pelvis dilatation, which was shown by postnatal ultrasound to be ERpel. Sixty ERpel neonates were examined 1.5 months to 2.5 months after the ultrasound (US) diagnosis by both Tc-99m diethylene triamine penta-acetic acid (DPTA) dynamic renal scanning and (99m)Tc-pertechnetate direct cystography. Clinical assessment, urine cultures and renal ultrasound follow-up were maintained for 2 years. The proportion of urinary tract infections (UTIs) in patients with ERpel was compared with that of the total neonatal and infantile population with normal US scans in the region of our hospital. Associated minor congenital malformations were found in 12 of 79 neonates (15.2%). Four had a family history of ERpel. Among 60 neonates who underwent renal scanning, 36 (60%) were found to have urinary retention in the collecting system. Another nine (15%) had vesico-ureteral (VU) reflux, of which seven had urinary retention. Fifteen (25%) showed normal isotope imaging. Urinary tract infection was diagnosed in 16 ERpel neonates in whom only one exhibited VU reflux (grade 2). The incidence of neonatal UTI in the ERpel group was more than that of either neonatal or infantile UTI in those with normal US scans in the local population (20.2% vs 1.2% and 4.3%, respectively). Fifty-three infants completed a 2-year follow-up. Repeat renal ultrasonography indicated that one infant (1.8%) had developed bilateral hydronephrosis, 12 (22.6%) had unchanged findings, 18 (40%) showed an improvement (decrease of ERpel width or resolution in one side) and, in 22 (41.5%) infants, the condition had resolved. No clinical or kidney function deterioration was observed. Seven patients (13.2%) each had one episode of UTI during the 2-year follow-up period; none of them had VU reflux. Neonatal ERpel is more frequent in male infants. It is associated with greater rates of minor congenital malformations, VU reflux and UTI than in the general population of the same ages. The increased UTI incidence is not attributed to VU reflux.
肾外肾盂（ERpel）是在因更好地明确产前肾盂扩张而接受反复超声检查的新生儿中常见的超声检查结果。本研究试图确定ERpel是否具有重要的预后意义。对79例新生儿（17例女性）进行了检查。所有患儿均诊断为产前肾盂扩张，产后超声显示为肾外肾盂。60例肾外肾盂新生儿在超声（US）诊断后1.5个月至2.5个月接受了锝-99m二乙三胺五乙酸（DPTA）动态肾扫描和（99m）锝高锝酸盐直接膀胱造影检查。进行了2年的临床评估、尿培养和肾脏超声随访。将肾外肾盂患儿尿路感染（UTIs）的比例与我院该地区超声扫描正常的新生儿和婴儿总体人群的比例进行了比较。79例新生儿中有12例（15.2%）发现有相关的轻度先天性畸形。4例有肾外肾盂家族史。在60例接受肾脏扫描的新生儿中，36例（60%）发现集合系统有尿潴留。另外9例（15%）有膀胱输尿管（VU）反流，其中7例有尿潴留。15例（25%）同位素成像正常。16例肾外肾盂新生儿被诊断为尿路感染，其中只有1例有VU反流（2级）。肾外肾盂组新生儿尿路感染的发生率高于当地人群中超声扫描正常的新生儿或婴儿尿路感染的发生率（分别为20.2%对1.2%和4.3%）。53例婴儿完成了2年的随访。重复肾脏超声检查显示，1例婴儿（1.8%）出现双侧肾积水，12例（22.6%）结果无变化，18例（40%）有改善（肾外肾盂宽度减小或一侧病变消失），22例（41.5%）婴儿病情已缓解。未观察到临床或肾功能恶化。7例患者（13.2%）在2年随访期间各有1次尿路感染发作；他们均无VU反流。新生儿肾外肾盂在男婴中更常见。与同年龄的一般人群相比，其与轻度先天性畸形、VU反流和尿路感染的发生率更高有关。尿路感染发生率的增加并非归因于VU反流。
