Merlini L, Parvex P, Anooshiravani-Dumont M, Girardin E, Hanquinet S
Pediatric Radiology Unit, University Hospital Geneva, Switzerland.
Acta Paediatr. 2007 Aug;96(8):1131-4. doi: 10.1111/j.1651-2227.2007.00384.x. Epub 2007 Jun 21.
Mild antenatal renal pelvic dilatation (ARPD) revealed by prenatal ultrasound (US) raises the question whether or not screening for vesicoureteral reflux (VUR) is mandatory. The aim of our study was to suggest guidelines for postnatal management of infants with mild ARPD defined as an antero-posterior (AP) dilatation >5 and <10 mm.
Therefore we assessed the value of postnatal US at day 30 to predict VUR, the incidence of VUR at day 30 and the rate of spontaneous resolution at 1 year. Two hundred (200) infants with ARPD were included and had renal US and voiding cystourethrography (VCUG) at day 30. If VUR was present, VCUG was repeated 1 year later.
Incidence of VUR was 10% (20/200) at day 30 after birth and only 3% (6/200) 1 year later. VUR at day 30 was twice as frequent in children with postnatal dilatation (11%) than in nondilated kidneys (6%).
Considering the low incidence of VUR at 1 year, screening for VUR in mild ARDP seems not to be justified. However follow-up by US to detect increase in dilatation and clinical monitoring for signs of urinary infection is required.
产前超声（US）检查发现的轻度产前肾盂扩张（ARPD）引发了是否必须筛查膀胱输尿管反流（VUR）的问题。我们研究的目的是为定义为前后径（AP）扩张>5且<10mm的轻度ARPD婴儿的产后管理提供指导方针。
因此，我们评估了出生后30天进行产后超声检查以预测VUR的价值、出生后30天VUR的发生率以及1岁时的自发缓解率。纳入了200例ARPD婴儿，并在出生后30天进行了肾脏超声检查和排尿性膀胱尿道造影（VCUG）。如果存在VUR，则在1年后重复进行VCUG检查。
出生后30天VUR的发生率为10%（20/200），1年后仅为3%（6/200）。出生后肾盂扩张的儿童在出生后30天出现VUR的频率是非扩张肾脏儿童的两倍（11%比6%）。
考虑到1岁时VUR的发生率较低，对轻度ARDP进行VUR筛查似乎没有必要。然而，需要通过超声进行随访以检测扩张是否增加，并对泌尿系统感染的迹象进行临床监测。
