Arena Francesco, Arena Salvatore, Paolata Antonina, Campenni Alfredo, Zuccarello Biagio, Romeo Giuseppe
Unit of Pediatric Surgery, Department of Medical and Surgical Pediatric Sciences, University of Messina, Messina, Italy.
Int J Urol. 2007 Jun;14(6):491-5. doi: 10.1111/j.1442-2042.2007.01764.x.
To evaluate if a complete urological screening is justified by potential urological anomalies in newborns or infants with asymptomatic renal ectopia (RE).
The database records of 60 consecutive neonatal cases of RE diagnosed at the authors' hospital from 1990 to 2004 were retrospectively reviewed.
At diagnosis, mean patient age was 1.6 months. In 58 of 60 patients, the suspected diagnosis of RE was made during prenatal or postnatal screening ultrasonography, including two newborns with anorectal malformation. There were 24 patients with crossed RE (C-RE) and 36 patients with simple RE (S-RE). A solitary RE was present in two patients. The most frequent associated urological abnormality was vesico-ureteral reflux (37.5% of C-RE and 16.6% of S-RE). Hydronephrosis was detected in seven RE and five contralateral kidneys. An obstructive megaureter was present in one patient with C-RE. In 40% of S-RE and 92.9% of C-RE, the (99m)Tc DMSA documented reduction of function of RE. The longitudinal diameter of the ectopic kidney was significantly smaller than the contralateral one. Other non-renal diseases were present in 15% of patients, of which the most frequent was cryptorchidism (6.6%).
A complete urological evaluation is necessary in newborns with C-RE for the high incidence of associated urological anomalies, of which VUR is the most frequent. A complete urological evaluation is also reasonable in patients with S-RE who have a pelvic dilatation. No diagnosis or treatment of the associated urological diseases, in consideration of congenital decreased function of the ectopic kidney, might predispose these children to improvement of renal function impairment.
评估对于无症状肾异位（RE）的新生儿或婴儿，潜在的泌尿系统异常是否足以证明进行全面的泌尿系统筛查是合理的。
回顾性分析了作者所在医院1990年至2004年连续诊断的60例新生儿RE病例的数据库记录。
诊断时，患者平均年龄为1.6个月。60例患者中有58例在产前或产后筛查超声检查时被怀疑诊断为RE，其中包括2例患有肛门直肠畸形的新生儿。有24例交叉性肾异位（C-RE）患者和36例单纯性肾异位（S-RE）患者。2例患者为孤立性肾异位。最常见的相关泌尿系统异常是膀胱输尿管反流（C-RE患者中占37.5%，S-RE患者中占16.6%）。7例RE和5例对侧肾脏检测到肾积水。1例C-RE患者存在梗阻性巨输尿管。在40%的S-RE和92.9%的C-RE中，（99m）锝二巯基丁二酸（99mTc DMSA）显示RE功能降低。异位肾的纵径明显小于对侧肾脏。15%的患者存在其他非肾脏疾病，其中最常见的是隐睾症（6.6%）。
由于相关泌尿系统异常的高发生率，对于C-RE新生儿有必要进行全面的泌尿系统评估，其中膀胱输尿管反流最为常见。对于有盆腔扩张的S-RE患者，进行全面的泌尿系统评估也是合理的。考虑到异位肾先天性功能下降，不对相关泌尿系统疾病进行诊断或治疗可能会使这些儿童肾功能损害加重。
