Coelho Graziela M, Bouzada Maria Candida F, Pereira Alamanda K, Figueiredo Bruno F, Leite Maria Rafaela S, Oliveira Danielly S, Oliveira Eduardo A
Pediatric Nephrourology Unit, Department of Pediatrics, Hospital Das Clinicas, Federal University Of Minas Gerais, Belo Horizonte, MG, Brazil.
Pediatr Nephrol. 2007 Oct;22(10):1727-34. doi: 10.1007/s00467-007-0539-6. Epub 2007 Jul 26.
The purpose of this study was to report the outcome of infants with antenatal hydronephrosis. Between May 1999 and June 2006, all patients diagnosed with isolated fetal renal pelvic dilatation (RPD) were prospectively followed. The events of interest were: presence of uropathy, need for surgical intervention, RPD resolution, urinary tract infection (UTI), and hypertension. RPD was classified as mild (5-9.9 mm), moderate (10-14.9 mm) or severe (>or=15 mm). A total of 192 patients was included in the analysis; 114 were assigned to the group of non-significant findings (59.4%) and 78 to the group of significant uropathy (40.6%). Of 89 patients with mild dilatation, 16 (18%) presented uropathy. Median follow-up time was 24 months. Twenty-seven patients (15%) required surgical intervention. During follow-up, UTI occurred in 27 (14%) children. Of 89 patients with mild dilatation, seven (7.8%) presented UTI during follow-up. Renal function, blood pressure, and somatic growth were within normal range at last visit. The majority of patients with mild fetal RPD have no significant findings during infancy. Nevertheless, our prospective study has shown that 18% of these patients presented uropathy and 7.8% had UTI during a medium-term follow-up time. Our findings suggested that, in contrast to patients with moderate/severe RPD, infants with mild RPD do not require invasive diagnostic procedures but need strict clinical surveillance for UTI and progression of RPD.
本研究的目的是报告产前肾积水婴儿的预后情况。在1999年5月至2006年6月期间，对所有诊断为孤立性胎儿肾盂扩张（RPD）的患者进行了前瞻性随访。关注的事件包括：是否存在泌尿系统疾病、是否需要手术干预、RPD是否消退、是否发生尿路感染（UTI）以及是否患有高血压。RPD被分为轻度（5 - 9.9毫米）、中度（10 - 14.9毫米）或重度（≥15毫米）。共有192例患者纳入分析；114例被归入无显著异常组（59.4%），78例被归入有显著泌尿系统疾病组（40.6%）。在89例轻度扩张的患者中，16例（18%）出现泌尿系统疾病。中位随访时间为24个月。27例患者（15%）需要手术干预。在随访期间，27例（14%）儿童发生了UTI。在89例轻度扩张的患者中，7例（7.8%）在随访期间出现了UTI。末次随访时肾功能、血压和身体生长均在正常范围内。大多数轻度胎儿RPD患者在婴儿期无显著异常。然而，我们的前瞻性研究表明，在中期随访期间，这些患者中有18%出现了泌尿系统疾病，7.8%发生了UTI。我们的研究结果表明，与中度/重度RPD患者不同，轻度RPD婴儿不需要进行侵入性诊断程序，但需要对UTI和RPD进展进行严格的临床监测。
