Lidefelt Karl-Johan, Herthelius Maria, Soeria-Atmadja Sandra
Department of Paediatrics, Karolinska University Hospital, 14186, Stockholm, Sweden.
Pediatr Nephrol. 2009 Mar;24(3):533-6. doi: 10.1007/s00467-008-1043-3. Epub 2008 Nov 12.
The aim of this study was to determine whether a postnatal ultrasound (US) can detect infants with antenatal renal pelvis dilatation (ARPD) who run a minimal risk of renal damage 2 years after birth. The study cohort consisted of 14,000 pregnant women who consecutively underwent routine US examinations during the second trimester. Subsequent examinations were performed on the basis of obstetrical indications. In total, 106 foetuses were diagnosed with ARPD > or =5 mm. Two postnatal US were performed on the newborns: on postpartum days 5-7 and during the third week of life. The findings were considered to be normal when the renal pelvis diameter (RPD) was < or = 7 mm and when there was no calyceal or ureteric dilatation or signs of renal dysplasia or other anomalies. Voiding cystourethrography (VCUG) was done at 6-8 weeks after birth. When the children reached 2 years of age, renal status was evaluated with DMSA scintigraphy or, if not possible, US. In 53 of the 103 children available for evaluation, the postnatal US findings were normal; 49 of the 53 children were also given a DMSA, and the results were normal in all cases. An US scan (all normal) only was performed in three children because the families refused a DMSA. One family refused any form of examination at the 2-year follow-up. Based on our results, we conclude that postnatal US can detect infants who do not require follow-up assessments of renal development.
本研究的目的是确定产后超声（US）能否检测出出生后2年肾损害风险极低的产前肾盂扩张（ARPD）婴儿。研究队列包括14000名在孕中期连续接受常规超声检查的孕妇。后续检查根据产科指征进行。共有106例胎儿被诊断为ARPD≥5mm。对新生儿进行了两次产后超声检查：产后第5 - 7天和出生后第三周。当肾盂直径（RPD）≤7mm且无肾盏或输尿管扩张、肾发育不良或其他异常迹象时，检查结果被认为正常。出生后6 - 8周进行排尿性膀胱尿道造影（VCUG）。当儿童满2岁时，用二巯丁二酸（DMSA）肾闪烁扫描评估肾脏状况，若无法进行则用超声评估。在可供评估的103名儿童中，53名儿童的产后超声检查结果正常；这53名儿童中有49名也进行了DMSA检查，所有病例结果均正常。3名儿童仅进行了超声扫描（均正常），因为其家人拒绝进行DMSA检查。1个家庭在2年随访时拒绝任何形式的检查。根据我们的结果，我们得出结论，产后超声可以检测出不需要进行肾脏发育随访评估的婴儿。
