Department of Pediatric, Pediatric Nephrology Unit, University Hospital of Geneva, University of Geneva, 6 Willy-Donzé Street, 1211 Geneva, Switzerland.
Pediatr Nephrol. 2010 Sep;25(9):1687-92. doi: 10.1007/s00467-010-1543-9. Epub 2010 Jun 4.
Antenatal hydronephrosis (ANH) is a frequent anomaly detected on fetal ultrasound scans. There is no consensus recommendation for the postnatal follow-up and/or the necessity to perform a voiding cystourethrography (VCUG) to diagnose vesicoureteral reflux (VUR). We conducted a cohort/non-randomized trial of 121 patients with ANH, defined as an anterior posterior diameter (APD) >or=5 mm after the 20th week of gestation, to evaluate the ability of the antenatal and postnatal ultrasonography results to predict VUR. All infants had two successive ultrasounds at 5 days and 1 month, respectively, after birth. A VCUG was performed at 6 weeks in children with a persistent APD >or=5 mm and/or an ureteral dilatation observed on at least one of two postnatal ultrasounds. In total, 88 patients had VCUG and nine had VUR, with five having high-grade reflux (>grade II). The risk of VUR increased significantly with the degree of APD detected on the postnatal ultrasound scan (p = 0.03). The odds ratios were 5.0 [95% confidence interval (CI) 0.5-51.2] for APD = 7-9 mm and 9.1 (95% CI 1.0-80.9) for APD >or=10 mm. The results of this study show that among our patient cohort antenatal ultrasound was not predictive of reflux. There was, however, a relation between the importance of the postnatal renal pelvis diameter and the risk of VUR. A cut-off of 7 mm showed a fair ability of ultrasonography to predict VUR and a cut-off of 10 mm enabled all severe refluxes in the 88 patients who had a VCUG to be diagnosed.
产前肾积水（ANH）是胎儿超声扫描中常见的异常。对于产后随访和/或是否需要进行排尿性膀胱尿道造影（VCUG）以诊断膀胱输尿管反流（VUR），目前尚无共识建议。我们对 121 例 ANH 患者进行了队列/非随机试验，将 ANH 定义为妊娠 20 周后前后径（APD）≥5mm，以评估产前和产后超声结果预测 VUR 的能力。所有婴儿在出生后 5 天和 1 个月分别进行了两次连续超声检查。如果持续存在 APD≥5mm 和/或至少有两次产后超声检查发现输尿管扩张，则在 6 周时进行 VCUG。共有 88 例患者进行了 VCUG，9 例有 VUR，其中 5 例为高级反流（>II 级）。VUR 的风险随着产后超声检查中检测到的 APD 程度显著增加（p=0.03）。APD=7-9mm 的比值比为 5.0[95%置信区间（CI）0.5-51.2]，APD≥10mm 的比值比为 9.1（95%CI 1.0-80.9）。本研究结果表明，在我们的患者队列中，产前超声不能预测反流。然而，产后肾盂直径的重要性与 VUR 的风险之间存在一定关系。7mm 的截断值显示超声检查有一定能力预测 VUR，而 10mm 的截断值可以诊断 88 例进行 VCUG 的患者中所有严重反流。
