Emmanuelli V, Lahoche-Manucci A, Holder-Espinasse M, Devisme L, Vaast P, Dieux-Coeslier A, Dehennault M, Petit S, Besson R, Houfflin-Debarge V
Pôle d'obstétrique, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France.
J Gynecol Obstet Biol Reprod (Paris). 2010 Dec;39(8):637-46. doi: 10.1016/j.jgyn.2010.07.012. Epub 2010 Sep 15.
To evaluate the prenatal diagnosis and the prognostic value of ultrasound in case of fetal hyperechogenic kidneys.
Seventeen prenatally diagnosed cases of hyperechogenic kidneys were retrospectively reviewed at the University Hospital of Lille from 1997 to 2008. The clinical and ultrasound data were compared to the postnatal follow-up and the long-term prognosis.
The aetiologies are nine recessive polycystic kidney diseases, three dominant, two Bardet-Biedl syndromes and three cases of transient renal hyperechogenicity. No renal ultrasonographic criterion is specific of aetiology. Five pregnancies were terminated. We observed one neonatal death and 11 survivors (median follow-up: 30months) including two infants with hypertension. All oligohydramnios (n=8) were associated with poor prenatal outcomes (terminations of pregnancy, neonatal death or hypertension) compared to the other nine with normal amniotic fluid volume (nine children symptom-free). Kidneys less or equal to +4 S.D. and a normal amniotic fluid volume were associated with a good prognosis (n=7, seven symptom-free).
The fetal kidneys characteristics on prenatal ultrasound fail to provide an accurate etiological diagnosis. Only congenital defects and family history adjust the aetiology. Amniotic fluid volume and fetal kidney size are the best prenatal predictors of outcome.
评估胎儿肾回声增强情况下超声的产前诊断及预后价值。
回顾性分析了1997年至2008年在里尔大学医院产前诊断为肾回声增强的17例病例。将临床及超声数据与产后随访及长期预后进行比较。
病因包括9例隐性多囊肾病、3例显性多囊肾病、2例巴德-比德尔综合征及3例短暂性肾回声增强。没有肾超声检查标准可明确病因。5例妊娠终止。观察到1例新生儿死亡，11例存活（中位随访时间：30个月），其中2例婴儿患有高血压。与羊水正常的另外9例（9名儿童无症状）相比，所有羊水过少病例（n = 8）均伴有不良产前结局（妊娠终止、新生儿死亡或高血压）。肾脏小于或等于+4标准差且羊水正常与良好预后相关（n = 7，7名无症状）。
产前超声检查显示的胎儿肾脏特征无法提供准确的病因诊断。只有先天性缺陷和家族史可辅助病因判断。羊水量和胎儿肾脏大小是最佳的产前预后预测指标。
