Elder J S, O'Grady J P, Ashmead G, Duckett J W, Philipson E
Division of Urology, Rainbow Babies and Children's Hospital, Cleveland, Ohio.
J Urol. 1990 Aug;144(2 Pt 2):574-8; discussion 593-4. doi: 10.1016/s0022-5347(17)39526-5.
In the fetus with bilateral hydronephrosis it has been reported that a normal volume of amniotic fluid, absence of renal cortical cysts, urinary sodium less than 100 mEq./l., chloride less than 90 mEq./l. and osmolarity less than 210 mOsm. are prognostic factors indicative of good renal function, whereas oligohydramnios, cortical cysts and higher urinary levels of sodium, chloride or osmolarity suggest irreversible renal dysplasia. We report 5 cases in which the fetal urinary electrolytes were not predictive of ultimate renal function. In 3 instances fetal urinary electrolytes and osmolarity were abnormally elevated but the infants survived without ventilatory support. In 2 of these 3 patients the volume of amniotic fluid was normal. Diagnoses included posterior urethral valves, prune belly variant and bilateral ureteropelvic junction obstruction. In 2 cases with oligohydramnios fetal urinary electrolytes were suggestive of satisfactory renal function but the infants died of pulmonary hypoplasia and had bilateral renal dysplasia, prune belly syndrome and urethral atresia. Presently, the volume of amniotic fluid remains the most important prognostic sign in the fetus with bilateral hydronephrosis. Further work is necessary to identify other factors that may be more reliable as prognostic indexes of fetal renal function.
据报道，对于双侧肾积水的胎儿，羊水正常、无肾皮质囊肿、尿钠低于100 mEq./l、氯化物低于90 mEq./l以及渗透压低于210 mOsm是提示肾功能良好的预后因素，而羊水过少、皮质囊肿以及尿钠、氯化物或渗透压水平较高则提示不可逆的肾发育不良。我们报告了5例胎儿尿电解质不能预测最终肾功能的病例。其中3例胎儿尿电解质和渗透压异常升高，但婴儿在无需通气支持的情况下存活。这3例患者中有2例羊水正常。诊断包括后尿道瓣膜、梅干腹变异型和双侧输尿管肾盂连接处梗阻。2例羊水过少的病例中，胎儿尿电解质提示肾功能良好，但婴儿死于肺发育不全，且患有双侧肾发育不良、梅干腹综合征和尿道闭锁。目前，羊水的量仍然是双侧肾积水胎儿最重要的预后指标。有必要开展进一步研究以确定其他可能作为胎儿肾功能预后指标更可靠的因素。
