Department of Bio-Imaging and Radiological Sciences, School of Medicine and Department of Pediatrics, Catholic University of the Sacred Heart, Polyclinic A. Gemelli, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2013 Aug;17(16):2232-9.
Fetal hydronephrosis is the most common anomaly detected on antenatal ultrasound examination, affecting 1-5% pregnancies.
A new management in mild antenatal renal pelvis dilatation (ARPD), using a technique based on both morphological and dynamical evaluation.
Prospective study conducted during a 36-months period in 180 consecutive newborns referred as having mild ARPD. Examinations consisted in a morphological ultra-sound (US) scan evaluating antero-posterior diameter, renal parenchyma, ureteral evidence and pelvis morphology and, subsequently, a dynamic evaluation to analyze any change of the urinary tract during bladder voiding. All children were evaluated both at 3rd day and 1 month after birth. They were divided among those with negative examinations and those with at least one positive scan, trying to discriminate within the latter, children suspected for transient pyelectasis from those suspected for organic pathology.
108 patients had normal US findings both at birth and at 1 month. The remaining 72 babies had at least one abnormal US examination: 54 were suspected for transient pyelectasis, while 18 suspected for organic pathology. At the end of the study, 61 babies (33.9%) had final diagnosis of transient pyelectasis and 11 cases (6.1%) of organic pathology. At one month the dynamic pattern of US findings had the highest negative predictive value, while renal parenchyma evaluation has the highest accuracy.
a dynamic US approach allowed to better select among infants suspected for transient pyelectasis from those suspected for organic pathology, avoiding unnecessary and invasive examinations in healthy babies.
胎儿肾积水是产前超声检查最常见的异常，影响 1-5%的妊娠。
采用基于形态和动力学评估的新技术对轻度产前肾盂扩张（ARPD）进行新的管理。
对 180 例连续新生儿进行了为期 36 个月的前瞻性研究，这些新生儿被转诊为轻度 ARPD。检查包括形态超声（US）扫描，评估前后直径、肾实质、输尿管证据和肾盂形态，随后进行动态评估，以分析膀胱排空期间尿路的任何变化。所有儿童均在出生后第 3 天和第 1 个月进行评估。根据检查结果将其分为阴性组和至少有一次阳性扫描组，试图在后者中区分疑似短暂肾盂扩张的儿童和疑似器质性病变的儿童。
108 例儿童在出生和 1 个月时的 US 检查均正常。其余 72 例婴儿至少有一次异常 US 检查：54 例疑似短暂肾盂扩张，18 例疑似器质性病变。研究结束时，61 例婴儿（33.9%）最终诊断为短暂肾盂扩张，11 例（6.1%）为器质性病变。在 1 个月时，US 检查的动态模式具有最高的阴性预测值，而肾实质评估具有最高的准确性。
动态 US 方法可更好地对疑似短暂肾盂扩张的婴儿与疑似器质性病变的婴儿进行区分，避免对健康婴儿进行不必要和有创的检查。
