Rianthavorn Pornpimol, Limwattana Sorawan
Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand.
Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.
World J Urol. 2015 Oct;33(10):1645-50. doi: 10.1007/s00345-015-1478-7. Epub 2015 Jan 7.
To determine the diagnostic accuracy of anteroposterior renal pelvic diameter (APD) measurement and the society for fetal urology (SFU) grading in neonatal ultrasonography (USG) for detecting uropathy in newborns having antenatal isolated hydronephrosis (IH), characterized by hydronephrosis without ureter and bladder abnormalities, and to study time to resolution and factors predicting resolution of insignificant hydronephrosis.
Ninety-six healthy newborns (129 kidneys) with IH, who underwent USG at age 7-30 days and voiding cystourethrography (VCUG) in conjunction with diuretic renography (DR) if APD > 10 mm or SFU grade 3-4 in neonatal USG, and at least a 12-month follow-up were divided into significant and insignificant hydronephrosis using the combined data of sequential USG, VCUG, and DR as the reference standard.
Areas under the receiver operating characteristic plots (95 % CI) were 0.86 (0.79-0.94) versus 0.81 (0.73-0.89); p = 0.08, and 87.6 versus 79.8 % of cases were correctly classified, for APD ≥ 16 mm versus SFU grade 4, respectively. Ureteropelvic junction obstruction (UPJO) was the most common uropathy diagnosed. Of 85 kidneys with insignificant hydronephrosis, 57 underwent spontaneous resolution. The resolution rates were 24, 40, and 68 % at age 6, 12, and 24 months, respectively. APD was the only independent factor predicting resolution with the hazard ratio of 0.83 (95 % CI 0.74-0.92; p = 0.001).
In IH, neonatal USG was a useful diagnostic tool to detect uropathy, mainly UPJO. Further investigation should be recommended when APD ≥ 16 mm or SFU grade 4.
确定在新生儿超声检查（USG）中，前后径肾盂直径（APD）测量及胎儿泌尿外科学会（SFU）分级对于检测产前孤立性肾积水（IH）新生儿泌尿系统疾病的诊断准确性。IH的特征为肾积水且无输尿管及膀胱异常，并研究轻度肾积水的消退时间及预测消退的因素。
96例患有IH的健康新生儿（129个肾脏），在7 - 30日龄时接受了USG检查，若新生儿USG检查中APD>10 mm或SFU 3 - 4级，则同时接受排尿性膀胱尿道造影（VCUG）及利尿肾图（DR）检查，且至少进行了12个月的随访。以连续USG、VCUG及DR的综合数据作为参考标准，将其分为重度和轻度肾积水。
受试者工作特征曲线下面积（95% CI）分别为0.86（0.79 - 0.94）和0.81（0.73 - 0.89）；p = 0.08，APD≥16 mm与SFU 4级分别正确分类了87.6%和79.8%的病例。输尿管肾盂连接部梗阻（UPJO）是最常见的诊断出的泌尿系统疾病。85例轻度肾积水的肾脏中，57例自然消退。6、12和24月龄时的消退率分别为24%、40%和68%。APD是预测消退的唯一独立因素，风险比为0.83（95% CI 0.74 - 0.92；p = 0.001）。
在IH中，新生儿USG是检测泌尿系统疾病（主要是UPJO）的有用诊断工具。当APD≥16 mm或SFU 4级时，应建议进一步检查。
