Bragagnini Paolo, Estors Blanca, Delgado Reyes, Rihuete Miguel Ángel, Gracia Jesús
Servicio Cirugía Pediátrica, Hospital Universitario Nuestra Señora de Candelaria. Santa Cruz de Tenerife. España.
Hospital Universitario Son Espaces. Palma de Mallorca. España.
Arch Esp Urol. 2016 Dec;69(10):680-690.
To determine prenatal and postnatal independent predictors of poor outcome, spontaneous resolution, or the need for surgery in patients with prenatal hydronephrosis.
We performed a retrospective study of patients with prenatal hydronephrosis. The renal pelvis APD was measured in the third prenatal trimester ultrasound, as well as in the first and second postnatal ultrasound. Other variables were taken into account, both prenatal and postnatal. For statistical analysis we used Student t-test, chi-square test, survival analysis, logrank test, and ROC curves.
We included 218 patients with 293 renal units (RU). Of these, 147/293 (50.2%) RU were operated. 76/293 (25.9%) RU had spontaneous resolution and other 76/293 (25.9%) RU had poor outcome. As risk factors for surgery we found low birth weight (OR 3.84; 95% CI 1.24-11.84), prematurity (OR 4.17; 95% CI 1.35-12.88), duplication (OR 4.99; 95% CI 2.21-11.23) and the presence of nephrourological underlying pathology (OR 53.54; 95% CI 26.23-109.27). For the non-spontaneous resolution, we found as risk factors the alterations of amniotic fluid volume (RR 1.46; 95% CI 1.33-1.60) as well as the underlying nephrourological pathology and duplication. In the poor outcome, we found as risk factors the alterations of amniotic fluid volume (OR 4.54; 95% CI 1.31-15.62), the presence of nephrourological pathology (OR 4.81 95% CI 2.60-8.89) and RU that was operated (OR 4.23, 95% CI 2.35-7.60). The APD of the renal pelvis in all three ultrasounds were reliable for surgery prediction (area under the curve 0.65; 0.82; 0.71) or spontaneous resolution (area under the curve 0.80; 0.91; 0.80), only the first postnatal ultrasound has predictive value in the poor outcome (area under the curve 0.73). The higher sensitivity and specificity of the APD as predictor value was on the first postnatal ultrasound, 14.60 mm for surgery; 11.35 mm for spontaneous resolution and 15.50 mm for poor outcome.
The higher APD in the renal pelvis in any of the three ultrasounds, the greater the chances of surgery and failure of spontaneous resolution. The first postnatal ultrasound is the most reliable in predicting outcome of prenatal hydronephrosis. There are other factors to take into account to predict the outcomes of these patients.
确定产前肾积水患者预后不良、自然消退或手术需求的产前和产后独立预测因素。
我们对产前肾积水患者进行了一项回顾性研究。在产前晚期超声检查以及产后首次和第二次超声检查中测量肾盂前后径（APD）。同时考虑了产前和产后的其他变量。对于统计分析，我们使用了学生t检验、卡方检验、生存分析、对数秩检验和ROC曲线。
我们纳入了218例患者的293个肾单位（RU）。其中，147/293（50.2%）个肾单位接受了手术。76/293（25.9%）个肾单位自然消退，另外76/293（25.9%）个肾单位预后不良。作为手术的危险因素，我们发现低出生体重（OR 3.84；95% CI 1.24 - 11.84）、早产（OR 4.17；95% CI 1.35 - 12.88）、重复肾（OR 4.99；95% CI 2.21 - 11.23）以及存在泌尿系统潜在病变（OR 53.54；95% CI 26.23 - 109.27）。对于非自然消退，我们发现羊水过少的改变（RR 1.46；95% CI 1.33 - 1.60）以及泌尿系统潜在病变和重复肾是危险因素。在预后不良方面，我们发现羊水过少的改变（OR 4.54；95% CI 1.31 - 15.62）、存在泌尿系统病变（OR 4.81，95% CI 2.60 - 8.89）以及接受手术的肾单位（OR 4.23，95% CI 2.35 - 7.60）是危险因素。所有三次超声检查中的肾盂APD对手术预测（曲线下面积0.65；0.82；0.71）或自然消退（曲线下面积0.80；0.91；0.80）都是可靠的，只有产后首次超声检查对预后不良具有预测价值（曲线下面积0.73）。APD作为预测值的敏感性和特异性在产后首次超声检查时更高，手术的APD为14.60 mm；自然消退为11.35 mm；预后不良为15.50 mm。
三次超声检查中任何一次肾盂APD越高，手术几率和自然消退失败的几率就越大。产后首次超声检查在预测产前肾积水的预后方面最可靠。预测这些患者的预后还需考虑其他因素。
