Sarhan Osama M, El Helaly Ahmed, Al Otay Abdul Hakim, Al Ghanbar Mustafa, Nakshabandi Ziad
Mansoura Urology and Nephrology Centre, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Pediatric Urology Division, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
Can Urol Assoc J. 2018 Mar;12(3):E137-E141. doi: 10.5489/cuaj.4587. Epub 2017 Dec 22.
Fetal hydronephrosis (HN) occurs in approximately 5% of pregnancies and its prognosis depends mainly on the grade of the dilation. We attempted to determine the fate of isolated, unilateral, high-grade HN in children with antenatal diagnosis, emphasizing the risk factors for progression.
We retrospectively evaluated 424 children (690 kidney units) with antenatal HN in the period between 2010 and 2014. We included only those patients with isolated high-grade HN (Society for Fetal Urology [SFU] Grade 3 or 4). Patients with bilateral HN or unilateral HN associated with dilated ureter or reflux and patients with missed followup were excluded. The prognosis of HN (whether improved, stabilized, or progressed) and the need for surgical intervention in this subset of patients was evaluated.
A total of 44 children (34 boys and 10 girls) were identified. Ultrasounds showed SFU Grade 3 HN in 24 (54%) and SFU Grade 4 HN in 20 (46%). After a mean followup of three years (range 1-5), 10 children (23%) needed surgical intervention; four Grade 3 HN (16%) and six Grade 4 HN (30%). The majority of children with differential renal function (DRF) ≥40% (69.5%) were stable or improved. Five girls (50%) and five boys (17%) progressed and required surgical intervention. No patient with a renal pelvis anteroposterior diameter (APD) <1.5 cm needed surgical intervention.
Infants with isolated, unilateral, high-grade HN might be managed conservatively. Male gender, DRF ≥40%, SFU Grade 3 HN, and APD <1.5 cm were favourable prognostic factors.
胎儿肾积水（HN）在约5%的妊娠中出现，其预后主要取决于扩张程度。我们试图确定产前诊断为孤立性、单侧、高级别HN的儿童的病情转归，重点关注病情进展的危险因素。
我们回顾性评估了2010年至2014年期间424例产前诊断为HN的儿童（690个肾单位）。我们仅纳入那些孤立性高级别HN（胎儿泌尿外科学会[SFU]3级或4级）的患者。排除双侧HN或单侧HN合并输尿管扩张或反流的患者以及失访患者。评估了该亚组患者HN的预后（是否改善、稳定或进展）以及手术干预的必要性。
共确定44例儿童（34例男孩和10例女孩）。超声检查显示24例（54%）为SFU 3级HN，20例（46%）为SFU 4级HN。平均随访三年（范围1 - 5年）后，10例儿童（23%）需要手术干预；4例3级HN（16%）和6例4级HN（30%）。大多数肾功能差异（DRF）≥40%的儿童（69.5%）病情稳定或改善。5例女孩（50%）和5例男孩（17%）病情进展并需要手术干预。肾盂前后径（APD）<1.5 cm的患者均无需手术干预。
孤立性、单侧、高级别HN的婴儿可能可以保守治疗。男性、DRF≥40%、SFU 3级HN和APD<1.5 cm是有利的预后因素。
