Cakici Evrim Kargin, Aydog Ozlem, Eroglu Fehime Kara, Yazilitas Fatma, Ozlu Sare Gulfem, Uner Cigdem, Renda Rahime, Yılmaz Engin, Bulbul Mehmet
Department of Pediatric Nephrology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey.
Department of Pediatric Nephrology, 19 Mayis University Medical School, Samsun, Turkey.
Pediatr Int. 2019 Mar;61(3):271-277. doi: 10.1111/ped.13788. Epub 2019 Mar 18.
The aim of this study was to identify the cut-offs of postnatal anteroposterior renal pelvic diameter (APRPD), according to the urinary tract dilation (UTD) classification system, to identify the predictors of final diagnosis of UTD and the need for surgery.
A total of 260 infants (336 renal units) with prenatally detected UTD were prospectively evaluated on serial ultrasonography by the same radiologist. Additional voiding cystourethrography and scintigraphy was done according to the clinical algorithm.
Prenatal and postnatal APRPD in patients with transient dilation were significantly lower than in those with urinary tract anomalies (UTA). On follow up, the slope of decrease in APRPD was significantly higher in transient dilation compared with UTA. APRPD 10 mm at first-month ultrasonography, predicted UTA with a sensitivity of 83.1%, and specificity of 71.1%. On multivariate analysis the likelihood of surgical intervention and final diagnosis were predicted independently by the UTD system risk group.
Careful ultrasonography evaluation can avoid unnecessary testing in patients with transient or clinically insignificant dilation. The UTD classification system is valid for evaluation of postnatal hydronephrosis and is reliable in predicting the need for surgical intervention.
本研究的目的是根据泌尿道扩张（UTD）分类系统确定出生后肾盂前后径（APRPD）的临界值，以确定UTD最终诊断的预测因素及手术需求。
对260例产前检测出UTD的婴儿（336个肾单位）由同一位放射科医生进行系列超声检查的前瞻性评估。根据临床方案进行额外的排尿性膀胱尿道造影和闪烁扫描。
短暂扩张患者的产前和产后APRPD显著低于尿路异常（UTA）患者。随访时，短暂扩张患者APRPD的下降斜率显著高于UTA患者。出生后第一个月超声检查时APRPD为10 mm，预测UTA的敏感性为83.1%，特异性为71.1%。多因素分析显示，UTD系统风险组可独立预测手术干预的可能性和最终诊断。
仔细的超声检查评估可避免对短暂性或临床意义不显著的扩张患者进行不必要的检查。UTD分类系统对评估出生后肾积水有效，且在预测手术干预需求方面可靠。
