Department of Pediatric Surgery, Cerrahpaşa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Turkey
Division of Pediatric Nephrology, Department of Pediatrics, Cerrahpaşa Medical Faculty, İstanbul University-Cerrahpaşa, İstanbul, Turkey
Turk J Med Sci. 2021 Aug 30;51(4):2029-2035. doi: 10.3906/sag-2012-99.
BACKGROUND/AIM: The criteria for surgical management of ureteropelvic junction obstruction are not well-defined, and there is a risk for loss of renal function before the operation. In this context, certain changes in contralateral kidney had been investigated in order to increase the sensitivity of diagnosis. In this study, we aimed to investigate whether contralateral transient minimal hydronephrosis (CTMH) can be considered as an “early alarm” sign for worsening of the affected kidney in infants with hydronephrosis.
A total of 182 infants (92 surgically treated and 90 conservatively followed-up) with unilateral hydronephrosis were retrospectively analyzed. Ultrasonography and renal scan findings were evaluated. Correlation between the appearance of CTMH, contralateral compensatory hypertrophy (CCH) on ultrasonography, and prognosis of the affected kidney were evaluated.
Among the surgically treated patients, 18 (19.6%) patients developed CTMH on average 7 months (0–13 months) before surgery. Among these 18 patients with CTMH, 12 patients (66.6%) had loss of renal function preoperatively, while this ratio was 29.7% on their counterparts (p = 0049). CCH was observed in 31 (33.7%) individuals in surgically treated patient group including all 18 patients with CTMH, while none of the conservatively followed-up patients developed CCH and/or CTMH. In the multiple logistic regression analysis, among the variables investigated, CTMH was found as an independent predictor of the deterioration in the affected kidney and of the poor prognosis (p = 0.011 and p = 0.0004, respectively).
In our study, among the variables investigated, CTMH was found as an independent predictor of the deterioration in the affected kidney and poor prognosis in infants followed-up with isolated unilateral hydronephrosis. Additionally, CTMH can be considered as an “early alarm” sign for worsening of the affected kidney and the need for surgical intervention.
背景/目的：肾盂输尿管连接部梗阻的手术治疗标准尚未明确，并且在手术前存在肾功能丧失的风险。在这种情况下，已经研究了对侧肾脏的某些变化，以提高诊断的敏感性。在本研究中，我们旨在探讨对侧短暂性轻度肾积水（CTMH）是否可以被视为积水婴儿中受影响肾脏恶化的“早期警报”标志。
回顾性分析了 182 例单侧肾积水婴儿（92 例手术治疗和 90 例保守随访）的资料。评估了超声和肾扫描结果。评估了 CTMH 的出现与超声检查中的对侧代偿性肥大（CCH）以及受影响肾脏的预后之间的相关性。
在手术治疗的患者中，平均在手术前 7 个月（0-13 个月）出现 CTMH 的患者有 18 例（19.6%）。在这 18 例 CTMH 患者中，12 例（66.6%）患者术前出现肾功能丧失，而对照组这一比例为 29.7%（p=0.049）。在手术治疗组中，31 例（33.7%）患者观察到 CCH，包括所有 18 例 CTMH 患者，而在保守随访的患者中无一例出现 CCH 和/或 CTMH。在多变量逻辑回归分析中，在所研究的变量中，CTMH 被发现是受影响肾脏恶化和不良预后的独立预测因子（p=0.011 和 p=0.0004）。
在本研究中，在所研究的变量中，CTMH 被发现是孤立性单侧肾积水婴儿受影响肾脏恶化和不良预后的独立预测因子。此外，CTMH 可被视为受影响肾脏恶化和需要手术干预的“早期警报”标志。
