Department of Paediatric Surgery and Urology, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK.
Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK.
Early Hum Dev. 2021 Jun;157:105382. doi: 10.1016/j.earlhumdev.2021.105382. Epub 2021 May 4.
The majority of simple renal cysts diagnosed postnatally are asymptomatic and rarely require treatment unless they become symptomatic or complex. We hypothesised that prenatally-detected simple renal cysts would have a similar harmless outcome.
To establish the natural history and postnatal outcome of prenatally-diagnosed simple renal cysts.
Single-centre retrospective case-series review (12-year period).
All patients with prenatally-diagnosed simple renal cysts (defined as a solitary, non-septated, non-communicating cyst in an otherwise normal kidney).
Prenatal and postnatal changes to cyst size, persistence, resolution or modification of diagnosis. Data is presented as the proportion of patients or median (range).
30 cysts were detected (2 bilateral, 26 unilateral) in 28 fetuses (median gestational age of 23 [20-36] weeks). Median maximum diameter was 15 (4-35) mm at initial diagnosis and 17.5 (4-100) mm across all prenatal scans. On follow-up scans diagnosis was modified in 16 (53%) to: multicystic dysplastic kidney (MCDK), dilated duplex kidney, hydronephrosis, urinoma, renal agenesis and adrenal mass. 12 (40%) cysts resolved. 2 (7%) asymptomatic cysts persisted at one year postnatally. Cyst maximum diameter in the modified diagnosis group (21.5 [10-100] mm) was significantly larger than the simple cyst group (12 [4-20] mm) (P = 0.03).
Our study revealed the challenges of prenatal ultrasound imaging, with modified diagnoses in over half the cases. Kidneys with solitary cysts could evolve into multicystic kidneys or involute completely, which suggests a true alteration in morphology rather than sonographic error. Persistent simple cysts in an otherwise normal kidney, however, resolved spontaneously or remained asymptomatic. Prenatally-detected simple cysts should be monitored with serial imaging.
大多数在产后诊断出的单纯性肾囊肿是无症状的，除非出现症状或变得复杂，否则很少需要治疗。我们假设产前诊断出的单纯性肾囊肿也会有类似的无害结果。
确定产前诊断出的单纯性肾囊肿的自然病史和产后结局。
单中心回顾性病例系列研究（12 年期间）。
所有产前诊断出的单纯性肾囊肿患者（定义为在正常肾脏中出现的单个、非分隔、非交通的囊肿）。
囊肿大小、持续存在、消退或诊断改变的产前和产后变化。数据以患者的比例或中位数（范围）表示。
在 28 例胎儿中发现了 30 个囊肿（双侧 2 个，单侧 26 个）（中位孕龄 23 [20-36] 周）。初始诊断时最大直径中位数为 15（4-35）mm，所有产前扫描的最大直径中位数为 17.5（4-100）mm。在随访扫描中，16 例（53%）的诊断发生了改变：多囊性发育不良肾、扩张双肾盂肾、肾积水、尿囊肿、肾发育不全和肾上腺肿块。12 例（40%）囊肿消退。2 例（7%）无症状囊肿在产后 1 年持续存在。在修改诊断组中，囊肿最大直径（21.5 [10-100] mm）明显大于单纯囊肿组（12 [4-20] mm）（P=0.03）。
我们的研究揭示了产前超声成像的挑战，超过一半的病例需要修改诊断。孤立性囊肿的肾脏可能会发展成多囊性肾脏或完全退化，这表明形态学的真正改变，而不是超声的误差。然而，在其他方面正常的肾脏中持续存在的单纯性囊肿会自发消退或保持无症状。产前诊断出的单纯性囊肿应通过连续影像学检查进行监测。
