Frech-Dörfler Martina, Durand Sabrina, Prüfer Friederike, Holland-Cunz Stefan, Rudin Christoph
Department of Pediatric Surgery, University Children's Hospital, 4031 Basel, Switzerland.
Department of Neonatology, University Children's Hospital, 4031 Basel, Switzerland.
Children (Basel). 2022 Dec 2;9(12):1890. doi: 10.3390/children9121890.
Prenatal hydronephrosis is common and may vary in size. Although mostly unproblematic, it may be a sign of urinary tract obstruction of differing severity.
CASE DIAGNOSIS/TREATMENT: We present a boy with prenatally detected bilateral giant hydronephrosis. A prenatal ultrasound showed the whole abdominal cavity of the fetus filled with urine. Kidney parenchyma could not be seen. The boy was born at 34 + 1 weeks' gestation. After delivery, he showed a severely distended abdomen. Insertion of a nasogastric tube was not possible, and he had to be intubated due to respiratory distress. A bilateral percutaneous nephrostomy was performed immediately. After a few hours, he could be stabilized and extubated. An ultrasound on the following day showed two kidney units with normal kidney parenchyma of normal size. The initially slightly elevated serum creatinine level normalized within one week. An antegrade pyelography via the nephrostomy tubes showed bilateral ureteropelvic junction obstruction.
Severe bilateral hydronephrosis may be associated with good outcome and well-preserved kidney function. Prenatal counseling should be done carefully, with discussion of different treatment possibilities and without definitive prediction of outcome.
产前肾积水很常见，其大小可能各异。尽管多数情况下并无问题，但它可能是不同严重程度尿路梗阻的迹象。
病例诊断/治疗：我们报告一名产前检测出双侧巨大肾积水的男婴。产前超声显示胎儿整个腹腔充满尿液，未见肾实质。该男婴于孕34 + 1周出生。出生后，他腹部严重膨隆，无法插入鼻胃管，因呼吸窘迫需行气管插管。立即进行了双侧经皮肾造瘘术。数小时后，他病情稳定并拔除气管插管。次日超声显示两个肾单位，肾实质正常，大小正常。最初略有升高的血清肌酐水平在一周内恢复正常。通过肾造瘘管进行的顺行肾盂造影显示双侧输尿管肾盂连接处梗阻。
严重双侧肾积水可能预后良好且肾功能保存良好。产前咨询应谨慎进行，讨论不同的治疗可能性，且不做结局的确定性预测。
