Singh Rana P, Sahu Shyam S, Singh Abhishek Kumar, Ranjan Rajiv
Urology, RIMS, Ranchi, Jharkhand, India.
Paediatric Surgery, RIMS, Ranchi, Jharkhand, India.
J Pharm Bioallied Sci. 2024 Jul;16(Suppl 3):S2848-S2850. doi: 10.4103/jpbs.jpbs_412_24. Epub 2024 Jul 31.
Antenatal hydronephrosis (ANH) is a common prenatal finding that requires careful evaluation to determine appropriate management strategies. The variability in outcomes underscores the need for refined diagnostic and monitoring protocols to differentiate between cases necessitating intervention and those likely to resolve spontaneously.
A prospective clinical study was conducted involving 150 pregnant women diagnosed with ANH between gestational weeks 18 to 24. Prenatal ultrasounds were performed at regular intervals to monitor renal pelvic dilatation. Postnatal evaluations included renal ultrasound, voiding cystourethrography, and nuclear renal scans to assess renal function and identify associated anomalies. Management decisions were based on standardized criteria including degree of hydronephrosis, presence of associated anomalies, and renal function.
Of the 150 cases, 80 (53.3%) resolved spontaneously during the prenatal period, while 70 (46.7%) required postnatal intervention. Among the intervention group, 45 cases (64.3%) required surgical correction for persistent hydronephrosis or associated anomalies, while the remaining 25 cases (35.7%) were managed conservatively with close monitoring. Arbitrarily, the mean anteroposterior renal pelvic diameter (APRPD) in the resolved group was 5.2 mm, compared to 10.6 mm in the intervention group. The median postnatal follow-up duration was 24 months.
This study highlights the importance of systematic evaluation and monitoring in managing ANH. While a significant proportion of cases resolve spontaneously, a careful assessment of associated anomalies and renal function is crucial in identifying cases requiring intervention. The arbitrary APRPD values presented underscore the potential for establishing diagnostic thresholds to guide clinical decision-making. Refinement of treatment protocols based on such parameters can improve outcomes and reduce unnecessary interventions in infants with ANH.
产前肾积水（ANH）是一种常见的产前检查发现，需要仔细评估以确定合适的管理策略。结果的变异性强调了需要完善的诊断和监测方案，以区分需要干预的病例和可能自发缓解的病例。
进行了一项前瞻性临床研究，纳入了150例在妊娠18至24周期间被诊断为ANH的孕妇。定期进行产前超声检查以监测肾盂扩张情况。产后评估包括肾脏超声、排尿性膀胱尿道造影和核素肾扫描，以评估肾功能并识别相关异常。管理决策基于标准化标准，包括肾积水程度、相关异常的存在情况和肾功能。
在150例病例中，80例（53.3%）在产前自发缓解，而70例（46.7%）需要产后干预。在干预组中，45例（64.3%）因持续性肾积水或相关异常需要手术矫正，其余25例（35.7%）通过密切监测进行保守治疗。任意选取，缓解组的平均肾盂前后径（APRPD）为5.2毫米，而干预组为10.6毫米。产后中位随访时间为24个月。
本研究强调了系统评估和监测在管理ANH中的重要性。虽然很大一部分病例会自发缓解，但仔细评估相关异常和肾功能对于识别需要干预的病例至关重要。所呈现的任意APRPD值强调了建立诊断阈值以指导临床决策的潜力。基于这些参数完善治疗方案可以改善结局并减少对ANH婴儿的不必要干预。
