Adra A M, Mejides A A, Dennaoui M S, Beydoun S N
Department of Obstetrics and Gynecology, University of Miami School of Medicine, FL 33101, USA.
Am J Obstet Gynecol. 1995 Oct;173(4):1263-6. doi: 10.1016/0002-9378(95)91367-x.
Our purpose was to determine the degree of fetal pyelectasis predictive of neonatal renal pathologic processes.
Eighty-four cases of pyelectasis were identified during the study period (1989 through 1993). Fetuses with anteroposterior diameter of the renal pelvis > or = 4 mm before 33 weeks or > or = 7 mm after 33 weeks without caliectasis were included. Fetuses with an anteroposterior diameter of > 10 mm were excluded. Postnatal evaluation included renal sonogram, voiding cystourethrogram, and renal flow and function studies.
Sixteen cases were excluded because of incomplete postnatal workup. Renal pathologic processes were found in 30 of 68 (44%) at birth; the most common were ureteropelvic junction obstruction (37%) and vesicoureteral reflux (33%). Only four cases required surgical intervention (13%), and the remaining 87% were managed conservatively. A normal urinary tract was found in 25% of the infants and the remaining 21 of 68 (31%) had regression of pyelectasis before birth. Fetuses with a dilated anteroposterior diameter > or = 8 mm after 28 weeks' gestation were found to have renal pathologic features in two of three of the cases, with sensitivity, specificity, and positive and negative predictive values of 87%, 41%, 66.7% and 70%, respectively.
Fetuses with an anteroposterior diameter of the renal pelvis > or = 8 mm after 28 weeks' gestation require appropriate urologic evaluation after birth.
我们的目的是确定可预测新生儿肾脏病理过程的胎儿肾盂扩张程度。
在研究期间（1989年至1993年）共识别出84例肾盂扩张病例。纳入肾盂前后径在33周前≥4mm或33周后≥7mm且无肾盏扩张的胎儿。肾盂前后径>10mm的胎儿被排除。产后评估包括肾脏超声检查、排尿性膀胱尿道造影以及肾脏血流和功能研究。
16例因产后检查不完整而被排除。68例中有30例（44%）在出生时发现肾脏病理过程；最常见的是肾盂输尿管连接部梗阻（37%）和膀胱输尿管反流（33%）。仅4例需要手术干预（13%），其余87%采取保守治疗。25%的婴儿尿路正常，68例中的其余21例（31%）在出生前肾盂扩张消退。妊娠28周后肾盂前后径扩张≥8mm的胎儿，三分之二的病例有肾脏病理特征，其敏感性、特异性、阳性预测值和阴性预测值分别为87%、41%、66.7%和70%。
妊娠28周后肾盂前后径≥8mm的胎儿出生后需要进行适当的泌尿外科评估。
