Freedman E R, Rickwood A M
Regional Department of Paediatric Urology, Royal Liverpool Children's Hospital Alder Hey, England.
J Pediatr Surg. 1994 Jun;29(6):769-72. doi: 10.1016/0022-3468(94)90366-2.
Renal function in neonates with antenatally diagnosed pelviureteric obstruction is usually well preserved and rarely deteriorates in the short term. To assess if function is maintained in the medium term, and, where not, if any factors are predictive of deterioration, the authors reviewed their cases (1985 to 1992) of antenatally diagnosed unilateral pelviureteric obstruction with renographic confirmation (type II and IIIb curves). Initial renographic assessment was performed at 1 to 3 months. Among the 160 cases, initial differential function exceeded 40% in 140 (87.5%), and these were managed expectantly with renographic follow-up, usually at 24, 48, and 72 months of age. The 20 patients with reduced differential function underwent early intervention (pyeloplasty, or trial of nephrostomy drainage in those with very poor function). Follow-up in those managed expectantly showed good differential function in 135 (96.5%), despite persistence of renographic obstruction in two thirds of the cases, more than half of which have had renographic follow-up beyond 4 years. Differential function decreased to below 40% in five patients (3.5%); this was not related to the type of renographic curve or severity of the hydronephrosis. The natural history of antenatally diagnosed pelviureteric obstruction continues to appear benign, and it may differ from that in older children who present clinically.
产前诊断为肾盂输尿管梗阻的新生儿，其肾功能通常保存良好，短期内很少恶化。为评估其中期肾功能是否维持正常，若未维持正常，是否有任何因素可预测肾功能恶化，作者回顾了他们在1985年至1992年间经肾图证实（II型和IIIb型曲线）的产前诊断为单侧肾盂输尿管梗阻的病例。初始肾图评估在1至3个月时进行。在这160例病例中，140例（87.5%）的初始分肾功能超过40%，这些病例通过肾图随访进行观察性处理，通常在患儿24、48和72个月大时进行。20例分肾功能降低的患者接受了早期干预（肾盂成形术，或对功能极差者试行肾造瘘引流）。观察性处理的患者随访结果显示，135例（96.5%）分肾功能良好，尽管三分之二的病例肾图梗阻持续存在，其中一半以上的病例肾图随访超过4年。5例患者（3.5%）的分肾功能降至40%以下；这与肾图曲线类型或肾积水严重程度无关。产前诊断为肾盂输尿管梗阻的自然病程似乎仍然是良性的，可能与临床发病的大龄儿童不同。
