Cameron D, Lupton B A, Farquharson D, Hiruki T
Department of Pediatrics, University of British Columbia, British Columbia's Children's Hospital, Vancouver, Canada.
Obstet Gynecol. 1994 May;83(5 Pt 2):872-6.
Renal agenesis causes severe oligohydramnios, which results in compression effects, lung hypoplasia, and rapid neonatal death.
We report a case of renal agenesis identified in a fetus in which serial amnioinfusions were employed to prevent pulmonary hypoplasia and compression effects. A total of ten amnioinfusions were performed between 17-33 weeks' gestation. Chorioamnionitis led to preterm delivery at 33 weeks. The infant had no significant pulmonary hypoplasia and none of the compression effects usually associated with the oligohydramnios sequence. Peritoneal dialysis was provided for the infant with a long-term aim of eventual renal replacement therapy, but dialysis was unsuccessful and the infant died at the age of 23 days. Autopsy revealed slightly small lungs and extensive cavitating lesions in the brain, which were presumed to be of peripartum or antenatal origin. The chain of events leading to this unusual course of action is described, and the ethical aspects are outlined.
At present, this type of procedure is not an appropriate intervention in cases of renal agenesis, and such management is strongly discouraged.
肾缺如导致严重羊水过少，进而产生压迫效应、肺发育不全并导致新生儿迅速死亡。
我们报告一例在胎儿中诊断出肾缺如的病例，该病例采用了系列羊膜腔灌注以预防肺发育不全和压迫效应。在妊娠17至33周期间共进行了十次羊膜腔灌注。绒毛膜羊膜炎导致孕33周早产。婴儿无明显肺发育不全，也没有通常与羊水过少序列相关的压迫效应。为婴儿进行了腹膜透析，最终目标是进行长期肾脏替代治疗，但透析未成功，婴儿于23日龄时死亡。尸检显示肺略小，脑内有广泛的空洞性病变，推测为围产期或产前起源。描述了导致这一不同寻常治疗过程的一系列事件，并概述了伦理方面的问题。
目前，这种类型的手术在肾缺如病例中并非合适的干预措施，强烈不鼓励进行此类处理。
