Barker A P, Cave M M, Thomas D F, Lilford R J, Irving H C, Arthur R J, Smith S E
Department of Paediatric Surgery/Urology, St James's University Hospital, Leeds, UK.
Br J Urol. 1995 Nov;76(5):649-52. doi: 10.1111/j.1464-410x.1995.tb07796.x.
To examine the relationship between pre-natal ultrasonographic findings typical of pelvi-ureteric junction (PUJ) obstruction and post-natal renal function in the affected kidney.
This retrospective study comprised 35 infants in whom pre-natal ultrasonography had identified a unilateral pattern of dilatation of the renal pelvis and calices typical of PUJ obstruction. In each case, the presence of unilateral hydronephrosis had been confirmed post-natally by ultrasonography, and differential function and drainage evaluated by isotope renography. The results of isotope renography were compared with the severity and timing of onset of the fetal hydronephrosis.
Eleven kidneys (31%) appeared normal in the second trimester and dilatation only became apparent during the third trimester. Mean differential function in these kidneys was 48%. However, mean differential function was reduced (mean 38%) in those kidneys noted to be dilated between 16 and 24 weeks gestation. Differential function was loosely correlated with the severity of dilatation in early onset cases, i.e. the mean differential function was 42% for mild, 37% for moderate and 27% for severe dilatation. A considerable variation in differential function values was present in each group except for those with severe dilatation, which was a significant predictor of poor functional outcome when compared with mild and moderate dilatation combined (P < 0.01).
Fetal PUJ obstruction is a heterogeneous condition permitting only broad predictions of functional outcome. Severe dilatation detected on second trimester imaging predicted significant loss of function. Mild and moderate degrees of dilatation were associated with a one in three risk of functional impairment in the obstructed kidney.
探讨产前超声检查发现的典型肾盂输尿管连接处（PUJ）梗阻与患侧肾脏产后肾功能之间的关系。
这项回顾性研究纳入了35例婴儿，这些婴儿产前超声检查发现有典型PUJ梗阻的肾盂和肾盏单侧扩张模式。每例患者产后均经超声检查证实存在单侧肾积水，并通过同位素肾图评估分肾功能和引流情况。将同位素肾图结果与胎儿肾积水的严重程度和发病时间进行比较。
11个肾脏（31%）在孕中期看起来正常，仅在孕晚期才出现扩张。这些肾脏的平均分肾功能为48%。然而，在妊娠16至24周之间发现有扩张的那些肾脏，其平均分肾功能降低（平均为38%）。在发病较早的病例中，分肾功能与扩张严重程度呈弱相关，即轻度扩张的平均分肾功能为42%，中度为37%，重度为27%。除重度扩张组外，每组的分肾功能值都有相当大的差异，与轻度和中度扩张合并组相比，重度扩张是功能预后不良的重要预测指标（P < 0.01）。
胎儿PUJ梗阻是一种异质性疾病，只能对功能预后进行大致预测。孕中期影像学检查发现的重度扩张预示着功能的显著丧失。轻度和中度扩张与梗阻侧肾脏功能受损的风险为三分之一相关。
