Qureshi F, Jacques S M, Seifman B, Quintero R, Evans M I, Smith C, Johnson M P
Department of Pathology, Hutzel Hospital, Detroit, MI 48201, USA.
Fetal Diagn Ther. 1996 Sep-Oct;11(5):306-12. doi: 10.1159/000264329.
We evaluated 8 second-trimester fetuses who had undergone termination because of obstructive uropathies and correlated the renal histopathology with fetal urine biochemical prognostic parameters. Prenatal evaluation included serial vesicocentesis, karyotyping, and sonography. According to the urinary biochemical parameters, 3 fetuses were classified to be in the good prognostic category, 2 in the borderline prognostic category, and 3 in the poor prognostic category. The kidneys were evaluated both grossly and microscopically for hydronephrosis, pelvicaliceal dilatation, cystic changes and fibrosis. Fetuses in the poor prognostic category had severely damaged renal architecture, microcysts, macrocysts, and extensive fibrosis. Fetuses in the good prognostic category had minimal histopathologic changes with preservation of the architecture. Fetuses in the borderline category showed a moderate degree of renal damage but with focally preserved architecture. We conclude (1) that there is a direct correlation between elevation in urinary electrolytes and proteins and extent of underlying renal histopathological damage and (2) that appropriate detailed prenatal evaluation of the renal function can identify fetuses who could potentially benefit from in utero therapy.
我们评估了8例因梗阻性尿路疾病而接受妊娠中期引产的胎儿，并将肾脏组织病理学与胎儿尿液生化预后参数进行关联分析。产前评估包括系列膀胱穿刺术、染色体核型分析和超声检查。根据尿液生化参数，3例胎儿被归类为预后良好组，2例为临界预后组，3例为预后不良组。对肾脏进行大体和显微镜检查，观察肾盂积水、肾盂肾盏扩张、囊性改变和纤维化情况。预后不良组的胎儿肾脏结构严重受损，出现微囊肿、大囊肿和广泛纤维化。预后良好组的胎儿组织病理学改变轻微，结构保留。临界组的胎儿显示出中度肾损害，但局部结构保留。我们得出结论：（1）尿液电解质和蛋白质升高与潜在肾脏组织病理学损害程度之间存在直接关联；（2）对肾功能进行适当详细的产前评估可以识别出可能从宫内治疗中获益的胎儿。
