Docimo S G, Silver R I
James Buchanan Brady Urological Institute, Baltimore, Maryland, USA.
J Urol. 1997 Apr;157(4):1387-9.
Published reports suggest the need to delay renal ultrasound for at least 1 week after birth to avoid a false-negative study due to oliguria. This recommendation has become standard. Considering the recent shift toward expectant management of prenatal hydronephrosis, there may be no advantage to the increased sensitivity of a delayed study.
Radiology records were reviewed for a 5-year period to identify renal ultrasound studies performed within 48 hours of birth.
Of 101 neonates known to have hydronephrosis on prenatal ultrasound who underwent sonography within 48 hours of birth 33 had a normal study (including mild hydronephrosis) and documented followup studies. None of these patients had a significant obstructive renal lesion within the first year of life. One child had an obstructive pattern on diuretic renography at age 18 months after previous studies were unremarkable. Cystography in 26 patients demonstrated vesicoureteral reflux in 4 (14.3%).
These data suggest that 1) there is no contraindication to early neonatal renal ultrasonography and 2) voiding cystourethrography is indicated for all infants with a history of prenatal hydronephrosis.
已发表的报告表明，出生后至少延迟1周进行肾脏超声检查，以避免因少尿导致假阴性检查结果。这一建议已成为标准做法。考虑到最近对产前肾积水采取期待性管理的转变，延迟检查提高的敏感性可能并无益处。
回顾了5年期间的放射学记录，以确定在出生后48小时内进行的肾脏超声检查。
在101例产前超声检查发现肾积水且在出生后48小时内接受超声检查的新生儿中，33例检查结果正常（包括轻度肾积水）并有后续记录的检查。这些患者在1岁内均未出现严重的梗阻性肾脏病变。1例儿童在之前检查无异常后，18个月时利尿肾图显示为梗阻性表现。26例患者的膀胱造影显示4例（14.3%）存在膀胱输尿管反流。
这些数据表明，1）新生儿早期肾脏超声检查无禁忌证，2）所有有产前肾积水病史的婴儿均需进行排尿性膀胱尿道造影。
