Anderson N G, Abbott G D, Mogridge N, Allan R B, Maling T M, Wells J E
Department of Radiology, Christchurch Hospital, New Zealand.
Pediatr Nephrol. 1997 Oct;11(5):610-6. doi: 10.1007/s004670050348.
There has been a low yield of primary vesicoureteric reflux (VUR) from screening the fetal urinary tract during obstetric sonography. We sought to determine whether changing the cut-off level of fetal renal pelvic diameter from 10 mm to 4 mm would improve the yield of VUR. In a prospective community-based study, a fetal renal pelvic diameter of 4 mm or more on a transverse view of the fetal renal hilum at obstetric sonography after 16 weeks' gestation was found in 426 fetuses from 9,800 consecutive pregnancies. After birth, renal sonography was performed on 386 of the 426 babies. Of the 386 babies, 264 (187 boys) had a voiding cystourethrogram (VCUG) at a mean age of 9 weeks. Primary VUR was detected in 33 (16 boys) of the 264 infants (13%), and secondary VUR in another 5 (2%). Only 5 of the 33 (15%) babies with primary VUR would have been detected if a cut-off point of 10 mm for fetal renal pelvic diameter had been used. The prevalence of reflux was similar at each cut-off level of antenatal renal pelvic diameter from 4 to 10 mm. Neither calyceal nor ureteric dilatation was helpful in differentiating those with from those without VUR. The postnatal renal sonogram did not distinguish whether reflux was present or not. More infants with primary VUR, particularly girls, were found by changing the cut-off point for fetal renal pelvic diameter from 10 mm to 4 mm, and performing a VCUG on all such infants even if the postnatal renal sonogram was normal. Of the 33 infants with primary VUR, 9 (27%, 5 boys) had an abnormal dimercaptosuccinic acid scan. Our findings support the screening of the obstetric population for a fetal renal pelvic diameter of 4 mm or more, and then investigating the infants for VUR after birth.
在产科超声检查中对胎儿泌尿道进行筛查时，原发性膀胱输尿管反流（VUR）的检出率较低。我们试图确定将胎儿肾盂直径的临界值从10毫米改为4毫米是否会提高VUR的检出率。在一项基于社区的前瞻性研究中，在9800例连续妊娠的胎儿中，有426例在妊娠16周后产科超声检查时胎儿肾盂肾门横断面上的直径达到或超过4毫米。出生后，对这426例婴儿中的386例进行了肾脏超声检查。在这386例婴儿中，264例（187名男孩）在平均9周龄时进行了排尿性膀胱尿道造影（VCUG）。在这264例婴儿中，检测到原发性VUR的有33例（16名男孩）（13%），继发性VUR的有另外5例（2%）。如果采用胎儿肾盂直径10毫米的临界值，那么在这33例原发性VUR婴儿中只能检测出5例（15%）。产前肾盂直径在4至10毫米的每个临界值水平下，反流的患病率相似。肾盏或输尿管扩张对鉴别有无VUR均无帮助。产后肾脏超声检查无法区分是否存在反流。通过将胎儿肾盂直径的临界值从10毫米改为4毫米，并对所有此类婴儿进行VCUG检查，即使产后肾脏超声检查正常，也发现了更多原发性VUR婴儿，尤其是女孩。在这33例原发性VUR婴儿中，9例（27%，5名男孩）二巯基琥珀酸扫描异常。我们的研究结果支持对产科人群筛查胎儿肾盂直径达到或超过4毫米的情况，然后在婴儿出生后对其进行VUR检查。
