Duygu ÖVÜNÇ HACIHAMDİOĞLU, Zekiye KÜPÇÜ, Gamze ÖZGÜRHAN

Antenatal Hidronefroz Tanılı İnfantların Bir Yıllık Takip Sonuçları

Amaç: Merkezimizde izlenen antenatal hidronefroz tanılı çocukların bir yıllık izlem sonuçlarınn sunulması amaçlanmıştır. Yöntem: Hastanemiz çocuk nefroloji polikliniğine başvuran antenatal hidronefroz tanısı almış 0-24 aylık infantlar Çocuk Nefroloji̇ Derneği̇ Konjenital Böbrek ve Üriner Yol Anomalileri Çalışma Grubu’nun İzlem Klavuzu’na göre takip edilmiştir. Bulgular: Antenatal dönemde hidronefroz tanısı almış 93 64 erkek hastanın postnatal 3.-4. günler ve 4.-6. haftalar arasındaki ultrasonografi sonuçlarına göre 5 hasta %5,4 normal, 70 hasta %75,3 hafif, 14 hasta %15,1 orta ve 4 hasta %4,3 ciddi hidronefroz tanısı almıştır. On hastaya voiding sistoüretrografi, 8 hastaya MAG3 sintigrafi uygulanmıştır. İki hasta unilateral 4. derece reflü tanısı ve 2 hasta unilateral ureteropelvik bileşke darlığı tanısı almıştır. Üreteropelvik bileşke darlığı olan hastalardan birine piyeloplasti uygulanmıştır. Bir yılık izlem sonunda 88 hastadan 47’sinde %53,4 anteroposterior çap

Anahtar Kelimeler:

Antenatal, hidronefroz, infant

One Year Follow-up Results of Infants with Antenatal Hydronephrosis

Objection: Our purpose is to present the results of the one year- follow up of infants who were diagnosed with antenatal hydronephrosis. Methods: Infants 0-24 months with diagnosis of antenatal hydronephrosis who were brought into pediatric nephrology outpatient clinics of our hospital were followed up according to the Turkish Pediatric Nephrology Society CAKUT Congenital Anomalies of Kidney and Urinary Tract Guidelines. Results: Ninety-three infants 64 males, 0.83 years, range 0.1-2.1 years previously diagnosed as antenatal hydronephrosis received diagnosis of healthy infant n=5; 5,4 % mild n=70; 75,3% , moderate n=14; 15,1% , and severe n=4; 4,3% hydronephrosis. Voiding cystourethrogram VCUG was performed in 10 10,7% patients, 2 of them had unilateral grade 4 vesicoureteral reflux VUR . MAG3 scan was performed in 8 8,6% patients, two of them had ureteropelvic junction obstruction, one of these patients had undergone pyeloplasty. After one year follow-up of 88 infants, 47 53,4% patients had normal, 23 26.1% patients had mild, 11 12,5% patients had moderate and 7 8% patients had severe hydronephrosis. Three cases 3,4% progressed from moderate to severe disease. Conclusion: The most frequent cause of antenatal hydronephrosis among our patients was transient antenatal hydronephrosis. However follow-up of cases with a tendency to progress is important.

Keywords:

Antenatal, hydronephrosis, infant,

PDF

___

1. Grandjean H, Larroque D, Levi S. The performance of routine ultrasonographic screening of pregnancies in the Eurofetus study, Am J Obstet Gynecol. 1999; 181(2):446-54. https://doi.org/10.1016/S0002-9378(99)70577-6
2. Elder JS. Antenatal hydronephrosis. Fetal and neonatal management, Pediatr Clin N Am. 1997;44(5):1299- 321. https://doi.org/10.1016/S0031-3955(05)70558-7
3. Chitty LS, Altman DG. Charts of fetal size: kidney and renal pelvis measurements, Prenat Diagn. 2003; 23(11):891-7. https://doi.org/10.1002/pd.693
4. Hothi DK, Wade AS, Gilbert R, Winyard PJ. Mild fetal renal pelvis dilatation: much ado about nothing? Clin J Am Soc Nephrol. 2009;4(1):168-77. https://doi.org/10.2215/CJN.00810208
5. http://cocuknefroloji.org/images/cankut-klavuz.pdf
6. Nguyen HT, Herndon CD, Cooper C, Gatti J, Kirsch A, Kokorowski P, et al. The society for fetal urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol. 2010;6:212- 31. https://doi.org/10.1016/j.jpurol.2010.02.205
7. Corteville JE, Gray DL, Crane JP. Congenital hydronephrosis: correlation of fetal ultrasonographic findings with infantoutcome. Am J Obstet Gynecol. 1991;165: 384e8.
8. Chou CY, Chen LC, Cheong ML, Tsai MS. Frequency of postnatal hydronephrosis in infants with a renal anteriorposterior diameter >4 mm on midtrimester ultrasound. Taiwan J Obstet Gynecol. 2015;54:554e8.
9. Barbosa JA, Chow JS, Benson CB, Yorioka MA, Bull AS, Retik AB, et al. Postnatal longitudinal evolution of children diagnosed with prenatal hydronephrosis: insights in natural history and referral pattern. Prenat Diagn. 2012;32:1242e9.
10. Mudrik-Zohar H, Meizner I, Bar-Sever Z, Ben-Meir D, Davidovits M. Prenatal sonographic predictors of post-natal pyeloplasty in fetuses with isolated hydronephrosis. Prenat Diagn. 2015;35:142e7.
11. Arora S, Yadav P, Kumar M, Singh SK, Sureka SK, Mittal V, et al. Predictors for the need of surgery in antenatally detected hydronephrosis due to UPJ obstruction e a prospective multivariate analysis. J Pediatr Urol. 2015;11:248. e1-5.
12. Lee RS, Borer JG. Perinatal urology. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, editors. CampbellWalsh urology. 11th ed. vol. 4. Philadelphia: Elsevier Health Sciences; 2015. p. 2873e92
13. Niewiesk S. Maternal antibodies: clinical significance, mechanism of interference with immune responses, and possible vaccination strategies. Front Immunol. 2014;5:446. https://doi.org/10.3389/fimmu.2014.00446
14. Varda BK, Finkelstein JB, Wang HH, Logvinenko T, Nelson CP. The association between continuous antibiotic prophylaxis and UTI from birth until initial postna tal imaging evaluation among newborns with antenatal hydronephrosis. J Pediatr Urol. 2018 Dec;14(6):539. e1-539.e6. Epub 2018 May 29. https://doi.org/10.1016/j.jpurol.2018.04.022
15. Jackson JN, Zee RS, Martin AN, Corbett ST, Herndon CDA. A practice pattern assessment of members of the Society of Pediatric Urology for evaluation and treatment of urinary tract dilation. J Pediatr Urol. 2017;13(6):602e7.
16. Braga LHP, Ruzhynsky V, Pemberton J, Farrokhyar F, Demaria J, Lorenzo AJ. Evaluating practice patterns in postnatal management of antenatal hydronephrosis: a national survey of Canadian pediatric urologists and nephrologists. Urology 2014;83(4):909e14.
17. Braga LH, Mijovic H, Farrokhyar F, Pemberton J, Demaria J, Lorenzo AJ. Antibiotic prophylaxis for urinary tract infections in antenatal hydronephrosis. Pediatrics 2013;131(1):e251e61.