Hafif ve Orta Dereceli İzole Antenatal Hidronefrozlu Süt Çocuklarının Postnatal İzlem Sonuçlarının Değerlendirilmesi

Antenatal hidronefroz doğum öncesi yapılan ultrasonografik incelemede en sık saptanan konjenital ürolojik anomalilerden biridir. Hafif ve orta dereceli izole antenatal hidronefrozun doğum sonrası dönemdeki yönetimi hakkında çelişkili sonuçlar bulunmaktadır. Bu çalışmanın amacı hafif ve orta dereceli izole antenatal hidronefrozlu süt çocuklarında ilk bir yılda idrar yolu enfeksiyonu (İYE) sıklığını ve klinik seyri araştırmaktır. Bu çalışmaya doğum sonrası 7 gün ile 2 hafta arasında yapılan ilk böbrek ultrasonografisinde hafif ve orta dereceli hidronefrozu olan hastalar dahil edildi. Hidronefroz dışında böbrek anomalisi olan, üreteral dilatasyonu ya da mesane anomalisi bulunan hastalar çalışmaya dahil edilmedi. Hidronefroz ön-arka pelvis çapı ölçülerek hafif (5-9.9 mm) ve orta (10-14.9 mm) dereceli olarak sınıflandırıldı. Çalışmaya 140 hasta [96 erkek (%68.6), 44 kız (%31.4)] dahil edildi. Altmış hasta (%42.9) hafif dereceli, 80 hasta (%57.1) orta dereceli hidronefroza sahipti. Spontan gerileme oranı hafif hidronefrozlu hastalarda diğer gruptan daha yüksekti [sırası ile n=58 (%96.6), n=48 (%60), p<0.01]. Ortanca gerileme zamanı hafif hidronefrozlu hastalarda daha kısa idi [ortanca gerileme zamanı; sırası ile 4 (3-5.25); 6 (5-7) ay, p<0.01]. İYE sıklığı hafif ve orta dereceli hidronefrozlu hastalar arasında farklı değildi (p>0.05). Hafif ve orta dereceli izole hidronefroz sıklıkla kendini sınırlayan bir durumdur. Hafif ve orta dereceli izole hidronefrozlu çocuklar antibiyotik profilaksisi başlanmadan izlenebilir.

Anahtar Kelimeler:

İdrar yolu enfeksiyonu, antibiyotik profilaksisi, izole antenatal hidronefroz

The Evaluation of Postnatal Follow-up Results of the İnfants with Mild and Moderate İsolated Antenatal Hydronephrosis

Antenatal hydronephrosis is one of the most common congenital urological anomalies identified on prenatal ultrasound. There are controversial results in the postnatal management of mild-moderate isolated antenatal hydronephrosis. The purpose of this study was to investigate the clinical outcome and the frequency of urinary tract infection in infants with mild-moderate isolated antenatal hydronephrosis during the first year of life. The patients with mild-moderate hydronephrosis on the first renal ultrasonography done between seven days and two weeks of age were included in this study. The patients with other kidney abnormalities other than hydronephrosis, ureteral dilatation or bladder abnormalities were not included in the study. Hydronephrosis was classified as mild (5-9.9 mm), moderate (10-14.9 mm) by anterior-posterior pelvic diameters. 140 patients [96 boys (68.6%), 44 girls (31.4%)] were included in the study. Sixty (42.9%) patients had mild hydronephrosis and 80 (57.1%) patients had moderate hydronephrosis. The rate of spontan resolution was higher in patients with mild hydronephrosis than other group [n=58 (96.6%), n=48 (60%), respectively, p<0.01]. The median regression time was shorter in patients with mild hydronephrosis [median regression time; 4 (3-5.25); 6 (5-7) months, respectively, p<0.01]. The frequency of urinary tract infection did not differ between the patients with mild and moderate hydronephrosis patients (p>0.05). There was no evidence of acute pyelonephritis and obstructive or progressive hydronephrosis. Mild and moderate isolated antenatal hydronephrosis is often a self-limited condition. Children with mild and moderate isolated antenatal hydronephrosis might be followed without antibiotic prophylaxis.

Keywords:

Urinary tract infection, antibiotic prophylaxis, isolated antenatal hydronephrosis,

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