Serkan TURSUN, Ayşegül ALPCAN, Yaşar KANDUR, Banu ACAR

Süt Çocukluğu Döneminde Konjenital Hidronefrozun Seyri

Amaç: Çalışmamızın amacı, konjenital hidronefroz vakalarında spontan düzelme oranlarını güncel bir bakış açısıyla incelemektir. Gereç ve Yöntemler: Konjenital hidronefroz tanılı 69 hasta (E/K=46/23) çalışmaya dahil edildi. Bulgular: Doğum sonrası ilk kontrolde bebeklerin ortalama yaşı 10.8 ± 7.6 gün iken çalışma sonunda yaşları 9.5±3.2 ay’dı. Takipte 48 (%69.5) hastanın renal pelvis anteriör-posteriör çapı düzelmişken, 8 (%11.6) hastanınki artmıştı. Ancak bu 8 hastanın MAG-3 görüntülemesi normaldi. Diğer 13 (%18.9) hastada, CAKUT (Böbrek ve üriner sistem konjenital anomalileri) tanılarından olan vezikoüretral reflü (n=8), üreteropelvik bileşke obstrüksyonu (n=5) saptandı. Ortalama başlangıç anteriör-posteriör çap ölçümü, çapı azalmış grupta 9.1±2.8 mm ve artmış grupta 9.7±2.8 mm’di (p=0.461). Son ölçümdeki ortalama anteriör-posteriör çapı ölçümü, çap ölçümü azalmış grupta, artmış gruba göre daha düşüktü (5.1±1.8 mm’ye karşılık 17.9±12.6 mm; p=0.001). Sol tarafta hidronefrozu olan hastaların yirmi altısında (%81.25) ve sağ tarafta hidronefrozu olan hastaların onunda (%71.4) anteriör-posteriör çapı ölçümü spontan olarak azaldı. Bilateral hidronefroz olan hastalarda spontan düzelme, tek taraflı olgulara göre daha düşük orandaydı (n=13; %56.5). Sonuç: Çalışmamız şunu göstermiştir ki konjenital hidronefroz vakalarında, doğum sonrası yapılan ilk ultrason görüntülemede, hafif düzeydeki hidronefroz varlığı, patolojik seyri dışlamamaktadır. Bu nedenle bu hastalarda ultrason görüntüleme işlemine belli aralıklarla devam edilmelidir.

Anahtar Kelimeler:

Konjenital hidronefroz, süt çocuğu, antenatal, renal pelvis çapı

The Course of Congenital Hydronephrosis in Infancy

Objective: The aim of our study is to examine the spontaneous resolution rates of congenital hydronephrosis from a recent perspective. Material and Methods: Sixty-nine pediatric patients (M/F=46/23) with congenital hydronephrosis were enrolled in this study. Results: The mean age at the first postnatal examination was 10.8±7.6 days, and the mean age at the time of the final examination was 9.5±3.2 months. Forty-eight patients’ renal anteroposterior diameters (APD) (69.5%) improved while 8 (11.6%) patients’ APDs worsened during the follow-up period. However, MAG3 of these 8 patients was normal. The remaining thirteen (18.9%) patients had congenital anomalies of the kidney and the urinary tract (8 vesicoureteral reflux, 5 cases of ureteropelvic junction obstruction). The mean baseline APD was 9.1±2.8 mm in the group with reduced APD, and 9.7±2.8 mm in the one with increased APD (p=0.461). The mean APD at the final visit was significantly lower in the group with reduced APD than that in the group with increased APD (5.1±1.8 mm vs 17.9±12.6 mm; p=0.001). The anteroposterior diameter of 26 (81.25%) patients with left-sided hydronephrosis and 10 (71.4%) patients with right-sided hydronephrosis regressed spontaneously. The rate of spontaneous resolution was relatively low in patients with bilateral hydronephrosis (n=13; 56.5%) compared to unilateral ones. Conclusion: Our study indicates that an initially mild hydronephrosis does not exclude a pathological course in cases of congenital hyronephrosis. Therefore, in such patients, routine ultrasonography should be done regularly.

Keywords:

Congenital hydronephrosis, infant, antenatal, renal pelvic diameter,

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