Hydronephrosis in infants and children: natural history and risk factors for persistence in children followed by a medical service.

Clinical medicine. Pediatrics Pub Date : 2009-12-16 Print Date: 2009-01-01 DOI:10.4137/cmped.s3584
Kristy Vandervoort, Stephanie Lasky, Christine Sethna, Rachel Frank, Suzanne Vento, Jeanne Choi-Rosen, Beatrice Goilav, Howard Trachtman
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引用次数: 9

Abstract

Background: Infants with neonatal hydronephrosis and a normal voiding cystourethrogram (VCUG) are presumed to have ureteropelvic junction obstruction (UPJO). There is little current information about the natural history of children with hydronephrosis or clinical factors that predict resolution of the radiological abnormality.

Objective: To determine the time course until spontaneous resolution of neonatal hydronephrosis and define risk factors for persistence of the abnormality.

Methods: This retrospective single center review examined infants and children <5 years of age with hydronephrosis who were followed for at least 12 months.

Results: 136 children were identified (96 male:40 female). The mean age at diagnosis of hydronephrosis was 3.3 ± 9.7 months and 76% of the patients were diagnosed at birth. The hydronephrosis was unilateral in 98 (72%) of cases, and hydronephrosis was at least moderate in severity in 22% of affected kidneys. At last follow-up at 30 ± 10 months, the abnormality had resolved in 77 out of 115 (67%) available patients, 30 (26%) had been referred to urology, and 12 (10%) had persistent hydronephrosis. Severity of hydronephrosis was the only clinical feature that predicted persistence of the abnormality (P < 0.001). There was an association between detection at birth and lack of resolution of hydronephrosis.

Conclusions: Children with hydronephrosis and presumed UPJO and normal kidney parenchyma can be followed for at least 2 years to allow for spontaneous resolution before referral to urology. Serial sonography can be performed at 6 month intervals in uncomplicated cases. More severe hydronephrosis and presence of the lesion at birth may predict infants and children requiring closer observation and referral for possible surgical correction of the hydronephrosis.

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婴儿和儿童肾积水:儿童持续存在的自然病史和危险因素,随后进行医疗服务。
背景:新生儿肾积水和排尿膀胱输尿管造影(VCUG)正常的婴儿被认为有肾盂输尿管连接处梗阻(UPJO)。目前关于儿童肾积水的自然病史或预测放射学异常解决的临床因素的信息很少。目的:确定新生儿肾积水自然消退的时间过程,并确定异常持续存在的危险因素。方法:本研究以婴幼儿为研究对象,采用回顾性单中心研究方法。结果:共纳入136例儿童(男96例,女40例)。确诊肾积水的平均年龄为3.3±9.7个月,76%的患者在出生时确诊。98例(72%)患者单侧肾积水,22%患者肾积水严重程度不低于中度。在30±10个月的最后随访中,115例患者中有77例(67%)异常消退,30例(26%)转介泌尿外科,12例(10%)持续肾积水。肾积水的严重程度是预测异常持续存在的唯一临床特征(P < 0.001)。在出生时检测到肾积水与缺乏解决之间存在关联。结论:肾积水、推测为UPJO和正常肾实质的儿童可随访至少2年,以便在转诊到泌尿科之前自行消退。无并发症的病例可每隔6个月进行连续超声检查。更严重的肾积水和出生时病变的存在可能预示着婴儿和儿童需要更密切的观察和可能的肾积水手术矫正转诊。
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