Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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1 year follow-up results of prenatally diagnosed unilateral hydronephrosis according to renal sonographic findings at 1 month of age

산전 초음파로 발견된 일측성 수신증의 생후 1개월 때의 초음파 소견에 따른 1년 추적 결과

  • Yoon, Hoe-Soo (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yum, Mi Sun (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Joo Hoon (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Young Seo (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Kun Seok (Department of Urology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yoon, Chong Hyun (Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Moon, Dae Hyuk (Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hahn, Hyewon (Department of Pediatrics, Eulji University School of Medicine)
  • 윤회수 (울산대학교 의과대학 서울아산병원 소아과) ;
  • 염미선 (울산대학교 의과대학 서울아산병원 소아과) ;
  • 이주훈 (울산대학교 의과대학 서울아산병원 소아과) ;
  • 박영서 (울산대학교 의과대학 서울아산병원 소아과) ;
  • 김건석 (울산대학교 의과대학 서울아산병원 비뇨기과) ;
  • 윤종현 (울산대학교 의과대학 서울아산병원 방사선과) ;
  • 문대혁 (울산대학교 의과대학 서울아산병원 핵의학과) ;
  • 한혜원 (을지의과대학교 소아과학교실)
  • Received : 2005.08.31
  • Accepted : 2005.10.06
  • Published : 2006.01.15
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Abstract

Purpose : The natural courses of prenatally diagnosed hydronephrosis(HN) are diverse. Our purpose was to determine if the findings of renal ultrasonography(USG) in patients with prenatal HN at 1 month of age can predict the 1 year follow-up results and determine the guideline of follow-up study. Methods : Among 462 hydronephrotic patients registered between 1996 and 2004, 153 unilateral hydronephrotic renal units were enrolled in this study, bilateral HN, vesicoureteral reflux and other associated anomaly were excluded. These were classified into four groups respectively, according to anterior posterior pelvic diameter(APPD) or Society for Fetal Urology(SFU) grading by USG findings at 1 month after birth. Renal USG and $Tc^{99m}$-mercaptoacetyl triglycerine(MAG3) scan were done according to a set protocol. Results : Most cases improved or remained stationary. No one underwent an operation SFU grade 1,2 groups and only one case of SFU grade 3 group was operated. Thirty two cases(64 percent) were operated on among the 50 cases of SFU grade 4 group. 0/2(0 percent), 5/11(45.5 percent), 11/17(64.7 percent) and 16/20(80 percent) were operated on in each group with APPD <10, 10-19, 20-29, >30 mm, and the operation risk is higher as the APPD is increased. Conclusion : In group with SFU grade below 3 and APPD below 10 mm, we can delay the follow-up study beyond existing set protocol. Operations are recommended immediately if diuretic renogram show the obstructive pattern or decreased renal function in SFU grade 4 group with APPD over 10 mm.

목 적 : 신생아 수신증은 산전 초음파가 널리 시행됨으로써 그 빈도가 증가하고 있다. 그러나 출생 후 수신증의 자연경과에 대한 이해는 아직 부족한 상태이다. 저자들은 산전 초음파에서 발견되어 산후 수신증으로 진단된 환아들에서 생후 1개월 때의 초음파 소견에 따른 1년 추적 결과를 알아보고, 초기 초음파 소견에 따라 이들의 경과를 예측해보고 치료방침을 세우는데 도움이 되고자 하였다. 방 법 : 1996년 11월부터 2004년 4월까지 산전 초음파상에서 수신증이 발견되어 생후 1개월에 시행한 신초음파검사상 수신증이 확인된 기타 요로기형이 없는 일측성 수신증 환아 중 서울아산병원 소아과에서 1년 이상 추적 관찰했던 153명의 환아를 대상으로 하였다. 신초음파검사상에서 신우전후경(anterior posterior pelvic diameter, APPD)과 Society for Fetal Urology(SFU) 지수 분류 정도에 따라 결과를 분석하였다. 결 과 : 초기 신초음파 소견 중 APPD가 20 mm 미만인 군의 경우에는 대부분 좋아지거나 변화가 없었고, SFU 지수가 1, 2군의 경우에도 대부분 좋아지거나 변화가 없었으며 수술한 경우는 한 례도 없었다. 3군의 경우에는 13례 중 1례(7.5%)만이 수술을 받았고 대부분 변화가 없었다. 4군의 경우에는 50례 중 32례(64%)가 수술을 받았다. SFU 지수 4군 안에서는 APPD의 크기가 증가할수록 수술 위험도가 높아 10 mm 미만, 10-19 mm, 20-29 mm, 30 mm 이상에서는 각각 0/2례(0%), 5/11례(45.5%), 11/17례(64.7%), 16/20례(80%)가 수술을 받았다. 결 론 : 초기 초음파 소견상 SFU 지수가 3 이하인 경우는 수술의 위험성이 적으므로 기존의 검사 계획보다 추적 검사 시기를 늦출 수 있고 검사수도 줄일 수 있을 것이다. 그러나, SFU 지수가 4인 경우, 특히 APPD가 큰 경우에는 향후 수술의 위험도가 높으므로 이뇨성 신기능검사에서 폐색이 의심되거나 신기능이 감소되는 소견을 보이면 빠른 시일 내에 수술을 하여야 한다.

Keywords

References

  1. Roth JA, Diamond DA. Prenatal hydronephrosis. Curr Opin Pediatr 2001;13:138-41 https://doi.org/10.1097/00008480-200104000-00009
  2. Ransley PG, Dhillon HK, Gordon I, Duffy PG, Dillon MJ, Barratt TM. The postnatal management of hydronephrosis diagnosed by prenatal ultrasound. J Urol 1990;144:584-7 https://doi.org/10.1016/S0022-5347(17)39528-9
  3. Blachar A, Blanchar Y, Livne PM, Zurkowski L, Pelet D, Mongilner B. Clinical outcome and follow-up of prenatal hydronephrosis. Pediatr Nephrol 1994;8:30-5 https://doi.org/10.1007/BF00868254
  4. Koff SA, Campbell KD. The nonoperative management of unilateral neonatal hydronephrosis : natural history of poorly functioning kidneys. J Urol 1994;152:593-5 https://doi.org/10.1016/S0022-5347(17)32658-7
  5. Chevalier RL, Klahr S. Therapeutic approaches in obstructive uropathy. Semin Nephrol 1998;18:652-8
  6. Subramaniam R, Kouriefs C, Dickon AP. Antenatally detected pelvi-ureteric junction obstruction : concerns about conservative management. Br J Urol 1999;84:335-8
  7. Conford PA, Rickwood AMK. Functional results of pyeloplasty in patients with antenatally diagnosed pelvi-ureteric junction obstruction. Br J Urol 1998;81:152-5 https://doi.org/10.1046/j.1464-410x.1998.00519.x
  8. Fernbach SK, Maizel M, Conway JJ. Ultrasound grading of hydronephrosis : introduction system used by the Society for Fetal Urology. Pediatr Radiol 1993;23:478-80 https://doi.org/10.1007/BF02012459
  9. Maderikan BA, Hayward C, Roberts GM. Clinical outcome of fetal uropathy. Arch Dis Child 1988;63:961-3 https://doi.org/10.1136/adc.63.8.961
  10. Podevin G, Mandelbrot L, Vuillard E, Oury JF, Aigrain Y. Outcome of urological abnormality prenatal diagnosed by ultrasound. Fetal Diagn Ther 1996;11:181-90 https://doi.org/10.1159/000264300
  11. Tripp BM, Homsey YL. Neonatal hydronephrosis- the controversy and management. Pediatr Nephrol 1995;9:503-9 https://doi.org/10.1007/BF00866741
  12. Capolicchio G, Leonard MP, Wong C, Jednak R, Brzezinski A, Salle JL. Prenatal diagnosis of hydronephrosis : impact on renal function and its recovery after pyeloplasty. J Urol 1999;162:1029-32 https://doi.org/10.1016/S0022-5347(01)68055-8
  13. Reznick VM, Budorick NE. Prenatal detection of congenital renal disease. Urol Clin North Am 1995;22:21-9
  14. Liang CC, Cheng PJ, Lin CJ, Chen HW, Chao AS, Chang SD. Outcome of prenatally diagnosed fetal hydronephrosis. J Reprod Med 2002;47:27-32
  15. Homsy YL, Sand F, Laberge I, Williot P, Pison C. Transitional hydronephrosis of the newborn and infant. J Urol 1990;144:579-83 https://doi.org/10.1016/S0022-5347(17)39527-7
  16. Arger PH, Coleman BG, Mintz MC. Routine fetal genitourinary tract screening. Radiology 1985;156:485-9 https://doi.org/10.1148/radiology.156.2.3892578
  17. Zerin JM. Hydronephrosis in the neonate and young infant : current concepts. Semin Ultrasound CT MR 1994;15:306-16
  18. Conway JJ. 'Well-tempered' diuresis renography : its historical development, physiological and technical pitfalls, and standardized technique protocol. Semin Nucl Med 1992;22: 74-84 https://doi.org/10.1016/S0001-2998(05)80083-2
  19. Frizberg AR, Kasina S, Eshima K, Johnson DL. Synthesis and biological evaluation of Tc-99m MAG3 as a hippuran replacement. J Nucl Med 1986;27:111-6.
  20. Ahamad G, Green P. Outcome of fetal pyelectasis diagnosed antenatally. J Obstetrics and Gynecology 2005;25: 119-22 https://doi.org/10.1080/01443610500041446
  21. King LR, Coughlin PW, Bloch EC, Bowie JD, Ansong K, Hanna MK. The case for immediate pyeloplasty in the neonate with ureteropelvic junction obstruction. J Urol 1984; 132:725-8 https://doi.org/10.1016/S0022-5347(17)49843-0
  22. Kass EJ, Fink-Bennet D. Contemporary techniques for the radioisotope evaluation of the dilated urinary tract. Urol Clin North Am 1990;17:273-89
  23. Ha SJ, Jung JH, Lee BS, Kim KS, Moon DH, Park YS. Optimal timing of surgery of hydronephrosis due to ureteropelvic junction obstruction in neonates and infants. Korean J Pediatr 2002;45:223-31
  24. Hahn HW, Jun NL, Park YS, Kim KS, Moon DH, Yoon CH. Guideline in the management of antenatally diagnosed unilateral hydronephrosis. J Korean Soc Pediatr Nephrol 2003;7:60-6
  25. Ulman I, Jayanthi VR, Koff SA. The long term follow-up of newborns with severe unilateral hydronephrosis initially treated nonoperatively. J Urol 2000;164:1101-5 https://doi.org/10.1016/S0022-5347(05)67262-X
  26. Onen A, Jayanthi VR, Koff SA. Long term follow-up of prenatally detected severe bilateral newborn hydronephrosis initially managed nonoperatively. J Urol 2002;168:118-20
  27. Lim DJ, Park JY, Kim JH, Paick SH, Oh SJ, Choi H. Clinical characteristics and outcome of hydronephrosis detected by prenatal ultrasonography. J Korean Med Sci 2003;18: 859-62 https://doi.org/10.3346/jkms.2003.18.6.859