UTD Sınıflamasının Antenatal Hidronefroz Prognozunu Tahmin Etmedeki Rolü

Year 2023, Volume: 2 Issue: 4, 189 - 193, 25.12.2023

Sevgin Taner , Gunay Ekberli

https://doi.org/10.57221/izmirtip.1342217

Abstract

Amaç: Antenatal hidronefroz (HN), böbrek ve üriner systemin konjenital anomalilerinin (CAKUT) bir tezahürünün yanı sıra geçici bir durumu da gösterebilir. CAKUT vakalarını tanımak ve gerekli müdahaleyi zamanında yapabilmek için farklı skorlama sistemleri geliştirilmiştir. Bu çalışmanın amacı antenatal HN ile hastanemize başvuran hastaların takip sonuçlarını ‘Üriner Trakt Dilatasyonu’ (ÜTD) sınıflamasına göre yeniden değerlendirmek ve sınıflamanın prognostik öngörüsünü belirlemektir.
Gereç ve Yöntemler: Şubat 2020-Mart 2021 tarihleri arasında Adana Şehir Eğitim ve Araştırma Hastanesi Çocuk Nefroloji ve Üroloji polikliniklerine antenatal HN tanısı ile başvuran hastalar çalışmaya alındı. Hastalar UTD sınıflamasına göre gruplandırıldı.
Bulgular: Çalışmaya dahil edilen 132 hastanın (93 erkek/39 kadın) 84'ü (%64) geçici/fizyolojik hidronefroz, 48'i (%36) CAKUT tanısı aldı. Kırk yedi hastada izole pelvik dilatasyonu (pelvis ön-arka çapı <10 mm) saptandı. UTD sınıflamasına dahil edilmeyen (UTD-P0) bu hastaların dördü (%9) CAKUT tanısı aldı. CAKUT insidansı UTD-P1 grubunda %13, UTD-P2 grubunda %55 ve UTD-P3 grubunda %100 idi. UTD P3 grubunda CAKUT varlığı, böbrek fonksiyon kaybı ve cerrahi girişim gereksinimi daha sıktı.
Sonuç: UTD sınıflaması hastaların prognozunu tahmin etmede yardımcıdır. Ancak UTD sınıflamasına (P0) dahil olmayan grupta bile CAKUT olgularının varlığı bize tek bir US görüntülemenin yanıltıcı olabileceğini hatırlatmaktadır. UTD Sınıflamasına göre, herhangi bir derecede antenatal HN'si olan çocuklar, normal popülasyona kıyasla postnatal patoloji riski altındadır. Özellikle orta ve şiddetli antenatal HN, önemli bir patolojik sonuç riskine sahiptir. Bu hastaların kapsamlı doğum sonrası tanı yönetimini yürütmek önemlidir.

Keywords

hidronefroz, antenatal hidronefroz, CAKUT, UTD

The Role of UTD Classification in Predicting Prognosis of Antenatal Hydronephrosis

Abstract

Evaluation of Patients with Antenatal Hydronephrosis According to UTD Classification
Aim: Antenatal hydronephrosis (HN) may indicate a temporary benign condition, as well as a manifestation of congenital anomalies of the kidney and urinary system (CAKUT). Different scoring systems have been introduced to recognize CAKUT cases and to perform the necessary intervention in a timely manner. The aim of this study is to reevaluate the follow-up results of patients admitted to our hospital with antenatal HN according to the Urinary Tract Dilation (UTD) classification, and to determine the prognostic prediction of the classification in determining the presence of CAKUT and the need for surgery.
Materials and Methods: Patients admitted to Adana City Training and Research Hospital Pediatric Nephrology and Urology outpatient clinics with the diagnosis of antenatal HN between February 2020-March 2021 included in the study. Patients were grouped according to the UTD classification.
Results: Of the 132 patients (93 male/39 female), 84 (64%) of the patients were evaluated as transient/physiological hydronephrosis, 48 (36%) as CAKUT. Isolated pelvic dilatation (pelvis anteroposterior diameter <10 mm) was detected in 47 patients. These patients were not included in the UTD classification (P0). Four (9%) of the UTD-P0 patients were evaluated as CAKUT. The incidence of CAKUT was 13% in patients with UTD-P1, 55% in patients with UTD-P2 and 100% in patients with UTD-P3. The diagnosis of CAKUT, loss of kidney function, and the need for surgical intervention were more common in patients in the UTD P3 group, respectively.
Conclusion: UTD classification is helpful in predicting prognosis of the patient. However, the presence of CAKUT cases even in the group not included in the UTD classification (P0) reminds us that a single US imaging can be misleading. According to the UTD Classification, children with any degree of antenatal HN are at risk for postnatal pathology compared to the normal population. Particularly moderate and severe antenatal HN has a significant risk of pathologic outcome. It is important to carry out comprehensive postnatal diagnosis management of these patients.

Keywords

hydronephrosis, antenatal hydronephrosis, CAKUT, UTD

References

• References 1.Lee RS, Cendron M, Kinnamon DD, Nguyen HT. Antenatal hydronephrosis as a predictor of postnatal outcome: a meta-analysis. Pediatrics. 2006;118:586-93.
• 2.Blyth B, Snyder HM, Duckett JW. Antenatal diagnosis and subsequent management of hydronephrosis. J Urol. 1993;149:693– 8.
• 3.Livera LN, Brookfield DS, Egginton JA, Hawnaur JM. Antenatal ultrasonography to detect fetal renal abnormalities: a prospective screening programme. BMJ. 1989;298:1421–3.
• 4.Nguyen HT, Benson CB, Bromley B, Campbell JB, Chow J, Coleman B, et al. Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). J Pediatr Urol.2014;10:982–8.
• 5.Scalabre A, Demede D, Gaillard S, Pracros JP, Mouriquand P, Mure PY. Prognostic value of ultrasound grading systems in prenatally diagnosed unilateral urinary tract dilatation. J Urol. 2017; 197:1144–9.
• 6.Hodhod A, Capolicchio JP, Jednak R, El-Sherif E, El-Doray Ael-A, El-Sherbiny M. Evaluation of urinary tract dilation classification system for grading postnatal hydronephrosis. J Urol. 2016;195:725. Taner et al. 192
• 7.Yalcinkaya F, Ozcakar ZB. Management of antenatal hydronephrosis. Pediatr Nephrol. 2020;35:2231-9.
• 8.Oliveira EA, Oliveira MC, Mak RH. Evaluation and management of hydronephrosis in the neonate. Curr Opin Pediatr. 2016;28:195-201.
• 9.Aksu N, Yavascan O, Kangin M, Kara OD, Aydin Y, Erdogan H, et al. Postnatal management of infants with antenatally detected hydronephrosis. Pediatr Nephrol.2005;20:1253–9.
• 10.Signorelli M, Cerri V, Taddei F, Groli C, Bianchi UA. Prenatal diagnosis and management of mild fetal pyelectasis: im- plications for neonatal outcome and follow-up. Eur J Obstet Gynecol Reprod Biol.2005;118:154–9.
• 11.Passerotti CC, Kalish LA, Chow J, Passerotti AM, Recabal P, Cendron M, et al. The predictive value of the first postnatal ultrasound in children with antenatal hydronephrosis. J Pediatr Urol. 2011;7:128-36.
• 12.Policiano C, Djokovic D, Carvalho R, Monteiro C, Melo MA, Graça LM. Ultrasound antenatal detection of urinary tract anomalies in the last decade: outcome and prognosis. J Matern Fetal Neonatal Med. 2015;28:959-63.
• 13.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.
• 14.Skoog SJ, Peters CA, Arant BS Jr, Copp HL, Elder JS, Hudson RG, et al. Pediatric vesicoureteral reflux guidelines panel summary report: clinical practice guidelines for screening siblings of children with vesicoureteral reflux and neonates/infants with prenatal hydronephrosis. J Urol. 2010;184:1145-51.
• 15.Braga LH, McGrath M, Farrokhyar F, Jegatheeswaran K, Lorenzo AJ. Society for fetal urology classification vs urinary tract dilation grading system for prognostication in prenatal hydronephrosis: a time to resolution analysis. J Urol. 2018;199:1615-21.