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Journal of the Korean Society of Pediatric Nephrology 2003;7(1): 60-66.
산전 초음파로 발견된 수신증의 치료 방침
한혜원, 전누리, 김건석, 문대혁, 윤종현, 박영서
1울산대학교 의과대학 서울아산병원 소아과
2울산대학교 의과대학 서울아산병원 소아과
3울산대학교 의과대학 서울아산병원 비뇨기과
4울산대학교 의과대학 서울아산병원 핵의학과
5울산대학교 의과대학 서울아산병원 방사선과
6울산대학교 의과대학 서울아산병원 소아과
Guideline in the Management of Antenatally Diagnosed Unilateral Hydronephrosis
Hye-Won Hahn, Nu-Lee Jun, Kun-Seok Kim, Dae-Hyuk Moon, Chong-Hyun Yoon, Young-Seo Park
1Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine
2Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine
3Department of Urology, Asan Medical Center, University of Ulsan College of Medicine
4Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine
5Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine
6Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine
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ABSTRACT
Purpose : Neonatal hydronephrosis has been detected with increasing frequency with the widespread use of prenatal ultrasonography, but the consensus about its postnatal management has not yet been reached, especially about surgical intervention. We attempted to determine the guideline of follow-up study and surgical intervention of hydronephrosis by analyzing clinical outcomes of neonates with hydronephrosis.
Materials and Methods : Between 1994 and 2000, 128 hydronephrotic kidneys were postnatally confirmed. Cases associated with other urologic anomalies were excluded and 90 unilateral hydronephrotic kidneys with a minimum follow-up of 12 months were enrolled in this study. We classified the patients into 6 groups according to the anterior posterior pelvic diameter(APPD) at initial ultrasonography(USG) within 1 month after birth. Renal USG and $Tc^{99m}-mercaptoacetyl$ triglycerine(MAG3) scan were done according to a set protocol, and pyeloplasty was performed when indicated according to our protocol.
Results : Most cases whose APPD were below 10 mm improved or resolved. Only few cases with APPD above 20 mm showed spontaneous improvement and most(88%) had undergone operation. Those with initial APPD within 10-19 mm showed variable outcomes. When the risk factors for irreversible renal functional deterioration were analyzed, the age at pyeloplasty and pre-operative functional deficit were significant.
Conclusion : We concluded that in infants with initial APPD below 10 mm, consideration of surgery is not needed, and in those with initial APPD above 20 mm, early operation is recommended. Our set protocol based on initial USG is useful, but the cut-off value of relative renal function(RRF) for operation might be increased to 40% to improve post operative RRF.
Key words: Neonatal hydronephrosis | Anterior posterior pelvic diameter(APPD) | Ultrasonography | A protocol for follow-up | Relative renal function
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