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Journal of the Korean Society of Pediatric Nephrology 2006;10(1): 33-39.
주산기에 발견된 수신증의 자연 경과와 치료 방침
채수호, 이지혁, 진동규, 박관현, 백경훈
1성균관대학교 의과대학 삼성서울병원 소아과
2성균관대학교 의과대학 삼성서울병원 소아과
3성균관대학교 의과대학 삼성서울병원 소아과
4성균관대학교 의과대학 삼성서울병원 비뇨기과
5성균관대학교 의과대학 삼성서울병원 소아과
Guidelines for the Management of Hydronephrosis Detected in the Perinatal Period
Soo-Ho Chae, Ji-Hyuk Lee, Dong-Kyu Jin, Kwan-Hyun Park, Kyung-Hoon Paik
1Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine
2Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine
3Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine
4Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine
5Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine
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ABSTRACT
Purpose : Neonatal hydronephrosis is diagnosed with an incidence of 4.5-7% of pregnancies. Recently, early detection of neonatal hydroneprosis with antenatal ultrasonography has be-come possible. But consensus about its management has not been reached, especially concerning surgical intervention. The purpose of this study is to analyze the natural course of neonatal hydronephrosis and to determine the guideline of surgical intervention and follow up study.
Methods : Sixty nine hydronephrotic kidneys were confirmed from April 2001 to April 2005. All cases were rechecked by ultrasonography once at least and had a minimum follow-up of 6 months. We classified the patients into 4 groups according to the anterior posterior pelvic diameter(APPD) on perinatal ultrasonography. Ultrasonography to measure the APPD diameter and Society for Fetal Urology(SFU) grade, $^{99m}Tc-MAG3$ scan were done to a set protocol. Pyeloplasty was peformed according to the protocol.
Results : Pyeloplasty was not needed in most cases where the APPD was below 10 mm and where the SFU grade were less than grade 3. Many cases with APPD 10 mm above or SFU grade III above had undergone pyeloplasty. We found a correlation between obstruction grade on MAG3 scan and whether surgery was performed or not.
Conclusion : If APPD is above 10 mm, SFU grade is above grade 3 or urinary tract obstruction is suspected by MAG3 scan, pyeloplasty must be considered. In cases where APPD is below 10mm and SFU grade is less than grade 3, we can observe the natural course of neonatal hydronephrosis with consecutive follow-up.
Key words: Neonatal hydronephrosis | Anterior posterior pelvic diameter | Perinatal ultrasonography
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