2926例学龄儿童尿液筛查分析

目的通过实施学龄儿童慢性肾脏病（chronic kidney disease,CKD）的尿液筛查模式,及早发现和诊断CKD,建立“初级登记、二级筛查随访、三级诊治严重患儿”的三级管理模式,从而使筛查出的肾脏病患儿得到有效管理,最终减少终末性肾病的发生率。方法选择小学一年级和六年级的学生3015名,由学校发放《告知尿液筛查告家长书》及专用试管留取晨尿。采用尿液试纸目测法检测尿液,将2次尿液筛检查均出现潜血、蛋白质或白细胞阳性者转至随州市妇幼保健院就诊,行尿液镜检或尿沉渣分析,阳性者定为尿检异常,对其中符合转诊条件者转诊至三级医院接受治疗,对不符合转诊条件者进行治疗或建档随访。结果完成尿液筛查总人数2926例,一年级有1533例（占53.39%）,六年级有1393例（占47.61%）。第一次尿液筛阳性人数533人（占18.22%）,第二次尿液筛阳性人数126人（占4.31%）。二级医院尿检阳性人数33人（占1.13%）,其中一年级23例（占0.79%）,六年级10例（占0.34%）,男生10例（占0.34%）,女生23例（占0.79%）。有3例患儿根据病情转诊至三级医院,17例尿白细胞阳性患儿经本院治疗后复查尿检转阴,6例确诊肾积石给予排石药物治疗,剩余7例每6月复诊随访1次,并建立随访档案。结论儿童 CKD尿液筛查模式具有经济、可操作性强等优点,能有效筛查出肾脏病患儿,其三级管理模式能对筛查出的患儿进行有效的管理,适合我国国情,适合在基层推广运用。     

超声波早期筛查新生儿及婴儿发育性髋关节异常

目的 探讨超声波早期筛查新生儿及婴儿发育性髋关节异常(DDH)的应用效果.方法 对1 139例新生儿及216例小婴儿行髋关节超声筛查,新生儿初次检查异常者30d时复查;采用Graf法及股骨头覆盖率比值测量髋关节,简化Graf法评判髋关节发育情况.,结果 全部1 355例受检者中,正常髋关节1 270例(93.73%),髋关节不稳定52例(3.84%),髋关节发育不良29例,半脱位3例,脱位1例,共占2.43%.结论 在新生儿及小婴儿中进行超声筛查DDH,方法 简便安全,可早期发现可疑及阳性病例.     

先天性小耳畸形合并先天泌尿生殖系统畸形发病率的研究

目的 研究先天性小耳畸形合并泌尿生殖系统先天畸形的发病率,分析两者的相关性。方法 回顾性分析2015年1月至2019年12月3 143例小耳畸形患者,通过肾脏超声或腹部CT检查,统计其中合并泌尿生殖系统畸形的病例,并对其畸形进行分类;对先天性小耳畸形合并泌尿生殖系统畸形患者的发病情况、患耳侧别与泌尿生殖系统畸形侧别之间的相关性等进行分析。结果 在3 143例小耳畸形患者中,163例伴有泌尿、生殖系统方面的畸形,包括单侧肾脏缺如、肾脏发育不全、肾脏积水、尿道下裂、睾丸发育异常等,总发病率为5.2%。数据分析显示,先天性小耳畸形伴发先天性泌尿生殖系统畸形的患者中,Ⅱ度小耳畸形的占比最高,肾积水、肾囊肿和睾丸发育异常的占比较高,且先天性小耳畸形的侧别与先天性泌尿系统畸形的侧别具有相关性。结论 泌尿生殖系统畸形在先天性小耳畸形患者中比一般人群中发病率高,且两者大概率是同侧畸形,可通过体格检查、肾脏超声及腹部CT诊断。先天性小耳畸形患者的诊疗中应关注患者肾脏功能,以改善此类患者预后。     

尿路结构异常儿童合并泌尿系感染的病原菌分析

目的探讨尿路结构异常儿童合并泌尿系感染（UTI）致病菌的分布及药物敏感及耐药情况。 方法收集2012年1月至2016年12月中山大学附属第三医院及汕头市中心医院符合UTI住院患儿476例,分为尿路正常组及尿路异常组,比较两组间病原菌构成比及对抗菌药物的敏感和耐药情况。 结果尿路异常者162例（肾积水最为常见,占43.83%）,尿路正常儿童314例。尿路异常儿童合并感染常见于男性（P<0.05）,共检出致病菌166株,革兰氏阴性菌（G^-）为主（71.08%）,大肠埃希菌占首位（40.36%）,肠球菌属居第2位（22.89%）,粪肠球菌在尿路异常组常见（χ²=4.59,P=0.032）。两组间常见病原菌耐药性差异无统计学意义。 结论尿路结构异常男性儿童易发生泌尿系感染,且肠球菌感染的发生率高于尿路结构正常儿童。     

超声在诊断胎儿颜面畸形中的应用价值及颜面部畸形与染色体异常的关系研究

目的:探究超声在诊断胎儿颜面畸形中的临床价值,进一步分析颜面部畸形与染色体异常的关系。方法:回顾性分析2018年12月-2019年7月在笔者医院超声科行产前筛查的1533例孕妇的资料,以超声筛查胎儿颜面部异常者(超声异常组,n=30)和超声筛查胎儿颜面部正常但具有高危因素者(超声正常高危组,n=66)作为研究对象。记录超声及染色体检查结果,分析颜面部畸形与染色体异常的关系。结果:30例超声筛查颜面部异常胎儿中,8例单纯颜面部异常,22例颜面部异常合并其他异常。超声异常合并其他异常组NT厚度显著高于超声单纯异常组和超声正常高危组,差异有统计学意义(P<0.05)。超声异常组胎儿染色体异变率为20.00%,显著高于超声正常高危组的4.55%,差异有统计学意义(P<0.05)。结论:产前筛查中应用超声诊断可以明显提高染色体异常胎儿的检出率,值得临床推广应用。     

彩色多普勒超声在无精子症诊断中应用价值的评估

目的 评价超声在梗阻性无精子症诊断中的作用.方法 158例梗阻性无精子症患者,经过体格体检查、精液分析及血液激素水平测定后,均进行了阴囊超声及经直肠彩色多普勒超声检查.结果 在158例梗阻性无精子症患者的超声检查中,25例无阳性结果,133例超声检查结果异常,阳性率为84.2%.其病因是多方面的,包括远端梗阻和近端梗阻,共分为4种分类：（1）先天性发育异常,如：精囊缺失或精囊发育不良以及输精管单侧及双侧缺失（55例）;（2）射精管梗阻（EDO）（34例）;（3）附睾病变（25例）;（4）炎症性病变（19例）.结论 阴囊超声及经直肠超声检查是临床诊断梗阻性无精子症的重要手段.     

肾盂输尿管连接部梗阻患儿出生后第1年内手术的临床及影像学特征:肾盂直径大小的意义

研究背景:根据产前超声检测显示泌尿系统异常的发生率大约是1%,其中大约1/3是尿道发育异常.对于胎儿来说,肾盂输尿管连接部梗阻(Ureteropelvic junction obstruction,UPJO)是导致其肾脏集合系统明显扩张的最常见的原因,约占所有病例的7%～35%.     

马蹄肾的首诊表现、合并症及影像检查分析

目的：马蹄肾是一种常见的先天性肾脏发育畸形,容易被漏诊或者误诊。本研究的目的是加深对马蹄肾临床和影像表现的认识。方法：回顾分析2008年1月-2013年6月在解放军总医院确诊为马蹄肾患者的一般情况、首诊表现、合并症及影像学检查结果。结果：（1）一般资料：共有53例影像诊断为马蹄肾患者纳入本研究,男：女为1．3：1;平均年龄为（40．2±17．5）岁。（2）首诊时表现：以腰痛、尿检异常等泌尿系统疾病相关临床表现为主诉就诊的28例（52．8％）;体检或因其他疾病意外发现的25例（47．2％）。（3）合并症：马蹄肾合并肾实质病变[表现为血尿或／（和）蛋白尿及肾衰竭]16例（30．2％）,尿路感染10例（18．9％）,泌尿系结石10例（18．9％）,肾积水10例（18．9％）,肾囊肿7例（13．2％）。（4）影像学检查：25例患者进行了超声检查,其中6例（24．0％）被误诊;16例患者接受了静脉肾盂造影检查,其中1例（6．3％）被漏诊。29例进行了肾脏CT检查、10例进行了肾脏MRI检查,无1例漏诊或误诊。13例ECT检查提示双肾影轮廓欠清晰或呈倒“八”字,放射性同位素分布存在不同程度减低、甚至单侧肾脏不显影。结论：马蹄肾首诊时泌尿系统表现约占一半;常见的合并症是肾实质病变、尿路感染、结石、肾积水及肾囊肿;CT或MRI是诊断马蹄肾最准确的手段。     

髓质海绵肾患者肾移植后移植肾衰竭1例

正髓质海绵肾(medullary sponge kidney,MSK)是一种少见的先天性肾脏发育异常疾病,其在普通人群的发病率约为1/20 000~1/5 000,常见于男性,少数病例可引起慢性肾衰竭。现报道我院一例海绵肾致慢性肾衰,行肾移植后移植肾再次发生肾衰竭的患者,并结合文献资料分析MSK患者的发病机制及肾移植术前术后的注意事项。     

成人肠旋转不良合并肠扭转的超声诊断价值

<正>先天性肠旋转不良是由于胚胎期中肠在发育过程中的正常旋转发生异常所致,大多在新生儿期及婴幼儿期发病,且多合并肠扭转,而成人发病率极低[1]。2011-05—2014-06间,6例成人肠旋转不良合并肠扭转患者经我院手术证实,现回顾分析超声检查并与其他影像检查对比分析的临床资料,以探讨超声检查在成人先天性肠旋转不良合并肠扭转中的诊断价值。1资料与方法 1.1一般资料本组6例患者均首先由超声检查诊断为肠旋转不     

Perinatal management of congenital anomalies of the urinary tract detected in utero

The routine use of maternal ultrasonography has led to frequent discovery of fetal anatomical abnormalities of the urinary tract. Herein we report on 35 cases with congenital urogenital anomalies which were found during the last 5 years by the prenatal ultrasonography and referred to our clinic either for treatment or consultation. 1. Findings of prenatal ultrasonography There were 12 cases of hydronephrosis, 7 of multicystic dysplastic kidney, 4 of megaureter, 3 of posterior urethral valve, 2 of ureterocele, 2 of vesicoureteral reflux and 5 other cases. Fetal anomalies were diagnosed during routine maternal examination, as intrauterine growth retardation, oligohydramnios, or the recurrent risk secondary to genetic risk factor or previous abnormal pregnancies. Prenatal diagnosis was made as early as 20 weeks of gestation in a case of hypoplastic urethra with large bladder diverticula. In about 30% of cases, abnormalities were found before 30 weeks of gestation. Oligohydramnios was evident in 5 cases. Prenatal diagnosis was correct in about 60% of cases. In the remainder the diagnosis was either incomplete or incorrect. Errors in the diagnosis resulted from difficulties in the differentiation of dilated ureter, intestinal dilation or intraperitoneal cystic masses. 2. Management in newborn periods Of the patients, 12 were treated urologically in newborn periods. Although patients with distended bladder and dilatation of upper tracts first underwent therapeutic placement of the urethral catheter, upper tract diversion with nephrostomy or tubeless ureterocutaneostomy was required in 2 because of continued elevation of serum creatinine levels. In 2 neonates nephrectomy was indicated for unilateral multicystic kidney, because the large cystic mass might compress the intestine.(ABSTRACT TRUNCATED AT 250 WORDS)     

Vesicoureteral reflux in male and female neonates as detected by voiding ultrasonography

BACKGROUND: Vesicoureteral reflux (VUR) is assumed to be congenital, and its early diagnosis is desired in order to prevent acquired renal damage. However, the incidence of VUR in neonates remains to be revealed. METHODS: Two thousand newborn babies (1048 boys and 952 girls) underwent voiding ultrasonography (an ultrasound examination of urinary tract during provoked voiding). Those who showed transient renal pelvic dilation during voiding, who had small kidneys, or who subsequently developed urinary infection underwent voiding cystourethrography. RESULTS: Transient renal pelvic dilation was observed in 16 babies (0.8%), including one boy with small kidneys. Among the rest of the babies, one boy had a small kidney, and nine babies subsequently developed urinary infection. Voiding cystourethrography revealed VUR in 24 ureters of 16 children (11 boys and 5 girls). Dimercaptosuccinate renoscintigraphy confirmed small kidneys, with generally reduced tracer uptake in a total of three boys, all having VUR. Voiding ultrasonography detected transient renal pelvic dilation in 17 (71%) of the 24 kidneys with VUR and, strikingly, 16 of the 17 (94%) kidneys with high-grade VUR (grade III or more). CONCLUSION: This study effectively detected VUR in 0.8% of the neonates (mostly of high grades and predominantly in males) and voiding ultrasonography showed a decided usefulness for the detection of VUR. The male preponderance of VUR in neonates was considered to be due to the occurrence of congenitally small kidneys, with reflux found exclusively in males and easier ultrasound detection of VUR in male neonates because the majority of diagnoses are reported to be high grades of VUR.     

Renal function in children with solitary kidney

Renal function of eighteen children with solitary kidney (14 congenital and 4 acquired) was assessed using DMSA renal uptake rate and urinary excretion of alpha 1-MG, beta 2-MG, NAG and microalbumin. Seven of the cases were associated with vesicoureteral reflux (VUR) and two with congenital hydronephrosis. These anomalies have been already treated surgically before entering this study. DMSA renal uptake rate of 8 children was the same as that of the controls (51.8 +/- 3.7%; mean +/- SD). However, the uptake rate of 10 cases were more than 2SD below the mean of the controls. In five of them, including two children with no other urinary tract anomaly, the uptake rate was less than 70% of the mean of the controls. Half of 14 children evaluated with alpha 1-MG showed high values. In 6 of these 7 cases, DMSA renal uptake rate was more than 2SD below the mean of the controls. Urinary microalbumin was not correlated with urinary alpha 1-MG or DMSA renal uptake rate. Three of 4 children with high values of urinary microalbumin were more than 10 years old. Nine of 12 children evaluated with all the indices mentioned above showed high values of urinary alpha 1-MG and/or microalbumin. Low DMSA renal uptake rate was revealed in 7 out of these 9 children including two cases without urinary tract anomaly. These results indicate that, in the cases with solitary kidney even though no other urinary tract anomaly is recognized, renal overload may have already developed in early life.     

Early Versus Late Surgical Management of Fetal Reflux Nephropathy

Purpose

Considering that infants with reflux nephropathy may be susceptible to urinary tract infection or longer postnatal vesicoureteral reflux, an early antireflux procedure rather than chemoprophylaxis may be indicated after birth.

Materials and Methods

In 15 male and 7 female neonates bilateral and unilateral primary high grade vesicoureteral reflux was detected prenatally in 15 and 7, respectively, on the basis of dilatation of the urinary tract. There was grade III or IV reflux in the 37 refluxing renal units and all patients received chemoprophylaxis after birth. In 11 neonates congenital reflux nephropathy was diagnosed during month 1 of life, including 5 (9 refluxing renal units) who underwent early antireflux surgery without evidence of urinary tract infection and 6 (11 refluxing renal units) who underwent late surgery with a history of urinary tract infection. All patients treated nonsurgically and surgically were monitored up to 2 years and for 2 years and for 2 years postoperatively, respectively.

Results

Of the 11 patients (17 renal units) without congenital reflux nephropathy reflux improved in 53%, a documented urinary tract infection occurred in 2 and there was no development of new scars in a previously normal kidney. In the 11 patients (20 renal units) with congenital reflux nephropathy the parenchymal defect detected during month 1 of life was general or focal, that is at the mid zone as well as the poles. Surgery was performed at a mean of 8 weeks of life in 5 patients without a documented urinary tract infection, 24 weeks earlier than in the 6 with a history of urinary tract infections. Postoperative breakthrough infections occurred in all 6 infants who underwent late surgery and in none who underwent early surgery (p <0.05). New scarring developed in previously scarred renal units but there was more new scarring in the renal units treated with late surgery (10 of 11, 90%) than in those treated with early surgery (2 of 9, 22%, p <0.001). In both groups retardation of growth was identified in the renal units with general nephropathy.

Conclusions

Renal units with fetal reflux nephropathy were susceptible to urinary tract infections and new scar formation. Early antireflux surgery performed before a urinary tract infection develops offers a better prognosis than late surgery.     

Clinical characteristics of primary vesicoureteral reflux in infants: multicenter retrospective study in Japan

PURPOSE: We evaluate clinical characteristics of primary vesicoureteral reflux in infants in a multicenter study in Japan with special reference to the relation of renal parenchymal damage to urinary tract infection and gender. MATERIALS AND METHODS: Infants younger than 1 year old with primary vesicoureteral reflux were recruited from 14 hospitals during the 3-year registration period beginning in January 1996 and ending in December 1998. Various clinical parameters as well as renal parenchymal lesion on dimercaptosuccinic acid scintigraphy were evaluated. RESULTS: Of 356 infants enrolled 296 (83%) were male and 60 (17%) were female. In 85% of infants presenting symptom was febrile urinary tract infection. There were 204 bilateral (57%) and 152 unilateral (43%) cases. Reflux was bilateral in 56% of males versus 65% of females, and high grade (grades IV and V) in 58% of males versus 55% of females. Diffuse parenchymal lesion was similarly noted in infants with or without prior urinary tract infection (38% and 46%, respectively) and was more often noted in male than in female infants (42% versus 25%). CONCLUSIONS: Despite the current use of screening prenatal ultrasound, many infants are still diagnosed as having vesicoureteral reflux only after the occurrence of urinary tract infection. The greater severity of renal parenchymal lesion in male infants combined with similar incidence of diffuse parenchymal lesion in those with or without prior infection suggests preexisting congenital abnormalities in the male refluxing kidney.     

Prenatal diagnosis of urinary tract malformation

Malformation of the urinary tract (UT) is among the most common of all congenital malformations. Prior to the common usage of prenatal ultrasound, these anomalies were undetected until pediatric complications prompted investigation. When diagnosed and treated in early infancy, children with urinary tract malformations have a much better prognosis than when diagnosis is delayed beyond 1–2 years. Since the first report of the prenatal diagnosis of polycystic kidney disease by Garrett et al. in 1970, most forms of congenital urinary tract malformation have been diagnosed antenatally with the use of sonography. A review of the normal and abnormal development of the urinary system, some genetic aspects of UT malformations, and an overiew of the major UT anomalies and their prenatal diagnosis is presented.     

Acute renal damage in infants after first urinary tract infection

Urinary tract infection (UTI) is one of the most common causes of unexplained fever in neonates. The aim of this study was to determine the incidence of urinary tract anomalies and acute renal damage in neonates who presented with first urinary tract infection in the first 8 weeks of life. We reviewed the records of 95 infants, who were hospitalised with UTI during a 6-year period (1994-1999). Patients with antenatally diagnosed hydronephrosis and incomplete radiological investigations were excluded from the study. Of the remaining 57 patients, 42 were boys and 15 girls. The mean age at diagnosis was 32 days (range 5-60 days). All patients underwent renal ultrasonography (US), voiding cystourethrogram (VCUG) and (99m)Tc-dimercaptosuccinic acid (DMSA) scan. Urinary tract abnormalities were detected in 20 (35%) patients. Vesicoureteral reflux (VUR) was found in 19 (33%) neonates, 7 girls and 12 boys. Acute cortical defects on DMSA scan were present in 19 kidneys of patients with VUR and in 25 of those without reflux. Only one-third of neonates after first symptomatic UTI had VUR. We recommend that US, VCUG, and DMSA scan should be routinely performed after the first UTI in infants younger than 8 weeks.     

Obstructive nephropathy

Congenital anomalies of the kidney and urinary tract (CAKUT) are regarded as a single entity. The degree of obstruction may have an additional influence on the parenchymal malfunction. Congenital dilatation of the upper urinary tract associated with symptomatic urinary tract infection must be treated early with intensive antibiotic therapy. In some cases temporary urinary diversion is also required. Further diagnostic procedures are then postponed in such cases. In all other cases of dilatation of the upper urinary tract diagnosed prenatally or early in the postnatal period, diuresis renography is still the cornerstone of diagnosis, even though it has definite limitations in young infants and in babies with poor kidney function. Functional gadolinum MR-urography will become the method of choice in the near future, since it combines good functional and excellent morphological presentation. When an obstruction hampering function is definitely present surgical correction is indicated: open and endoscopic surgery yield similarly good results. Molecular markers in CAKUT may soon be used as prognostic indicators. Examination of the molecular alterations that occur in renal and urinary tract anomalies may also lead to medicamentous protection of renal function.     

Unilateral multicystic dysplastic kidney: experience in children

OBJECTIVES: To report a retrospective study of unilateral multicystic dysplastic kidneys (MCDK) in children, assessing the contralateral kidneys and urinary tract, the functional consequences, and the urological and nephrological management and outcome, as unilateral MCDK is the most common cause of renal cystic disease in children, and malformations of the contralateral urinary tract and kidney (pelvi-ureteric obstruction, megaureter, reflux, renal dysplasia) have been reported. PATIENTS AND METHODS: The study included 97 patients (60 boys, 37 girls) with MCDK seen between 1985 and 1998; 82 were diagnosed in utero by ultrasonography (US). After birth, the diagnosis was verified by US, renal scanning (in 93) or intravenous urography (in four), and 89 (92%) had voiding cysto-urethrography (VCUG). Of the 97 children, 87 (90% had a mean (range) follow-up of 44.3 (15-115) months. RESULTS: The MCDK was removed in 17 children; the follow-up of 75 children (five lost to follow-up) showed total involution of the MCDK in 25%, shrinkage in 60% and a stable size in 15%. None had any sign of malignancy. The contralateral kidney showed anomalies in 19 of 97 children (20%); 12 had a dilated renal pelvis (two with megaureter), six had a high echogenicity of the contralateral kidney (one had reflux, and two also pelvic dilatation). In only four of the 89 children was reflux found by VCUG; 16 of the 19 anomalies were detected by US. Five children needed surgery on the contralateral urinary tract (three a pyeloplasty, and one each a pyeloplasty plus ureteroneocystostomy, and an antireflux procedure). Of the contralateral kidneys 43% showed compensatory hypertrophy. There was mild renal insufficiency in three children; renal function seemed to be slightly impaired in many. Five infants had hypertension (four with spontaneous resolution) caused by renal scarring after pyelonephritis or inborn dysplasia of the contralateral kidney. There were symptomatic urinary tract infections in seven children. CONCLUSION: US can be used safely to diagnose unilateral MCDKs and malformations of the contralateral urinary tract and kidney. In cases where US of the dysplastic kidney remains uncertain renal scintigraphy is necessary to detect the lack of renal function. The low rate of reflux makes routine VCUG unnecessary if the contralateral upper urinary tract and kidney appear to be normal on US. Nephrectomy of the dysplastic kidney in typical cases is also unnecessary. A long-term nephro-urological follow-up of children with MCDK is recommended.