肾积水患儿的肾功能评估与结局预判

儿童肾积水目前的诊疗方案以保守观察为主,出现明确手术指征的肾积水患儿才进行手术治疗。然而,该诊疗方案历经几十年仍存在争议,各项检查对梗阻和肾功能受损的诊断能力、手术干预的指征和时机等问题尚未达成共识。目前肾积水的主要检查手段包括超声、同位素肾图、核磁共振等。基于对患者数据的观察分析得出的临界值、比值、分级和积分系统有助于判断哪些先天性肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)情况需要手术,而哪些可以继续观察随访;目前没有哪一项指标在诊断的敏感度和特异度上占据绝对优势。机器学习等较新的数据分析方法也正在被应用于肾积水的诊断,帮助提高超声和肾动态显像的诊断价值。此外,对尿液生物标志物诊断价值的探索工作也正在开展。本文将总结儿童肾积水的诊断方法在肾功能评估和结局预测中的价值,并对其最新进展进行评述。

Recent advances in renal function evaluation and outcome prediction of pediatric hydronephrosis

Hydronephrosis of children are generally conservatively managed while surgical intervention is only indicated whenever necessary.However,the management protocol has remained controversial.The diagnostic and predictive values of multiple examinations and surgical indications and timing are not standardized.Examinations of hydronephrosis include ultrasound,diuretic renogram and magnetic resonance urography(MRU).Cut-off values,ratio/index,grading and scoring systems from observational analysis of clinical data help to define the requirements of surgery and the necessities of continuing observations.Currently none of the above modalities dominates prominently in sensitivity and specificity.Novel technology of data analysis such as machine learning has been applied for boosting the diagnostic and predictive capacities of ultrasound and renogram.Clinical application of urinary biomarker is also under exploration.We here reviewed and evaluated recent advances of different diagnostic methods in renal function estimation and outcome prediction.