新生儿先天性肾脏和泌尿道畸形的超声筛查及随访

目的 探讨新生儿先天性肾脏和泌尿道畸形(congenital anomalies of the kidney and urinary tract,CAKUT)的发病情况,评价出生后早期行泌尿系超声筛查的价值。方法 对2016年1月至2018年12月于清华大学附属北京清华长庚医院出生和就诊的新生儿行泌尿系超声筛查并随访,同时对母孕产期资料进行分析,筛选与CAKUT发病相关的危险因素。结果 (1)本次筛查的2 655例新生儿中,CAKUT阳性82例(男60例,女22例),阳性率为3.1%(82/2 655), 其中肾积水66例,重复肾6例,多发性肾囊肿2例,肾囊性发育不良2例,髓质海绵肾1例,小肾脏3例,孤立肾1例,马蹄肾1例。(2)66例肾积水患儿中有4例失访;8例目前随访尚不足6个月,肾积水无明显变化,继续随访观察中;54例完成随访1年,1年内恢复正常32例,减轻3例,加重7例,无变化12例,其中1例因反复泌感、肾功能下降接受手术治疗。(3)CAKUT高危因素以孕晚期胎儿泌尿系超声异常最多,胎儿泌尿系超声异常的高危新生儿有44例,生后筛查发现CAKUT病例35例,发生率为79.5%(35/44)。(4)本次筛查的2 655例新生儿中,有2 611例新生儿产前泌尿系超声检查是正常的,这些产前泌尿系超声检查正常的新生儿中,有47例出生后泌尿系B超筛查符合CAKUT诊断,发生率为1.8%(47/2 611)。结论 新生儿最常见的CAKUT为肾积水,多数预后良好,但应定期随访;对新生儿尤其是母孕期胎儿泌尿系超声异常的高危新生儿行泌尿系统超声筛查,对于早期发现CA KUT有重要的临床意义。

Ultrasound screening and follow-up study of congenital anomalies of the kidney and urinary tract in neonates

Objective: To investigate the incidence of congenital anomalies of the kidney and urinary tract (CAKUT) in neonates, and to evaluate the value of urinary ultrasound screening in the early postnatal period.Methods: The neonates born or treated in Beijing Tsinghua Changgung Hospital affiliated to Tsinghua University between January 2016 and December 2018 accepted the urinary ultrasound scree-ning, and the neonates with problem were followed up. In the meanwhile, the maternal pregnancy data were analyzed to screen out the risk factors associated with the onset of CAKUT.Results: (1)A total of 2 655 neonates were screened by ultrasonography,of whom 82 neonates had been diagnosed with CAKUT(male: 60 cases,female: 22 cases),the positive rate was 3.1%(82/2 655).There were 66 cases of hydronephrosis, 6 cases of duplicate kidney, 2 cases of multiple renal cysts, 2 cases of renal cystic dysplasia, 1 case of medullary sponge kidney, 3 cases of small kidney, 1 case of isolated kidney, and 1 case of horseshoe kidney.(2)Of the 66 children with hydronephrosis, 4 cases were lost to the follow-up; 8 cases were followed for less than six months with no significant changes found, and still in the follow-up observation; 54 cases were followed up for 1 year, among which 32 cases were returned to normal within 1 year, 3 cases were alleviated, 7 cases were aggravated, and 12 cases were unchanged. One case underwent surgery for repeated urinary tract infections and decreased renal function.(3) Abnormal fetal urinary ultrasound in the late pregnancy was found to be the most common in the high risk factors of CAKUT. There were 44 high-risk newborns with abnormal fetal urinary ultrasound,and 35 cases of CAKUT were diagnosed after birth. The incidence rate was 79.5%(35/44). (4)Among the 2 655 newborns screened, 2 611 newborns had normal antenatal urinary ultrasonography. Among these neonates with normal urinary ultrasound during pregnancy,47 cases of CAKUT were diagnosed after birth, with an incidence of 1.8%(47/2 611).Conclusion: The most common CAKUT in neonates is hydronephrosis and most cases with hydronephrosis had a good prognosis, but they should be followed up regularly. Urinary ultrasound screening for neonates, especially those high-risk neonates with abnormal fetal urinary ultrasound, has important clinical implications for the early detection of CAKUT.