高回声肾是一种相对罕见的产前发现,这可能会产生显著的父母焦虑,由于不确定的预后。我们报告了大量经产前诊断为高回声肾的胎儿的围产期和婴儿结局。
这是对2002年至2017年间在大型三级胎儿医学单位中在产前诊断为高回声肾的所有病例的回顾性分析。高回声性定义为肾实质具有比肝脏更大的回声性。怀孕,病理和产后结局的收集来自1岁以下的医院和全科医生记录.肾脏异常结果定义为超过6个月的肌酐升高,需要药物治疗或肾脏大手术的高血压,如肾切除术。严重的肾脏异常结果定义为在任何阶段都需要透析或肾脏移植。
在平均胎龄为21岁的情况下,发现了三百一十六例具有高回声肾的胎儿(范围,13-37)周。大多数病例(97%)具有双侧高回声肾。在有可用随访数据的265例病例中,其他相关的肾道异常在产前被确定为36%,39%的患者伴随肾外结构异常,15%的患者伴随染色体核型异常。在包括的316个案例中,139没有生存,包括105次终止妊娠,5例宫内死亡和29例新生儿早期死亡。这些胎儿中只有4.3%(6/139)具有孤立的高回声肾,而28.1%(39/139)与高回声肾相关的多个肾道异常,超过三分之二(67.6%;94/139)伴有肾外异常。在177例存活超过1个月的病例中,结果数据来自126例.其中,根据产前发现,60例(47.6%)有孤立的高回声肾,56(44.4%)有相关的肾脏结构异常,10(7.9%)有额外的肾外异常。仅考虑肾脏结果,13例(21.7%)肾功能异常,这三组中有10名(17.9%)和0名(0%)婴儿,分别,尽管在更复杂的病例中,并发病理明显影响全球结局。在孤立的肾脏高回声组中观察到新生儿死亡率为1.6%。羊水过少或肾脏体积异常的存在与肾功能异常无显著相关性(比值比(OR),2.32(99%CI,0.54-10.02)和OR,0.74(99%CI,0.21-2.59),分别)在这个组中。
高回声的肾脏通常并发相关的肾道和肾外异常,异常核型和遗传疾病,这些因素对总体结果的影响比肾脏回声的影响更大。具有孤立的高回声肾脏的胎儿的肾脏结局通常良好,超过70%的病例产后肾功能正常。重要的是,用于预后咨询,在本非选择系列中,所有具有孤立的高回声肾和正常羊水水平的胎儿在婴儿期的肾脏结局均正常.©2020作者由JohnWiley&SonsLtd代表国际妇产科超声学会出版的妇产科超声。
Hyperechogenic kidneys are a relatively rare antenatal finding, which can generate significant parental anxiety due to uncertain prognosis. We report on the perinatal and infant outcomes of a large cohort of fetuses with antenatally diagnosed hyperechogenic kidneys.
This was a retrospective analysis of all cases diagnosed prenatally with hyperechogenic kidneys between 2002 and 2017 in a large tertiary fetal medicine unit. Hyperechogenicity was defined as kidney parenchyma with greater echogenicity than that of the liver. Pregnancy, pathological and postnatal outcomes were collected from hospital and general practitioner records up to 1 year of age. Abnormal renal outcome was defined as elevated creatinine beyond 6 months of age, hypertension requiring medication or major kidney surgery, such as nephrectomy. Severe abnormal renal outcome was defined as the need for dialysis or kidney transplant at any stage.
Three-hundred and sixteen fetuses with hyperechogenic kidneys were identified at a mean gestational age of 21 (range, 13-37) weeks. The majority of cases (97%) had bilateral hyperechogenic kidneys. In the 265 cases with available follow-up data, other associated renal tract abnormalities were identified prenatally in 36%, concomitant extrarenal structural abnormalities in 39% and abnormal karyotype in 15% of cases. Of the 316 included cases, 139 did not survive, including 105 terminations of pregnancy, five intrauterine deaths and 29 early neonatal deaths. Only 4.3% (6/139) of these fetuses had isolated hyperechogenic kidneys while 28.1% (39/139) had associated multiple renal tract abnormalities alongside hyperechogenic kidneys and over two-thirds (67.6%; 94/139) had concomitant extrarenal abnormalities. Of the 177 cases that survived beyond 1 month of age, outcome data were available in 126. Of these, based on the antenatal findings, 60 (47.6%) cases had isolated hyperechogenic kidneys, 56 (44.4%) had associated renal structural abnormalities and 10 (7.9%) had additional extrarenal abnormalities. Considering renal outcome alone, kidney function was abnormal in 13 (21.7%), 10 (17.9%) and 0 (0%) infants in these three groups, respectively, although concurrent pathology clearly affected global outcome in the more complex cases. Neonatal mortality of 1.6% was observed in the isolated renal hyperechogenicity group. The presence of oligohydramnios or abnormal renal volume was not associated significantly with abnormal renal function (odds ratio (OR), 2.32 (99% CI, 0.54-10.02) and OR, 0.74 (99% CI, 0.21-2.59), respectively) in this group.
Hyperechogenic kidneys are often complicated by associated renal tract and extrarenal abnormalities, aberrant karyotype and genetic disease, and these factors have a greater effect on overall outcome than does kidney echogenicity. The renal outcome of fetuses with isolated hyperechogenic kidneys is good generally, with over 70% of cases having normal renal function postpartum. Importantly, for prognostic counseling, all of the fetuses in this non-selected series with isolated hyperechogenic kidneys and normal amniotic fluid levels had normal renal outcome in infancy. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.