已证明,膀胱羊膜分流术(VAS)和其他用于胎儿下尿路梗阻(LUTO)的膀胱引流技术可改善肺发育不全并增加最初预后不良的患者的生存率。目前,在妊娠期评估和预测出生后肾功能的预后工具有限。
目的是描述LUTO患者的肾实质面积(RPA)的产前生长,并确定其在一年寿命中作为肾功能预测指标的应用。
研究人群包括所有在胎儿VAS存活至出生的婴儿的回顾性队列。使用imageJ软件测量肾脏生长和大小,以计算顺序产前超声检查中的RPA。从具有最大纵向长度的每个肾脏的图像测量实质面积。这些测量值进一步相关,并作为生命第一年内终末期肾病(ESRD)的预测因子进行分析。
15例男性胎儿的LUTO病因包括8个后尿道瓣膜,四种鹰-巴雷特/李梅腹部综合征,两次尿道闭锁,和一个巨大的小结肠肠蠕动综合征。所有病人都有专利分流,到位,出生时。此外,超声参数,如羊水过少,钥匙孔标志,膀胱壁厚度组间无统计学差异。在ESRD组(r=0.409,p=0.018)和非ESRD组(r=0.657,p<0.001)中,肾实质生长与出生后肾功能相关。最值得注意的是,妊娠晚期RPA预测ESRD的最佳截止点确定为8cm2(灵敏度,0.714;特异性,0.882;和正似然比,6.071)(表)。
尽管LUTO有明确的VAS,产后发病率和死亡率仍然很高,强调肾发育不良在出生后肾功能衰竭中的作用,尽管尿路改道。在妊娠晚期,两组之间的肾脏生长具有统计学差异;在生命的第一年内发展为ESRD的患者中,RPA的发育似乎停滞。相比之下,未发生ESRD的患者肾实质继续呈线性增长.这表明产前RPA可能是产后ESRD的预测因素。
产前期间的RPA测量可以作为预测出生后肾功能和预测出生后临床干预措施的非侵入性工具发挥重要作用。
Vesicoamniotic shunting (VAS) and other bladder drainage techniques for fetal lower urinary tract obstruction (LUTO) have been proven to ameliorate pulmonary hypoplasia and increase survival in patients with an initial poor prognosis. Currently there are limited prognostic tools available during gestation to evaluate and predict postnatal renal function.
The aim was to describe the prenatal growth of the renal parenchymal area (RPA) in patients with LUTO and determine its application as a predictor of renal function at one year of life.
The study population comprised a retrospective cohort of all infants who survived the fetal VAS to birth. Renal growth and size were measured using imageJ software to calculate the RPA in sequential prenatal ultrasounds. The parenchymal area was measured from the image of each kidney with the greatest longitudinal length. These measurements were further correlated and analyzed as a predictor of end-stage renal disease (ESRD) within the first year of life.
Etiologies of LUTO in the 15 male fetuses included eight posterior urethral valves, four Eagle-Barrett/prune belly syndrome, two urethral atresia, and one megacystis microcolon intestinal hypoperistalsis syndrome. All patients had patent shunts, in place, at birth. Furthermore, ultrasonographic parameters such as oligohydramnios, keyhole sign, and bladder wall thickness showed no statistical difference between groups. Renal parenchymal growth correlated with postnatal renal function in both the ESRD (r = 0.409, p = 0.018) and the non-ESRD (r = 0.657, p < 0.001) groups. Most notably, RPA during the 3rd trimester predicted ESRD with the best cut-off point determined to be 8 cm2 (sensitivity, 0.714; specificity, 0.882; and positive likelihood ratio, 6.071) (Table).
Despite definitive VAS for LUTO, postnatal morbidity and mortality remain high, emphasizing the role of renal dysplasia in postnatal renal failure, in spite of urinary diversion. Renal growth statistically differs between groups in the 3rd trimester of gestation; RPA development appears stagnant in patients that developed ESRD within the first year of life. In contrast, patients that did not develop ESRD continued to have renal parenchymal growth in a linear fashion. This suggests that prenatal RPA may be predictive of postnatal ESRD.
RPA measurement during the prenatal period could play an important role as a non-invasive tool to predict postnatal renal function and to anticipate postnatal clinical interventions.