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Abstract(s)
Introdução: As malformações genitourinárias representam cerca de 20% do total das malformações fetais. A dilatação pielocalicial (DPC) pré-natal, definida pela presença no feto de um ou ambos os rins com algum grau de dilatação do sistema pielocalicial, é a anomalia urogenital mais comumente encontrada pela ecografia obstétrica. O seguimento de muitas DPC permanece discutível, pois na maioria dos casos são ligeiras e transitórias, representando uma variante fisiológica, de remissão espontânea, sem necessidade de intervenção terapêutica. Por outro lado, em alguns doentes, a DPC pode ser indicadora de patologia urológica efetiva, desde obstrução a refluxo vesicouretérico (RVU). Não há ainda dados pré-natais seguros que permitam distinguir precocemente as DPC fisiológicas daquelas às quais está associada uropatia. A relação entre o grau de dilatação pielocalicial pré-natal e o risco da criança apresentar RVU, continua incerta. Foi sugerido que o rastreio de dilatação do sistema urinário (SU) fetal durante a ecografia obstétrica possa conduzir à deteção do RVU logo após o nascimento, prevenindo assim a infeção urinária que, associada ao RVU, é causa de lesão renal.
Métodos: Trabalho de investigação retrospetivo, cuja amostra é constituída por crianças com diagnóstico pré-natal de DPC, seguidos em Consulta de Pediatria/Cirurgia Pediátrica no Centro Hospitalar Tondela-Viseu (CHTV). Foi feita a recolha de dados dos processos clínicos de crianças com diagnóstico pré-natal de DPC, e esses dados foram analisados no programa Microsoft Excel 2013.
Resultados: O diagnóstico pré-natal de DPC foi mais frequente no género masculino. 79,86% das crianças teve alta clínica aos 12 meses de idade e apenas 14,58% das crianças teve confirmação de uropatia associada à DPC. O RVU esteve presente em 6,25% do total da amostra e, mais especificamente, em 36% das crianças com patologia. Na estratificação das UR em classes de risco pré-natal, 58,76% das UR foi classificada como de baixo risco de patologia urológica (UTD A1). A confirmação da DPC na primeira ecografia pós-natal foi mais frequente no grupo de risco aumentado (UTD A2-3): 27,5% em oposição a 3,5% na UTD A1, assim como a presença de patologia urológica (30% em oposição a 8,77% na UTD A1). O RVU identificou-se em 7% das UR da UTD A1, em oposição a 7,5% das UR da UTD A2-3 e esteve presente em 15,38% das UR com confirmação de DPC na primeira ecografia pós-natal. Foram identificados graus idênticos de RVU em ambas as classes de risco pré-natal (III, IV e V) e essas UR foram todas submetidas a tratamento endoscópico.
Conclusões: O diagnóstico de RVU foi feito em 6,25% das crianças com diagnóstico pré-natal de DPC. Quanto maior o valor do diâmetro anteroposterior da pélvis renal (DAPPR), menor é a probabilidade de resolução pós-natal da DPC e maior é a probabilidade de deteção de patologia urológica, contudo, especificamente em relação ao RVU, essa relação não se verifica. Não havendo também uma classe de risco que se vincule a um determinado grau de RVU. Assim, a classe de risco pré-natal não é um bom preditor da presença de RVU e da gravidade deste. Relativamente ao prognóstico do RVU, não se encontraram diferenças entre as classes de risco, dado que todas as UR estratificadas foram submetidas a tratamento.
Introduction: Genitourinary malformations account for about 20% of fetal malformations. The prenatal renal pelvic dilatation (RPD), defined by the presence in the fetus of one or both kidneys with some degree of dilatation of the ureteropelvic system, is the most commonly urogenital anomaly found by obstetric ultrasound. The follow-up of many RPD remains questionable, because in most cases they are mild and transient, representing a physiological variant, of spontaneous remission, without the need for therapeutic intervention. On the other hand, in some patients, RPD can be an indicator of effective urologic disease, from obstruction to vesicoureteric reflux. There is still no prenatal safe data to distinguish beforehand the physiological RPD from those that are associated with underlying renal disease. The relationship between the degree of prenatal urinary tract dilatation and the risk of vesicoureteric reflux (VUR) in children remains uncertain. It has been suggested that urinary tract dilation screening during obstetric fetal ultrasound may lead to detection of the VUR soon after birth, thus preventing urinary infection, which associated with VUR, is a cause of renal injury. Methods: Retrospective research project, whose sample consisted of children with prenatal diagnosis of RPD, followed-up in Centro Hospitalar Tondela-Viseu in Pediatrics’/Pediatrics’ Surgery Consultation. Data was collected from medical records of children with prenatal diagnosis RPD, and analyzed in Microsoft Excel 2013 program. Results: Prenatal diagnosis of RPD was more frequent in males. 79.86% of the children had clinical discharge at 12 months of age and only 14.58% of children had confirmation of uropathy associated with the RPD. VUR was present in 6.25% of the total sample and, more specifically, in 36% of the children with pathology. In the stratification of RU in prenatal risk classes, 58.76% of the UR was classified as low-risk of urological pathology (UTD A1). The acknowledgment of the UTD in the first postnatal ultrasound was more frequent at increased risk group (UTD A2-3): 27.5% as opposed to 3.5% in UTD A1, as well as the presence of urologic pathology (30% as opposed to 8.77% in UTD A1). VUR was identified in 7% of the RU of UTD A1, as opposed to 7.5% of the RU of UTD A2-3 and was present in 15.38% of the RU with UTD confirmation in the first postnatal ultrasound. Identical degrees of VUR were identified in both prenatal risk classes (III, IV and V) and those RU have all been submitted to endoscopic treatment. Conclusion: The diagnosis of VUR was made in 6.25% of children with prenatal diagnosis of UTD. The higher the value of APDRP, the lower the probability of postnatal resolution of UTD and the greater the probability of detection of urologic pathology. However, particularly in relation to VUR, this relationship does not occur. There is not a risk class that is subordinated to a certain degree of VUR. Thus, prenatal risk class is not a good predictor of the presence of VUR and the severity of this. Regarding the prognosis of VUR, no differences were found between risk classes, as all stratified UR were submitted to treatment.
Introduction: Genitourinary malformations account for about 20% of fetal malformations. The prenatal renal pelvic dilatation (RPD), defined by the presence in the fetus of one or both kidneys with some degree of dilatation of the ureteropelvic system, is the most commonly urogenital anomaly found by obstetric ultrasound. The follow-up of many RPD remains questionable, because in most cases they are mild and transient, representing a physiological variant, of spontaneous remission, without the need for therapeutic intervention. On the other hand, in some patients, RPD can be an indicator of effective urologic disease, from obstruction to vesicoureteric reflux. There is still no prenatal safe data to distinguish beforehand the physiological RPD from those that are associated with underlying renal disease. The relationship between the degree of prenatal urinary tract dilatation and the risk of vesicoureteric reflux (VUR) in children remains uncertain. It has been suggested that urinary tract dilation screening during obstetric fetal ultrasound may lead to detection of the VUR soon after birth, thus preventing urinary infection, which associated with VUR, is a cause of renal injury. Methods: Retrospective research project, whose sample consisted of children with prenatal diagnosis of RPD, followed-up in Centro Hospitalar Tondela-Viseu in Pediatrics’/Pediatrics’ Surgery Consultation. Data was collected from medical records of children with prenatal diagnosis RPD, and analyzed in Microsoft Excel 2013 program. Results: Prenatal diagnosis of RPD was more frequent in males. 79.86% of the children had clinical discharge at 12 months of age and only 14.58% of children had confirmation of uropathy associated with the RPD. VUR was present in 6.25% of the total sample and, more specifically, in 36% of the children with pathology. In the stratification of RU in prenatal risk classes, 58.76% of the UR was classified as low-risk of urological pathology (UTD A1). The acknowledgment of the UTD in the first postnatal ultrasound was more frequent at increased risk group (UTD A2-3): 27.5% as opposed to 3.5% in UTD A1, as well as the presence of urologic pathology (30% as opposed to 8.77% in UTD A1). VUR was identified in 7% of the RU of UTD A1, as opposed to 7.5% of the RU of UTD A2-3 and was present in 15.38% of the RU with UTD confirmation in the first postnatal ultrasound. Identical degrees of VUR were identified in both prenatal risk classes (III, IV and V) and those RU have all been submitted to endoscopic treatment. Conclusion: The diagnosis of VUR was made in 6.25% of children with prenatal diagnosis of UTD. The higher the value of APDRP, the lower the probability of postnatal resolution of UTD and the greater the probability of detection of urologic pathology. However, particularly in relation to VUR, this relationship does not occur. There is not a risk class that is subordinated to a certain degree of VUR. Thus, prenatal risk class is not a good predictor of the presence of VUR and the severity of this. Regarding the prognosis of VUR, no differences were found between risk classes, as all stratified UR were submitted to treatment.
Description
Keywords
Diagnóstico Pré-Natal Dilatação Pielocalicial Refluxo Vesicouretérico