선천성 수신증을 위한 Onen 등급 분류법의 임상적인 타당성
Validation of Onen’s Alternative Grading System for Congenital Hydronephrosis
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목적: 선천성 수신증은 신장 초음파 검사를 통해 조기진단이 가능하며 초음파 소견과 질환의 예후가 연관성을 가진다. 기존 수신증의 분류법이 예후나 치료 방법 결정의 기준이 될 수 있는지에 대한 논란이 있어 Onen 분류법이 새로 제시되었다. 이에 선천성 수신증을 APDRP, SFU 및Onen 분류법으로 비교하였을 때 Onen 분류법이 단일 수신증뿐만 아니라 복합 수신증에서도 타당한지 알아보고자 하였다. 방법: 2002년 1월부터 2011년 12월까지 선천성 수신증으로 진단받은 203명의 환자 중 추적 관찰이 가능했던 153명(204신단위)의 의무 기록을 후향적으로 검토하였다. 이들의 신장 초음파 영상을 분석하여 APDRP를 측정하고 SFU 및 Onen 분류법으로 수신증의 등급을 나누었다. 단일 또는 복합 수신증인지 조사하고, 만 2세경의 수신증의임상 경과를 조사하여 자연 소실, 신기능 저하, 요로 폐쇄,요로 감염 및 수술적 치료 여부를 조사하였다. 결과: 선천성 수신증에서 SFU-1등급과 Onen-1등급의경우 단일 수신증이, SFU-4등급과 Onen-3등급의 경우는 복합 수신증이 많았다. 단일 수신증 군에서 만 2세까지 경과를 보면, 세 분류법 모두 수신증이 경미한 경우 자연 소실 빈도가 높았고 복합 수신증에서도 같은 결과를 보였다. 신기능 저하의 빈도는 단일 수신증은 Onen 분류법에 의한등급 사이에 유의한 차이가 없었으나, 복합 수신증에서는유의한 차이가 있었다. 요로 폐쇄와 수술적 치료의 빈도는 단일 수신증일 때 세 분류법 모두 고등급 수신증에서 유의하게 높았다. Onen 분류법의 고등급 수신증은 다른 분류법에 의한 것들과 비교하여 임상적 경과에 유의한 차이가 없었다. 결론: Onen 분류법은 APDRP 또는 SFU 분류법과 마찬가지로 단일 선천성 수신증의 임상 경과를 반영하며 복합수신증에서 다른 분류법과 달리 신기능의 예후와 연관성이 있었으나, 고등급 수신증에서는 각 분류법 사이에 유의한 차이가 없어서 Onen 분류법의 장점을 확인할 수 없었다.
Abstract
Purpose: The purpose of this study was to compare the validity of Onen’s alternative grading system (AGS) with that of the APDRP and SFU grading systems in patients with isolated and complicated congenital hydronephrosis. Methods: We retrospectively reviewed the medical records of 153 patients (204 renal units) diagnosed with congenital hydronephrosis between January 2002 and December 2011. We classified patients into 2 groups; isolated or complicated hydronephrosis. All renal units were graded according to anterior-posterior diameter of renal pelvis (APDRP), Society for Fetus Urology (SFU) and Onen’s grading systems. We analyzed the prognosis of hydronephrosis, according to each grading system, at 2 years of age. Results: There were 152 renal units with isolated hydronephrosis and 52 renal units with complicated hydronephrosis. The isolated hydronephrosis group had a lower grade according to Onen’s AGS, and showed more frequent spontaneous remission by 2 years of age. There was more frequent obstruction (P =0.000) and surgical treatment (P =0.000) of units with high-grade hydronephrosis according to Onen’s AGS. In the complicated hydronephrosis group the frequencies of spontaneous remission (P =0.015) and renal dysfunction (P =0.013) were significantly higher than those in high-grade hydronephrosis, as indicated by Onen’s AGS. There were no significant differences in clinical outcomes among the highest grade groups, according to the 3 systems, in either isolated or complicated hydronephrosis. Conclusion: Onen’s AGS reflects the prognosis of hydronephrosis as well as other grading systems in those with isolated hydronephrosis. It was better predictor of renal dysfunction in those with complicated hydronephrosis. However, Onen’s AGS was not superior to the other grading systems in terms of predicting prognosis, especially in high-grade hydronephrosis.
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