신생아 수신증의 원인과 임상 경과에 대한 고찰
Causes and Clinical Outcomes of Congenital Hydronephrosis
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목 적:본 연구자는 초음파로 진단된 신생아 수신증의 원인을 규명하고 임상 경과 등을 후향적으로 추적 관찰하여 수신증 환아를 효과적으로 관리하는 방법을 모색하고자 하였다. 방 법:1998년부터 2003년까지 충남대학교병원 신생아중환자실에 입원하였던 환아 중 신초음파로 진단된 수신증 환아 54명을 분석하였다. 결 과:신초음파로 진단된 수신증 환아는 전체 신생아중환자실에 입원하였던 환자 2,539명 중 54명(2.1%)이었으며, 남녀비는 3.5:1이었다. 54명에서의 77신단위의 수신증은 경증 33신단위(42.8%), 중등도 24신단위(31.1%), 중증 20신단위(26.1%)이었으며, 평균 추적관찰 기간은 9.31개월(0-30)이었다. 수신증의 원인으로는 46신단위 중에서 요관 신우 이행부 협착이 15신단위(32.6%), 다낭성 이형성 신이 3단위(6.5%), 요관 방광 이행부 협착과 거대요관이 각각 2단위(4.3 %), 방광요관역류 1단위(2.1%), 중복 신장이 1단위(2.1%)이었다. 수신증의 자연경과와 수술적 치료에서는 33신단위의 경증 수신증 중에서 25신단위(75.8%), 24신단위의 중등도 수신증 중에서 14신단위(58.3 %), 20신단위의 중증 수신증 중에서 1신단위(5 %)에서 자연 경감되었다. 수술적 치료를 받은 중증 수신증 12신단위 중 9신단위가 요관 신우 이행부 협착으로 가장 많았으며 진단에서 수술까지의 평균 기간은 10.3개월이었다. 결 론:신생아 수신증을 추적 관찰하는 동안 수신증의 정도가 심할 수록 낮은 자연 경감률을 나타내므로, 신생아 수신증에서 요로 폐색이 있거나 중등도 이상의 수신증이 있을 경우에는 일정한 주기로 초음파 검사와 배설성 신주사 추적검사를 시행하여 질병의 경과와 신장기능을 평가함으로써 효과적인 수술 시기를 결정해야 한다.
Abstract
Purpose:The most important management of congenital hydronephrosis consists of the early diagnosis and evaluation of the pathologic abnormalities of congenital hydronephrosis. This study was conducted to investigate the different causes of hydronephrosis and its clinical outcome. Methods:54 live neonates who were hospitalized and diagnosed with congenital hydronephrosis at Chungnam National University Hospital from Aug. 1998 to Aug. 2003 were retrospectively analyzed. Results:Hydronephrosis(renal pelvic AP diameter >5 mm) was postnatally detected in 54 cases(2.1%) among 2,539 neonates who were hospitalized from Aug. 1998 to Aug. 2003. There were three times more males than females. Additional imaging studies revealed that ureteropelvic junction obstruction was the most common postnatal diagnosis(48.7%), followed by multicystic dysplastic kidney, vesicoureteral reflux and duplication kidney with ureterocele. Spontaneous regression of hydronephrosis was revealed in 25 renal units(75.8%) of mild hydronephrosis, 14 renal units of moderate hydronephrosis and 1 renal unit of severe hydronephrosis. Operative correction were carried out in 14 renal units(70%) of severe hydronephrosis. Conclusion:The most common established cause of congenital hydronephrosis in this study was ureteropelvic junction obstruction. There are many cases of spontaneous regression in mild to moderate congenital hydronephrosis. Urinary tract infections occur in many neonates with hydronephrosis. Therefore, early detection and evaluation of congenital hydronephrosis and continuous follow-up at regular intervals are necessary for conservation of renal function.
참고문헌 (26)
- Jonathan A, "Roth, David A. Diamond. Prenatal hydronephrosis", 13, pp.138~41 (2001)
- Garrett WJ, "Prenaral diagnosis of fetal polycystic kidney by ultrasound", 10, pp.7~9 (1970)
- Grigon A, "Ureteropelvic junction stenosis:antenatal ultrasonographic diagnosis,postnatal investigation,and follow up", 160, pp.649~51 (1986)
- Mandell J, "Structural genitourinary defects detected in utero", 178, pp.193~6 (1991)
- YS Kang, "Postnatal ultrasonographic findings and progression of perinatal diagnosed hydronephrosis", 36, pp.1100~5 (1995)
- Ellis D, "Pediatric nephrology. Lippincott Williams and Wilkins", pp.73~8 (2004)
- YH Kim, "Clinical investigation of prenatally diagnosed hydronephrosis Korean Journal of Urology", 10, pp.178~87 (2002)
- Maizels M, "Grading nephroureteral dilatation detected in the first year of life;correlation with obstruction", 148, pp.609~14 (1992)
- Laing FC, "Postpartum evaluation of fetal hydronephrosis:Optimal timing for follow-up sonography", 152, pp.423~4 (1984)
- Cartwright PC, "Managing apparent ureteropelvic junction obstruction in newborn", pp.1224~7 (1992)
- Herndon CDA, "Consensus on the prenatal management of antenatally detected urologic abnormalities", 164, pp.1052~6 (2000)
- Homsy YL, "Transitional hydronephrosis of the newborn and infant", 144, pp.579~83 (1990)
- Brown T, "Neonatal hydronephrosis in the era of sonography", 148, pp.959~63 (1987)
- SE Park, "Clinical outcome and follow-up of neonatal hydronephrosis diagnosed antenatally", 2, pp.161~8 (1998)
- HY Yun, "The neonatal follow up and correlative analysis of fetal hydronephrosis Korean Soc Pediatr Nephrolo 1998", 1, pp.60~8 (1998)
- Woodward. M,, "Postnatal management of antenatal hydronephrosis", 89, pp.149~56 (2002)
- Ransley PG, "The postnatal management of hydronephrosis diagnosed by prenatal ultrasound", 144, pp.584~7 (1990)
- Koff SA, "Nonobstructive management of unilateral neonatal hydronephrosis:natural history of poorly functioning kidney", 148, pp.523~31 (1992)
- Tam JC, "Postnatal diagnosis and outcome of urinary tract abnormalities detected by antenatal ultrasound", 16, pp.633~7 (1994)
- Homsy YL, "Transitional neonatal hydronephrosis:fact of fantasy", 136, pp.339~ (1986)
- Nadel HR, "Neonatal renomegaly", 138, pp.1023~ (1987)
- Walsh PC,, "Campbell's urology. 7th ed. Philadelphia : W.B.Saunders", pp.1601~18 (1998)
- Koff SA, "Diuretic radionuclide assessment of obstruction in the infant;guidlines for successful interpretation", 140, pp.1167~ (1998)
- King LR, "Management of neonatal ureteropelvic junction obstruction", 2, pp.106~12 (2001)
- Utikalova A, "Prenatal and postnatal ultrasonic screening in the early diagnosis and treatment of congenital developmental defects of the kidneys and urinary tract", 75, pp.587~93 (1996)
- Arvind Bagga, "Consensus statement on management of antenatally detected hydronephrosis", 38, pp.1244~51 (2001)