Pitfalls of Prenatal Ultrasound Screening in Diagnostics of Serious Inborn Developmental Defects of the Kidney and Urinary Pathways
Authors:
H. Flögelová 1; O. Šmakal 2; J. Hálek 3,4; K. Michálková 5; P. Geier 1; P. Koranda 6; L. Doubrava 3; V. Janout 7
Authors‘ workplace:
Dětská klinika LF UP a FN, Olomouc
přednosta prof. MUDr. V. Mihál, CSc.
1; Urologická klinika LF UP a FN, Olomouc
přednosta doc. MUDr. V. Študent, Ph. D.
2; Novorozenecké oddělení FN, Olomouc
primář MUDr. L. Kantor, Ph. D.
3; Ústav lékařské biofyziky a biometrie LF UP a FN, Olomouc
ředitel prof. ing. J. Hálek, CSc.
4; Radiologická klinika LF UP a FN, Olomouc
přednosta doc. MUDr. M. Heřman, Ph. D.
5; Klinika nukleární medicíny LF UP a FN, Olomouc
přednosta doc. MUDr. M. Mysliveček, Ph. D.
6; Ústav preventivního lékařství LF UP a FN, Olomouc
ředitel prof. MUDr. V. Janout, CSc.
7
Published in:
Čes-slov Pediat 2008; 63 (11): 606-613.
Category:
Original Papers
Overview
Introduction:
Inborn developmental defects of the kidney and urinary pathways are frequent and their late diagnosis is associated with the risk of complications, which may results in serious affection of kidney function.
Objective:
The aim of this prospective study in to evaluate sensitivity of prenatal ultrasound screening in the detection of severe inborn developmental defects of the kidneys.
Materials and methods:
In 3,269 children, born at the Faculty Hospital in Olomouc in the period of 1st January 2005 through 31st December 2006 (the primary cohort), who underwent common prenatal ultrasound screening, were examined by postnatal ultrasound US) of the kidneys. Children with pathological findings of dilatation during prenatal US and/or those with dilatation of the renal pelvis in anterior-posterior (AP) projection ≥5 mm in postnatal US examination were further subjected to follow-up examinations and, when necessary, underwent urological examination. The authors evaluated the frequency of occurrence of severe defect of the kidney requiring surgical treatment in the primary cohort and the frequency of pathological finding of dilatation of the hollow system of the kidney during screening of these children.
Results:
In 12 children (0.36%) of the primary group there was a sufficiently severe kidney defect that a surgical solution was indicated. Four of these 12 children had a normal finding in the prenatal US examination, and all of the 12 children had a pathological finding during the postnatal examination. Sensitivity of the postnatal screening was 66.7%; 95% CI for sensitivity proved to be 34.9% to 90.1%.
Conclusion:
In the cohort there were a relatively high percentage of children with significant defect of the kidneys, who had not been detected during prenatal US. These results should be considered as preliminary, the study relating prenatal and postnatal US screening is still in progress. Only on the basis of a high number of examined children in the following years a final statistical processing will be performed and recommendation for effective improvement of diagnostics of inborn kidney defections will be created.
Key words:
inborn developmental defects of the kidney, prenatal and postnatal ultrasound screening
Sources
1. Fernbach SK, Maizels M, Conway JJ. Ultrasound grading of hydronephrosis: Introduction to the system used by the society for fetal urology. Pediatr. Radiol. 1993;23: 478–480.
2. Dinkel E, Ertel M, Dittrich M, Peters H, Berres M, et al. Kidney size in childhood. Sonographical growth charts for kidney length and volume. Pediatr. Radiol. 1985;15: 38–43.
3. Levi S, Hyjazi Y, Schaaps J-P, Defoori P, Colon R, Buekens P. Sensitivity and specifity of routine antenatal screening of congenital anomalies by ultrasound: The Belgian multicentric study. Ultrasound Obstet. Gynecol. 1991;1: 102–110.
4. Grandjean H, Larroque D, Levi S, and the Eurofetus Study Group. The performance of routine ultrasonographic screening of pregnancies in the Eurofetus Study. Am. J. Obstet. Gynecol. 1999;181: 446–454.
5. Riccabona M. Assessment and management of newborn hydronephrosis. World J. Urol. 2004;22: 73–78.
6. Beetz R, Bökenkamp A, Brandis M, Hoyer P, John U, Rascher W. Diagnostik bei konatalen Dilatationen der Harnwege. Urologe A 2001;40: 495–509.
7. Dudley JA, Haworth JM, McGraw ME, Frank JD, Tizard EJ. Clinical revelance and implications of antenatal hydronephrosis. Arch. Dis. Child. Fetal Neonatal Ed. 1997;76: 31–34.
8. Bhide A, Sairam S, Farrugia MK, Boddy SA, Thilaganathan B. The sensitivity of antenatal ultrasound for predicting renal tract surgery in early childhood. Ultrasound Obstet. Gynecol. 2005;25: 489–492.
9. Dremsek PA, Gindl K, Voitl P, Strobl R, Hafner E, et al. Renal pyelectasis in fetuses and neonates: diagnostic value of renal pelvis diameter in pre- and postnatal sonographic screening. AJR 1997;168: 1017–1019.
10. Narchi H. Postnatal ultrasound: a minimum requirement for moderate antenatal renal pelvic dilatation. Arch. Dis. Child. Fetal Neonatal Ed. 2006;91: 154–155.
11. Gramellini D, Fieni S, Caforio E, Benassi G, Bedochi L, et al. Diagnostic accuracy of fetal renal pelvis anteroposterior diameter as a predictor of significant postnatal nephrouropathy: second versus third trimester of pregnancy. Am. J. Obstet. Gynecol. 2006;194: 167–173.
12. Ismaili K, Hall M, Donner C, Thomas D, Vermeylen D, Avni FE. Results of systematic screening for minor degrees of fetal renal pelvis dilatation in an unselected population. Am. J. Obstet. Gynecol. 2003;188: 242–246.
13. Damen-Elias HAM, De Jong TPVM, Stigter RH, Visser GHA, Stoutenbeek PH. Congenital renal tract anomalies: otcome and follow-up of 402 cases detected antenatally between 1986 and 2001. Ultrasound Obstet. Gynecol. 2005;25: 134–143.
14. Bouzada MCF, Oliveira EA, Pereira AK, Leite HV, Rodrigues AM, et al. Diagnostic accuracy of fetal renal pelvis anteroposterior diameter as a predictor of uropathy: a prospective study. Ultrasound Obstet. Gynecol. 2004;24: 745–749.
15. John U, Kähler Ch, Schulz S, Mentzel HJ, Vogt S, Misselwitz J. The impact of fetal renal pelvic diameter on postnatal outcome. Prenat. Diagn. 2004;24: 591–595.
16. Odibo AO, Marchiano D, Quinones JN, Riesch D, Egan JFX, Macones GA. Mild pyelectasis: evaluating the relationship between gestational age and renal pelvic anterior-posterior diameter. Prenat. Diagn. 2003;23: 824–827.
17. Bouzada MCF, Oliveira EA, Pereira AK, Leite HV, Rodrigues AM, et al. Diagnostic accuracy of postnatal renal pelvic diameter as a predictor of uropathy: a prospective study. Pediatr. Radiol. 2004;34: 798–804.
Labels
Neonatology Paediatrics General practitioner for children and adolescentsArticle was published in
Czech-Slovak Pediatrics
2008 Issue 11
Most read in this issue
- Phenylketonuria in Adulthood
- Choledochal Cyst – Clinical Manifestations, Surgical Technique and Results
- Pitfalls of Prenatal Ultrasound Screening in Diagnostics of Serious Inborn Developmental Defects of the Kidney and Urinary Pathways
- Case Report of Injury in Rectum-Sigmoid Region in a Fifteen-Year Boy