Etiological analysis on inpatients with congenital anomalies of the kidney and urinary tract in a single centre in 5 years

doi:10.3760/cma.j.issn.1007-1245.2023.05.017

Abstract

Abstract:

Objective　To analyze the diagnosis and chief complaints of children with congenital anomalies of the kidney and urinary tract (CAKUT), in order to provide the clues for early diagnosis and treatment of CAKUT. Methods　The clinical data of hospitalized CAKUT cases in Shenzhen Children's Hospital from January 2015 to December 2019 were reviewed. The diagnosis and chief complaints were retrospectively analyzed. χ² test was used. Results　A total of 1 082 children with CAKUT were enrolled, including 702 boys and 380 girls. The proportion of hospitalized CAKUT cases was increased from 0.32% (152/47 227) in 2015 to 0.44% (267/60 280) in 2019 (χ²=11.22, P<0.05). The major CAKUT diseases included ureteropelvic junction obstruction (UPJO), duplex collecting system, vesicoureteric reflux (VUR), and renal dysplasia. A total of 483 cases (44.6%) were found with abnormalities by the prenatal ultrasound examination, among whom 75.4% (364/483) were younger than 1 year-old. A total of 452 cases (41.8%) showed urinary system symptoms, among whom 65.0% (294/452) were older than 1 year-old. A total of 147 cases (13.6%) had no clinical symptoms, and were found by physical examination or other reasons. Ultrasound examination was performed in 1 074 CAKUT patients (99.3%); on the basis of ultrasound results and clinical manifestations, other examinations were performed in 865 cases (79.9%). Conclusions　The proportion of CAKUT in our center shows a slow increasing trend year by year. UPJO, duplex collecting system, VUR, and renal dysplasia are the most common components of CAKUT. Prenatal and postnatal ultrasounography can be considered as the primary means of screening for CAKUT.

Key words:

Congenital anomalies of the kidney and urinary tract, Ureteropelvic junction obstruction, Vesicoureteric reflux, Duplex collecting system, Renal dysplasia, Initial symptom, Children

摘要：

目的　分析儿童先天性肾脏和尿道畸形（CAKUT）诊断及首次入院原因，为CAKUT早期诊断及治疗提供依据。方法　收集2015年1月至2019年12月深圳市儿童医院住院诊断为CAKUT临床资料，对其病种构成比及首次入院病因等信息进行回顾性分析。采用χ²检验。结果　1 082例CAKUT患儿中，男702例、女380例。2015年至2019年CAKUT住院构成比逐年上升，由2015年的0.32%（152/47 227）上升至2019年的0.44%（267/60 280）（χ²=11.22，P<0.05）。CAKUT住院构成比前4位病种分别为肾盂输尿管连接处梗阻（UPJO）、双集合系统、膀胱输尿管反流（VUR）和肾发育不良。首次入院因产前超声发现异常483例（44.6%），<1岁占75.4%（364/483）；452例（41.8%）以泌尿系统症状和体征为首诊入院，≥1岁占65.0%（294/452）；147例（13.6%）无相关症状，通过体检或因其他原因发现。1 074例（99.3%）行超声检查，865例（79.9%）选择性进行了其他影像学检查。结论　本中心CAKUT住院构成比呈逐年缓慢增长趋势，以UPJO、双集合系统、VUR和肾发育不良最为常见。产前和生后超声可作为CAKUT筛查的首选和主要手段。

关键词:

先天性肾脏和尿道畸形, 肾盂输尿管连接处梗阻, 膀胱输尿管反流, 双集合系统, 肾发育不良, 首发症状, 儿童

Ye Guochang, Gao Xiaojie, Ma Yijiao, Jia Shilei, Liu Libing.

Etiological analysis on inpatients with congenital anomalies of the kidney and urinary tract in a single centre in 5 years [J]. International Medicine and Health Guidance News, 2023, 29(5): 669-675.

叶国嫦高晓洁马颐姣贾实磊刘俐兵.

单中心5年先天性肾脏和尿路畸形住院构成分析 [J]. 国际医药卫生导报, 2023, 29(5): 669-675.

References

[1] Harambat J, Bonthuis M, Groothoff JW, et al. Lessons learned from the ESPN/ERA-EDTA Registry[J].Pediatr Nephrol,2016,31(11):2055-2064.DOI:10.1007/s00467- 015-3238-8.
[2] Kang HG, Choi HJ, Han KH, et al. KNOW-Ped CKD (KoreaN cohort study for outcomes in patients with pediatric CKD): Design and methods[J].BMC Nephrol,2016,17:35.DOI:10.1186/s12882-016-0248-0.
[3] Collins AJ, Foley RN, Herzog C, et al. United States Renal Data System 2008 Annual Data Report[J].Am J Kidney Dis,2009,53(1 Suppl):S1-374.DOI:10.1053/j.ajkd.2008. 10.005.
[4] 缪千帆,沈茜,徐虹,等. 慢性肾脏病2～5期患儿264例病因构成分析[J]. 中华儿科杂志,2015,53(9):665-669.DOI:10.3760/cma.j.issn.0578-1310.2015.09.007.
[5] Caruana G, Bertram JF. Congenital anomalies of the kidney and urinary tract genetics in mice and men[J].Nephrology (Carlton),2015,20(5):309-311.DOI:10.1111/nep.12402.
[6] 程俊丽. 儿童慢性肾脏病[J]. 国际儿科学杂志,2016,43(10):788-792.DOI:10.3760/cma.j.issn.1673-4408. 2016.10.012.
[7] Ichikawa I, Kuwayama F, Pope JC 4th, et al. Paradigm shift from classic anatomic theories to contemporary cell biological views of CAKUT[J].Kidney Int,2002,61(3):889-898.DOI:10.1046/j.1523-1755.2002.00188.x.
[8] Toka HR, Toka O, Hariri A, et al. Congenital anomalies of kidney and urinary tract[J].Semin Nephrol,2010,30(4):374-386.DOI:10.1016/j.semnephrol.2010.06.004.
[9] Caiulo VA, Caiulo S, Gargasole C, et al. Ultrasound mass screening for congenital anomalies of the kidney and urinary tract[J]. Pediatr Nephrol,2012,27(6):949-953.DOI:10.1007/s00467-011-2098-0.
[10] 付倩,刘小荣,陈植,等. 单中心371例儿童慢性肾脏病2～5期回顾性研究[J]. 中华实用儿科临床杂志,2020,35(5):338-343.DOI:10.3760/cma.j.cn101070-20190430-00369.
[11] 钟艳,吴贻怡,陆振林. 产前超声在胎儿泌尿系统畸形诊断中的应用价值评估[J]. 解放军预防医学杂志,2019,37(7):124-125.DOI:10.13704/j.cnki.jyyx.2019.07.058.
[12] 翁纽周,赖志雄. 彩色多普勒超声在胎儿泌尿系统畸形诊断中的应用价值[J]. 中国实用医刊,2018,45(24):104-105.DOI:10.3760/cma.j.issn.1674-4756.2018.24.036.
[13] Richter-Rodier M, Lange AE, Hinken B, et al. Ultrasound screening strategies for the diagnosis of congenital anomalies of the kidney and urinary tract[J].Ultraschall Med,2012,33(7):E333-E338.DOI:10.1055/s-0032- 1325611.
[14] Stolz G, Schumacher R, Wiesel A, et al. Pre- and postnatal kidney screening compared: an analysis of 34,450 newborn infants of the Mainz model birth register[J].Radiologe,2002,42(8):630-636.DOI:10.1007/s00117- 002-0773-7.
[15] Wühl E, van Stralen KJ, Verrina E, et al. Timing and outcome of renal replacement therapy in patients with congenital malformations of the kidney and urinary tract[J].Clin J Am Soc Nephrol,2013,8(1):67-74.DOI:10.2215/CJN.03310412.
[16] Ramanathan S, Kumar D, Khanna M, et al. Multi-modality imaging review of congenital abnormalities of kidney and upper urinary tract[J].World J Radiol,2016,8(2):132-141.DOI:10.4329/wjr.v8.i2.132.
[17] 于波. 产前超声对胎儿泌尿系统畸形的诊断价值[J]. 基层医学论坛,2020,24(13):1919-1920.DOI:10.19435/j.1672-1721.2020.13.090.
[18] Croitoru S, Gross M, Barmeir E. Duplicated ectopic ureter with vaginal insertion: 3D CT urography with i.v. and percutaneous contrast administration[J].AJR Am J Roentgenol,2007,189(5):W272-W274.DOI:10.2214/AJR.05.1431.
[19] 葛宁,杨文忠,张莎莎,等. CT尿路成像检查在儿童先天性肾脏和尿路畸形诊断中的应用[J/CD]. 中华妇幼临床医学杂志(电子版),2021,17(1):114-119.DOI:10.3877/cma.j.issn.1673-5250.2021.01.017.
[20] 王巍,刘俊,阚英,等. 核素利尿肾动态显像在不同程度小儿先天性肾积水中的应用价值[J]. 临床和实验医学杂志,2018,17(22):2411-2413.DOI:10.3969/j.issn.1671-4695. 2018.22.017.