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Páginas 441-448 (Noviembre 2000)
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Vol. 53. Núm. 5.
Páginas 441-448 (Noviembre 2000)
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Seguimiento posnatal del feto con pielectasia: un problema no resuelto
Postnatal Follow-Up Of Fetal Pyelectasis: An Unresolved Problem
Visitas
17547
R. Baraibar Castelló*, R. Porta Ribera
Departamento de Pediatría. Servicio de Neonatología. Institut Universitari Dexeus. Barcelona
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El control posnatal del feto con pielectasia ha sido objeto de controversia en la bibliografía reciente. La definición de pielectasia, la necesidad de estudiar o no a todos estos recién nacidos con el objetivo teórico de prevenir la nefropatía por reflujo y las infecciones urinarias, qué exploraciones hacerles y cuándo (ecografía posnatal, cistografía sistemática, estudios isotópicos), y si es necesario someterlos o no a profilaxis antibiótica, son aspectos que no están suficientemente aclarados. Tampoco la relación entre pielectasia prenatal, reflujo vesicorrenal e infección parece lineal.

Este artículo intenta ordenar las controversias actualmente existentes al respecto, comentando finalmente el papel de las alteraciones genéticas en el desarrollo de los distintos tipos de nefropatía y malformaciones renales.

Palabras clave:
Pielectasia fetal
Hidronefrosis prenatal
Recién nacido
Diagnóstico prenatal
Reflujo vesicoureteral

Postnatal follow-up of fetal pyelectasis is a controversial topic in recent literature.

Questions such as the definition of pyelectasis, whether these neonates should be selected for postnatal study in an attempt to prevent reflux nephropathy and urinary tract infections, which complementary investigations (postnatal ultrasonography, cystourethrography, isotopic studies) should be performed and when, and whether these neonates should be administered antibiotic prophylaxis are unresolved issues. In addition, the relationship between prenatal pyelectasis, vesicoureteral reflux and infections is not at present clear.

In this article, we try to review and order the present controversies, and briefly introduce the role of genetic aspects in the origin of different forms of nephropathy and renal malformations.

Key words:
Fetal pyelectasis
Congenital hydronephrosis
Newborn
Prenatal diagnosis
Vesicoureteral reflux
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Bibliogrífia
[1.]
R. Baraibar, V. Molina.
Diagnóstico y valoración prenatal del feto con defectos congénitos.
Manual de Neonatología 1.a ed, pp. 6-13
[2.]
B.S. Mahony.
Evaluación ecográfica del sistema genitourinario fetal.
Ecografía en Obstetricia y Ginecología, 3.a ed, pp. 422-454
[3.]
K.L. Reuter, R.L. Lebowitz.
Massive vesicoureteral reflux mimicking posterior urethral valves in a fetus.
J Clin Ultrasound, 13 (1985), pp. 584-586
[4.]
A. Grignon, R. Filion, D. Filiatrault, P. Robitaille, Y. Homsy, H. Boutin, et al.
R. Urinary tract dilatation in utero: classification and clinical application.
Radiology, 160 (1986), pp. 645-664
[5.]
C.E. Blane, S.A. Koff, R.A. Baverman.
Nonobstructive hydronephrosis: sonographic recognition and therapeutic implications.
[6.]
B.S. Mahony, P.W. Callen, R.A. Filly.
Fetal urethral obstruction: US evaluation.
Radiology, 13 (1985), pp. 584-587
[7.]
G.M. Glazer, R.A. Filly, P.W. Callen.
The varied sonographic apppereance of the urinary tract in the fetus and newborn with urethral obstruction.
Radiology, 144 (1982), pp. 563-566
[8.]
S.K. Fernbach, M. Maizels, J.J. Conway.
Ultrasound grding of hydronephrosis: introduction to the system used by the Society for Fetal Urology.
Pediatr Radiol, 23 (1993), pp. 478-480
[9.]
M. Maizels, B. Mitchell, E. Kass, S.K. Fernback, J.J. Conway.
Outcome of non especific hydronephrosis in the infant: A report from the registry of the Society for Fetal Urology.
J Urol, 152 (1994), pp. 2324-2327
[10.]
A. Ghidini, M. Sirtori, P. Vergani.
Ureteropelvic junction obstruction in utero ans ex utero.
Obstet Gynecol, 75 (1990), pp. 805-807
[11.]
P.G. Ransley, H.K. Dhillon, I. Gordon, P.G. Duffy, M.J. Dillon, T.M. Barratt.
The postnatal management of hydronephrosis diagnosed by prenatal ultrasound.
J Urol, 144 (1990), pp. 584-588
[12.]
B. Langer, U. Simeoni, Y. Montoya, R. Casanova, G. Schlaeder.
Antenatal diagnosis of upper urinary tract dilattation by ultrasound.
Fetal Diagn Ther, 11 (1996), pp. 191-198
[13.]
P.A. Dremsek, K. Gindl, Voitl, R. Strobl, E. Hafner, W. Geissler, et al.
Renal pyelectasis in fetuses and neonates: diagnostic value of renal pelvis diameter in pre and postnatal sonographic sreenning.
Am J Roentgenol, 168 (1997), pp. 1017-1019
[14.]
J.E. Corteville, D.L. Gray, J.P. Crane.
Congenital hydronephrosis: correlation of fetal ultrasonographic findings with infant outcome.
Am J Obstet Gynecol, 165 (1991), pp. 384-387
[15.]
J.G. Ouzonian, M.A. Castro, M. Fresquez, O.M. Al-Sulyman, B.W. Kovacs.
Prognostic significance of antenatally detected fetal pyelectasis.
Ultrasound Obstet Gynecol, 7 (1996), pp. 424-428
[16.]
W.H. Persutte, M. Koyle, R.R. Lenke, J. Klas, C. Ryan, J.C. Hobbins.
Mild pyelectasis ascertained with prenatal ultrasonography is pediatrically significant.
Ultrasound Obstet Gynecol, 10 (1997), pp. 12-18
[17.]
J. Lepercq, S. Beadouin, F. Bargy.
Outcome of 116 moderate renal pelvis dilatation at prenatal ultrasonography.
Fetal Diagn Ther, 13 (1998), pp. 79-81
[18.]
J.A. Dudley, J.M. Haworth, M.E. McGraw, J.D. Frank, E.J. Tizard.
Clinical relevance and implications of antenatal hydronephrosis.
Arch Dis Child, 76 (1997), pp. F31-F34
[19.]
M.S. Jawson, L. Dibble, S. Puri, J. Davis, J. Young, R. Dave, et al.
Prospective study of outcome in antenatally diagnosed renal pelvis dilatation.
Arch Dis Child, 80 (1999), pp. F135-F138
[20.]
R.A. Brobowsy, R.B. Levin, M.R. Lauria, M.C. Treadwell, B. Gonik, S.F. Bottoms.
In utero progression of isolated pelvis dilatation.
Am J Perinatol, 14 (1997), pp. 423-426
[21.]
N. Anderson, T. Clautice-Engle, R. Allan, G. Abbott, J.E. Wells.
Detection of obstructive urophaty in the fetus: predictivevalue of sonographic measurements of renal pelvic diameter at various gestational ages.
Am J Roentgenol, 164 (1995), pp. 719-723
[22.]
J. Mandell, B.R. Blyth, C.A. Peters, A.B. Retik, J.A. Estroff, B.R. Benacerraf.
Structural genitourinary defects detected in utero.
Radiology, 178 (1991), pp. 193-196
[23.]
R. Porta, M.C. Cespedes, A. Salva, V. Molina, B. De la Torre, M. Torrent, et al.
Dilatacio pielica prenatal com a indicador de risc d'infeccio urinaria i/o reflux vesico-ureteral.
Pediatr Catalana, 59 (1999), pp. S71
[24.]
W.H. Persutte, M. Hussey, J. Chyu, J.C. Hobbins.
Striking findings concerning the variability in the measurement of the fetal renal collecting system.
Ultrasound Obstet Gynecol, 15 (2000), pp. 186-190
[25.]
K.S. Allen, P.H. Arger, M. Mennuti, B.G. Coleman, M.C. Mintz, M. Fishman.
Effects of maternal hydration on fetal renal pyelectasis.
Radiology, 163 (1987), pp. 807-809
[26.]
M. Graif, A. Kessler, S. Hart, M. Daitzman, S. Mashiach, H. Boichis, et al.
Renal pyelectasis in pregnancy: correlative evaluation of fetal and maternal collecting systems.
Am J Obstet Gynecol, 167 (1992), pp. 1304-1306
[27.]
C.J. Babcock, M. Silvera, C. Drake, D. Levine.
Effect of maternal hydration on mild fetal pyelectasis.
J Ultrasound Med, 17 (1998), pp. 539-544
[28.]
A.H. Colodny.
Antenatal diagnosis and management of urinary abnormalities.
Pediatr Clin North Am, 34 (1987), pp. 1365-1381
[29.]
R.L. Lebowitz, H. Obling, K.V. Parkulainen, International Reflux Study in Children: Writting Committee:.
International system of radiologic grading of vesicoureteric reflux.
Pediatr Radiol, 15 (1985), pp. 105-109
[30.]
J.S. Elder, J.W. Duckett.
Management of the fetus and neonate with hydronephrosis detectedby prenatal ultrasonography.
Pediatr Ann, 17 (1988), pp. 19-28
[31.]
W.K. Hoddick, R.A. Filly, B.S. Mahoney, P.W. Callen.
Minimal fetal renal pyelectasis.
J Ultrasoun Med, 4 (1985), pp. 85-89
[32.]
Y.L. Homsy, F. Saad, I. Laberge, P. Williot, C. Pison.
Transitional hydronephrosis of the newborn and infants.
J Urol, 114 (1990), pp. 579-583
[33.]
B.R. Benacerraf, F.D. Frigoletto, D. Kramer.
A sonographic sign for the detection of Down syndrome in the second trimester fetus.
Radiology, 163 (1987), pp. 811-813
[34.]
B.R. Benacerraf, J. Mandell, J.A. Estroff, B.L. Harlow, F.D. Frigoletto Jr..
Fetal pyelectasis: a possible association with Down syndrome.
Obstet Gynecol, 76 (1990), pp. 58-60
[35.]
K.H. Nicolaides, H.H. Cheng, A. Abbas, R.J.M. Snijders, C. Gosden.
Fetal renal defects: associated malformations and chromosomal defects.
Fetal Ther, 7 (1992), pp. 1-11
[36.]
J.S. Elder.
Antenatal hydronephrosis. Fetal and neonatal management.
Peditr Clin North Am, 44 (1997), pp. 1299-1321
[37.]
A. Corett, B. Morag, M. Katz, D. Lotan, Z. Heyman, M. Hertz.
The impact of fetal screenning on indications for cystourethrography in infants.
Pediatr Radiol, 24 (1994), pp. 516-518
[38.]
G. Marra, G. Barbieri, C. Moioli, B.M. Assael, G. Grumieri, M.L. Caccamo.
Mild fetal hydronephrosis indicating vesicoureteric reflux.
Arch Dis Child, 70 (1994), pp. F147-F150
[39.]
G. Marra, G. Barbieri, C.A. Dell'Angnola, M.L. Caccamo, M.R. Castellani, B.M. Assael.
Congenital renal damage associated with primary vesicoyureteral reflux detected prenatally in male infants.
J Pediatr, 124 (1994), pp. 726-730
[40.]
G. Bosman, A. Reuss, J.M. Nijman, J.W. Wladimiroff.
Prenatal diagnosis and outcome of fetal ureteropelvic junction obstruction.
Ultrasound Med Biol, 17 (1991), pp. 117-120
[41.]
B.T. Steele, P. Robitaille, J. DeMaria, A. Grignon.
Follow-up evaluation of prenatally recognized vesicoureteric reflux.
J Pediatr, 115 (1989), pp. 95-96
[42.]
H. Bouachrine, J.L. Lemelle, F. Didier, M. Schmitt.
A follow up study of pre-natally detected primary vesicoureteral reflux: a review of 61 patients.
Br J Urol, 148 (1992), pp. 1224-1227
[43.]
J.S. Elder.
Importance of antenatal diagnosis of vesicoureteral reflux.
J Urol, 148 (1992), pp. 1750-1754
[44.]
G. Walsh, P.A. Dubbins.
Antenatal renal pelvis dilatation: A predictor of vesicoureteral reflux?.
Am J Roentgenol, 167 (1996), pp. 897-899
[45.]
F.C. Laing, V.D. Burke, V.W. Wing.
Post partum evaluation of fetal hydronephrosis: optimal timing for fololow up sonography.
Radiology, 152 (1984), pp. 423-425
[46.]
R.R. Bailey.
Vesicoureteric reflux in healthy infants and children.
Reflux Nephropathy, pp. 57-61
[47.]
B.S. Arant Jr.
Vesicoureteral reflux and renal injury.
Am J Kydney Dis, 17 (1991), pp. 491-511
[48.]
J.M. Tiballs, R. DeBruyn.
Primary vesico-ureteral reflux. How useful is postnatal ultrasound?.
Arch Dis Child, 75 (1996), pp. 444-446
[49.]
C.E. Blane, M.A. DiPietro, J.M. Zerin, A.B. Sedman, D.A. Bloom.
Renal sonography is not a reliable screening examination for vesicoureteral reflux.
J Urol, 15 (1993), pp. 752-754
[50.]
C. Duran, S. Rogol, J. Badia, F. Mellado, J.C. Rojo, N. Baena.
Incidència del reflux vesicoureteral als controls d'hidronefrosi prenatal.
Pediatr Catalana, 58 (1998), pp. 156-160
[51.]
J.A. Martin, J.L. Peiro, E. Chicaiza, R. Gosalbez.
Diez años de diagnóstico prenatal de uropatías. Estudio y conclusiones.
Cir Pediatr, 11 (1998), pp. 55-63
[52.]
P.D.E. Moriquand, E. Troisfontaines, D.T. Wilcox.
Antenatal and perinatal uro-nephrology: current questions and dilemmas.
Pediatr Nephrol, 13 (1999), pp. 938-944
[53.]
J.M. Angulo, A. Nogues, R. Areses.
Dilatación urinaria fetal por reflujo vesicoureteral.
Cir Ped, 4 (1991), pp. 197-200
[54.]
J.E.S. Scott, J.R.S. Lee, E.W. Hunter, M.G. Coulthard, J.N. Matthews.
Ultrasound screenning of newborn urinary tract.
Lancet, 338 (1991), pp. 1571-1573
[55.]
E.H. Garin, A. Campos, Y. Homsy.
Primary vesicoureteral reflux: review to current concepts.
Pediatr Nephrol, 12 (1998), pp. 249-256
[56.]
H.N. Noe.
The long term results of prospective studt reflux screening.
Br J Urol, 148 (1992), pp. 1739-1742
[57.]
K. Lakhoo, D.F.M. Thomas, M. Fuenfer, A.J. D'Crus.
Failure of prenatal ultrasonography to prevent urinary infection associated with underlying urological abnormalities.
Br J Urol, 77 (1996), pp. 905-908
[58.]
I. Máttyus, T. Verebèly, É. Kis.
Congenital pieloureteral stenosis. Is antibacterial prophylaxis indicated?.
Pediatr Nephrol, 12 (1998), pp. C141
[59.]
P.A.M. Anderson, AMK. Rickwood.
Features of primary vesicoureteric reflux detected by prenatal sonography.
Br J Urol, 67 (1991), pp. 267-271
[60.]
D.C.G. Crabbe, D.F.M. Thomas, A.C. Gordon, H.C. Irving, H.C. Artur.
Smith SEW. Use of 99mTcDMSA to show patterns of renal damage associated with prenatally detected vesicoureteral reflux.
J Urol, 148 (1992), pp. 1229-1231
[61.]
R. Baker, W. Wald, J. Maylath, I. Shulman.
Relation of age, sex and infection to reflux: data indicating high spontaneous cure rate in pediatric patients.
J Urol, 95 (1996), pp. 27-32
[62.]
S. Degani, Z. Leibovitz, I. Shapiro, R. Gonen, G. Ohel.
Fetal pyelectasis in consecutive pregnancies: a possible gen predisposition.
Ultrasound Obstet Gynecol, 10 (1997), pp. 19-21
[63.]
A.S. Woolf.
Emerging roles of obstruction and mutations in renal malformations.
Pediatr Radiol, 12 (1998), pp. 690-694
[64.]
T.D. Piscione, D. Norman, M.D. Rosemblum.
The malformed kidney: how gene mutations perturb developmental pathways.
Clin Genet, 56 (1999), pp. 341-356
[65.]
C.K. Yeung, M.L. Goldley, H.K. Dhillon, I. Gordon, P.G. Duffy, P.G. Ransley.
The characteristics of primary vesico-ureteric reflux in male and female infants with pre-natal hydronephrosis.
Br J Urol, 80 (1997), pp. 319-327
[66.]
B.M. Assael, S. Guez, G. Marra, E. Secco, G. Manzoni, M. Bosio, et al.
Congenital reflux nephropathy: a follow-up of 108 cases diagnosed perinatally.
Br J Urol, 82 (1998), pp. 252-257
[67.]
E.F. Avni, E. Gallety, F. Rypens.
A hypothesis for the higher incidence of vesicoureteral reflux and primary megaureters in male babies.
Pediatric Radiol, 22 (1992), pp. 1-7
[68.]
C. Duran, J. Badia, C. Figaro, S. Posas, J.C. Rojo, C. Domingo, et al.
Hidronefròsi prenatal. Actualització de la pauta de seguiment neonatal.
Pediatr Catalana, 60 (2000), pp. S72
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