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Malformações congénitas do rim e vias urinárias : uma análise do seguimento na consulta de uropatias perinatais
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As malformações congénitas do rim e vias urinárias (CAKUT) referem-se a um grupo heterogéneo e variado de alterações morfológicas ou funcionais que envolvem os rins e/ou o trato urinário, correspondendo a 20-30% de todas as malformações congénitas detetadas no período pré-natal, sendo responsáveis por 40 a 50% dos casos de doença renal crónica em idade pediátrica.
Este trabalho consistiu num estudo observacional, retrospetivo com uma amostra de 139 doentes, nascidos entre 1 de Janeiro de 2015 e 31 de Dezembro de 2016, com diagnóstico pré-natal de malformações do rim e vias urinárias referenciados à Consulta de Uropatias Perinatais do Serviço de Cirurgia Pediátrica do Hospital de Santa Maria. Foram recolhidas informações acerca de cada doente e de acordo com o diagnóstico, os doentes foram divididos em 3 grupos - hidronefrose transitória; hidronefrose primária e outras malformações nefro-urológicas – tendo sido analisado o seguimento em consulta durante um período de 2-3 anos.
Verificou-se que 71,9% das crianças apresentaram hidronefrose não patológica e que destas, 88% remitiram até ao 1º ano de vida. Outras malformações nefro-urológicas foram detetadas em 28,1% dos doentes, sendo que 33% destes apresentaram duas ou mais malformações concomitantes. Foram identificados 14 tipos diferentes de CAKUT, sendo a duplicação pielo-ureteral (8,7%), o megauretero (6,5%) e o refluxo vesico-ureteral (6,5%) as mais prevalentes.
Foram intervencionados cirurgicamente 20 doentes (14,4%), 65% dos quais com alterações bilaterais ou duas ou mais malformações em simultâneo. Da totalidade da amostra, 77,7% dos doentes tiveram alta clinica durante o período considerado neste estudo.
Congenital anomalies of the kidney and urinary tract (CAKUT) refer to a heterogeneous group of morphological or functional changes involving the kidney and/or urinary tract, representing 20-30% of all congenital malformations detected in the prenatal period and accounting for 40 to 50% of all cases of chronic kidney disease in children. This paper consists of an observational, retrospective study with a sample of 139 patients, born between January 1st 2015 and December 31st 2016, with prenatal diagnosis of congenital anomalies of the kidney and urinary tract referred to Hospital de Santa Maria’s consult of Perinatal Uropathies, Pediatric Surgery Department. Data was collected from each patient and, according to the diagnosis, patients were divided into 3 groups - transient hydronephrosis; primary hydronephrosis and other nephro-urological malformations – and the follow-up was analysed for a period of 2-3 years. We found that 71.9% of the children had non-pathological hydronephrosis and that of these, 88% remitted until the first year of life. Other nephro-urological malformations were detected in 28.1% of patients, 33% of whom had two or more concurrent malformations. Fourteen different forms of CAKUT were identified with pieloureteral duplication (8.7%), megaureter (6.5%) and vesicoureteral reflux (6.5%) being the most prevalent. Twenty patients (14.4%) were surgically intervened, 65% of whom had bilateral alterations or two or more malformations simultaneously. From the total sample, 77.7% of patients were clinically discharged during the period considered in this study.
Congenital anomalies of the kidney and urinary tract (CAKUT) refer to a heterogeneous group of morphological or functional changes involving the kidney and/or urinary tract, representing 20-30% of all congenital malformations detected in the prenatal period and accounting for 40 to 50% of all cases of chronic kidney disease in children. This paper consists of an observational, retrospective study with a sample of 139 patients, born between January 1st 2015 and December 31st 2016, with prenatal diagnosis of congenital anomalies of the kidney and urinary tract referred to Hospital de Santa Maria’s consult of Perinatal Uropathies, Pediatric Surgery Department. Data was collected from each patient and, according to the diagnosis, patients were divided into 3 groups - transient hydronephrosis; primary hydronephrosis and other nephro-urological malformations – and the follow-up was analysed for a period of 2-3 years. We found that 71.9% of the children had non-pathological hydronephrosis and that of these, 88% remitted until the first year of life. Other nephro-urological malformations were detected in 28.1% of patients, 33% of whom had two or more concurrent malformations. Fourteen different forms of CAKUT were identified with pieloureteral duplication (8.7%), megaureter (6.5%) and vesicoureteral reflux (6.5%) being the most prevalent. Twenty patients (14.4%) were surgically intervened, 65% of whom had bilateral alterations or two or more malformations simultaneously. From the total sample, 77.7% of patients were clinically discharged during the period considered in this study.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Palavras-chave
Malformações congénitas do rim e vias urinárias Hidronefrose pré-natal Urologia pediátrica Estudo retrospetivo Pediatria