MASS ULTRASOUND SCREENING FOR EARLY DETECTION OF CONGENITAL KIDNEY ABNORMALITIES IN INFANCY
Trefilov A.A., Ivanova I.E.
The Postgraduating Doctors’ Training Institute of the HealthCare Ministry of the Chuvash Republic, Municipal Children's Hospital № 3, Cheboksary, Russia
Introduction. Abnormalities of kidneys and urinary tract occupy from 10 to 35 % in structure of congenital anomalies and takes the fourth place after heart, nervous and musculoskeletal malformations. As of literature the dissemination of congenital pathology urinary system organ forms 0,5-7,5 on 1000 newborn. They are leading in the children physical inability and terminal nephritic insufficiency. Early detection renal malformations is possible during antenatal and postnatal ultrasonic screening.
In Chuvash we made mass ultrasound renal screening at children from 0 till 18 years in 2001-2004. In total 8333 children have been examined. High prevalence of congenital defects and small anomalies in all age groups of children, exceeding that in the next regions has been revealed. For the first time prevalence of anatomic variants nephritic malformations is studied, their features depending on ecobiogeochemical region of residing of the child are presented. The conducted research has served as a scientific base of necessity of ultrasonic screening in the first months of a life for revealing nephritic malformation.
In Russia the National project "Health" according to the order of Ministry of Health of the Russian Federation №307 at 2007.04.28 “About the standard supervision over the child of the first year of a life” had started obligatory abdominal and urologic ultrasonic examination at newborn children.
The purpose to analyse results of ultrasonic screening of kidneys at newborn and chest children to Cheboksary for 2 years.
Patients and methods. Ultrasonic research of kidneys on the device “My Lab 15” (Netherlands) with a set of multifrequency probes is conducted and its results at 2482 children (boys – 1244, girls – 1238) at the age of 1-3 months are analysed.
Results. 286.1‰ of children had pathological renal conditions. At the analysis of prevalence of congenital variants following laws are revealed. Congenital defects are met at 168 kids (70.9 ‰). Among boys frequency of detectability of congenital defects was more than among girls (80.3 and 59.7 ‰ accordingly, р <0.05). 143 children (57.6 ‰) had isolated defects, 32 children (12.9 ‰) had combination of congenital defects and small anomalies.
Small renal anomalies (pyelectasia, rotation, separation pelvis by a hypertrophic Bertin column, a syndrome of Fraily) are diagnosed at 461 (185.7‰) children. 2 babes had renal cyst.
Reactive-inflammatory changes are identified at 63 babies (25.4‰), improved density cut-in inclusions in kidneys are revealed at 22 kids (8.9‰). Thus, 28.61% of surveyed children had pathological urinary conditions. That it is possible to explain morph-functional immaturity of children of the first months of life and high level of congenital renal anomalies prevalence.
We analyzed prevalence of separate defects and small renal anomalies at the children population.
Prevalence renal agenesis has made 0.8‰ (equally at boys and girls), hypoplasia – 1.2‰ (boys – 1.6‰, girls – 0.8‰), duplex kidney – 20.5‰, variants of dystopia – 10.1‰, horseshoe kidney – 4.8‰ (boys – 6.4‰, girls – 3.2‰), hydronephrosis – 37.9‰ (boys – 43.4‰, girls – 32.2‰).
Prevalence of various anatomic variants of small anomalies makes: pyelectasia – 130.9‰ (boys – 146.3‰, girls – 115.5‰), rotation – 62.8‰, separation pelvis by a hypertrophic Bertin column – 20.0%, a symptom of Fraily – 4.4‰.
Conclusions
1. Pathological conditions from of the kidneys had diagnosed at 28.61% surveyed infants as the results morph-functional immaturity and high prevalence of congenital renal anomalies in population.
2. Prevalence of congenital defects has made 70.9‰ and was more among boys.
3. Prevalence of small renal anomalies – 185.7‰, renal cyst changes – 1.0‰.
4. hydronephros, duplex kidney and kidney dystopia are leading defects. And pyelectasiaes and rotations – small anomalies.
5. Prevalence malformations and small anomalies in infancy according to ultrasound screening had distinctions from that at mass inspection of children from 0 till 18 years.
6. All children with the revealed pathology require dynamic laboratory and tool supervision.