HIDRONEFROZA KOD DECE: OD PRENATALNE DIJAGNOZE DO TERAPIJE
DOI:
https://doi.org/10.46793/PP260102012TKljučne reči:
hidronefroza, prenatalni period, ureteropijelični spoj, hirurgijaApstrakt
Hidronefroza predstavlja dilataciju pijelokaliksnog sistema bubrega i najčešća je urološka anomalija dijagnostikovana prenatalno. Iako se javlja kod približno 1 od 100 trudnoća, klinički značajna uropatija sa opstrukcijom je znatno ređa. Ključni cilj dijagnostike je pravovremeno prepoznavanje opstruktivne dilatacije koja može dovesti do povišenog intrapijeličnog pritiska i progresivnog oštećenja bubrežnog parenhima. Najčešći uzrok hidronefroze u dečjem uzrastu je opstrukcija uretropijeličnog spoja (UPS). Opstrukcija može biti posledica anatomskog suženja, poremećene peristaltike (funkcionalna opstrukcija) ili spoljašnje kompresije, najčešće aberantnim krvnim sudom. Postoje i varijantni oblici UPS opstrukcije, kao i kombinovane anomalije sa vezikoureteralnim refluksom. Osnovni dijagnostički metod je ultrazvučni pregled, kako prenatalno tako i postnatalno, uz procenu anteroposteriornog dijametra bubrežne karlice i SFU gradusa. Dalja evaluacija uključuje mikcionu cistoureterografiju, dinamsku nuklearnu scintigrafiju i u selektovanim slučajevima MR urografiju. Procena rizika za oštećenje bubrega zasniva se na stepenu dilatacije, separatnoj bubrežnoj funkciji i dinamici drenaže. Lečenje može biti konzervativno ili hirurško. Operativno lečenje, najčešće pijeloplastika po Anderson-Hynes-u, indikovana je kod dokazane opstrukcije i pogoršanja bubrežne funkcije. Kod asimptomatskih pacijenata sa očuvanom funkcijom preporučuje se pažljiva opservacija uz antibiotsku profilaksu. Hidronefroza zahteva individualizovan i multidisciplinarni pristup. Pravilan odabir dijagnostičkih metoda i optimalno vreme intervencije ključni su za očuvanje bubrežne funkcije i dugoročno povoljan ishod.
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