태아의 비뇨기계 기형과 동반하는 주요 장기 기형에 대한 보고

Abstract

Objective: Due to advances in diagnosing fetal anomalies by ultrasound, prognosis of babies with anomalies, especially in urinary tract, has improved. However, multiple anomalies with poor prognosis are still noted. We analyze congenital defects which coexist with fetal urinary tract anomalies. Methods: We identified all pregnancies complicated by fetal urinary tract anomalies which were followed and delivered from 1998 August to 2008 July at Yonsei University Health System. Fetal urinary tract defects were subdivided to hydronephrosis, multicystic dysplastic kidney, polycystic kidney disease, renal agenesis, renal duplication and horse-shoe kidney. A retrospective study was performed regarding both medical records and ultrasound findings. Results: 236 (1.8%) in total 12,431 cases were identified with urinary tract defects and 25 (12.3%) cases had coexisting other anomalies. Hydronephrosis was found in 156 (68.2%) cases. Multicystic dysplastic kidney was found in 37 (15.6%) cases, renal duplication in 11 (4.7%), renal agenesis in 9 (3.8%), polycystic disease in 6 (2.5%) and horse-shoe kidney in 2 (1.0%). In 25 cases with coexisting anomalies, the most common type was congenital heart defect which was found in 9 (27.6%) cases. They were composed of 8 (24.5%) atrial septal defect and 1 (3.1%) ventricular septal defect combined with pulmonary atresia. Other coexisting anomalies were cerebral or gastrointestinal tract associated anomalies, Mullerian duct anomalies and polydactyly. Six in 9 (66.7%) fetuses with one kidney had other anomalies. Conclusion: Urinary tract anomalies in fetus seem to be associated with a variety of other malformation, especially cardiac anomalies. Detailed ultrasound or echocardiography should be carefully performed because of frequent coexisting fetal congenital anomalies. Furthermore, comprehensive prenatal counseling and postnatal evaluation and management will be needed.