Effectıve factors ın the determınatıon of the treatment method and tımıng ın cases wıth perınatal hydronephrosıs

Hidronefroz, which is characterized with the dilatation of renal pelvis and/or calix, is the most frequent antenatal renal anomaly. Antenatal hydronephrosis constitutes 50 % of the anomaly that is observed in prenatal USG. The most widely used method at the diagnosis of antenatal hydronephrosis is the maximum anteroposterior (AP) diameter of renal pelvis. It may occur depending on the unilateral hydronephrosis pelvi ureteric intersection obstruction, vesico-ureteral reflux or dysplasia. The most common cause is ureteropelvic obstruction and temporary hydronephrosis. The second common cause is vesicoureteral reflux. The most common cause of bilateral hydronephrosis observed among males is posterior uretral valv (PUV) and among females is ectopic obstructive uretorosel. It is utilized from medical monitoring and/or operation in the perinatal period, for the treatment of hydronephrosis patient. However, it is not defined which treatment method should be applied at first and it is settled upon monitoring. In our study, it is searched whether there are factors that can be effective on defining treatment method during diagnosis.The study enrolled 65 patients with perinatal hydronephrosis diagnosed and followed in the department of pediatric nephrology. After patients were evaluated for the clinic and physic findings, all patients were followed with USG. All of our patients were assessed with voidingsistouretrography (VCUG) in terms of VUR. However obstructive hydronephrosis ascertained facts were assessed with scintigraphy. Patients were examined for levels of serum cystatin C (cys C) and serum neutrophil gelatinase associated lipocalin (NGAL) and were evaluated in terms of angiotensin converting enzyme (ACE) gene polymorphism and kidney functions.46 of our cases were males (%70.8) and 19 (%29.2) were females. The age range of our patients changes between 1-30 days. 44 of our patients had (%67.7) unilateral hydronephrosis and 21 of our patients (%32.3) had bilateral hydronephrosis. It is assessed as physiological hydronephrosis in our cases in which the hydronephrosis regressed in terms of USG in the monitorings and no detected VUR in the VCUG. In our physiological hydronephrosis, there were 27 (%41.5) patients. The rest of our 38 patients (%58.4) were assessed as obstructive hydronephrosis. The most common reason of obstructive hydronephrosis were defined as UP stenosis. In the consequence of evaluation, surgical correction were performed in our 10 patients(%15.3). It was understood that in the defining, during the diagnosis, the rate of urine protein / urine creatine were an effective factor whether the patients which were detected antenatal hydronephrosis, are physiological or obstructive hydronephrosis or not. In addition that it was determined that the especially level of cyc C for the cases requiring surgical correction was a significant factor in defining the treatment method for the cases with obstructive hydronephrosis. Although in the physiological hydronephrosis group the levels of serum NGAL, and ACE insertion/deletion polymorphism in group of obstructive hydronephrosis were higher, there were not as statistically significant for these results in the between groups.Consequently, in our study, we come to conclusion that we need to define cases that can be applied properly in terms of diagnosis, monitoring and treatment for antenatal hydronephrosis and we need to abstain from unnecessary operation but then, we should not be late for the cases which requires real operation and we need dynamic approach to these cases.Key words: Hydronephrosis, cystatine C, NGAL, ACE, gene polymorphism, the newborn