| Objective:To summarize the ultrasonic characteristics of hydronephrosis in infants by different causes. Assess the clinical application value of ultrasound in identifying the causes of hydronephrosis in infants. Investigate the relationship between the level of hydronephrosis and the size and location of stone caused by feeding melamine contaminated milkMethod:A total of 78 infants with hydronephrosis were retrospectively analyzed using ultrasonography (including 37 cases of infants with physiological separation of renal pelvis,12 cases with congenital hydronephrosis,29 cases with hydronephrosis due to urolithiasis induced by feeding melamine contaminated milk powder.Also selected 26 cases of urolithiasis induced by feeding melamine contaminated milk powder but without hydronephrosis. Then investigate the ultrasonic characteristicsPHILIPS iU22,ATL HDI-5000, ALOKA Prosound SSD-α5 colour doppler ultrasonic diagnostic apparatus were used to observe the architecture of infant's kidneies from every groups.The ultrasonic frequencies were 2-5MHz ,2-5MHz ,4-9MHz. Take the prone position, showed several criteria incisal surface of kidney: coronal section, cross-sectional, vertical section, and oblique planes. Recorded the location and shape of kidney, measure the renal size; for hydronephrosis subjects infants to observe the renal sinus echo-free characteristics, whether the form is smooth, and measure the renal pelvis anteroposterior diameter; for infants with urolithiasis, recording the location, size and shape of calculis.Research carried out as follows: Investigate the ultrasonic characteristics of hydronephrosis by different causes in infants ,such as congenital hydronephrosis, urolithiasis, as well as physiological separation of renal pelvis.Eventually we will compared the anteoposterior diameter's differences among those following groups:physiological separation of renal pelvis group, congenital hydronephrosis group, as well as urolithiasis group due to taken melamine contaminated milk powder. Research if the size and location are different between infants with hydronephrosis due to urolithiasis induced by feeding melamine contaminated milk powder and urolithiasis cases without hydronephrosis.All of the measurement data were espressed as mean±standard deviation and students t test was used to explore statistical significance.Results:In this study, ultrasonic characteristics of each group are as follows:1 Physiological separation of the renal pelvis, 37 cases, no obvious clinical symptoms, occurred in this group isolated unilateral renal pelvis were 18 cases (9 cases at left, 9 cases at right) , accounting for 48.6%; bilateral renal pelvis were separated from their 19 cases, accounting for 51.4%. Sonographic chara,cteristics were as follows: visible within the anechoic renal pelvis area, appear before slitting strip in the kidney, and renal pelvis shape, take the same shape. Echo of the renal parenchyma were no obvious abnormalities.2 Congenital hydronephrosis group of 12 cases, 10 cases of congenital ureteral stenosis (9 cases in which unilateral stenosis, bilateral ureteral stenosis was 1case), a narrow part of the ureteropelvic junction for the 6 cases, ureterovesical junction stenosis for 4 cases. There are two cases of congenital ureterocele. Summarized in children with congenital hydronephrosis sonographic characteristics were as follows: no echo within the renal collecting system more pronounced, 12 cases, 10 cases showed renal calices, renal pelvis are expanding. Heavy water can be seen the increase in kidney size, renal parenchymal thinning.3 Melamine-contaminated milk powder due to stone with hydronephrosis Group: renal collecting system seen in the group-like strong echoes, irregular morphology, accompanied by acoustic shadow behind; or renal collecting system was within a small number of irregular spot accumulate, the rear silent film, or accompanied by a weak sound shadow.4 Melamine-contaminated milk powder due to non-consolidated stone water Group: stone shape was gathered mostly small spot; no significant renal system separation.Compared the anteoposterior diameter of three hydronephrosis group. We can found there were differences among the three groups: The anteroposterior diameters of renal pelvis in the group with congenital hydronephrosis (29.29±6.88)mm were significantly higher than those in the group with hydronephrosis caused by melamine(12.40±3.49)mm (P <0. 01). The anteroposterior diameters of renal pelvisi in the group with hydronephrosis caused by melamine(12.40±3.49)mm were significantly higher than those in the group with physiological hydronephrosis(6.03±2.05)mm. (P < 0. 01).Based on the Grignon'standard of hydronephrosis in infants,1 Infants of physiological separation of renal pelvis,35 cases of infants in hydronephrosis is in the first level。2 cases of infants in hydronephrosis is in the second-third level。2 Infants of congenital hydronephrosis,all of infants showd the most heavily level.3 Infants with hydronephrosis due to urolithiasis induced by feeding melamine contaminated milk powder, 4 cases of infants in hydronephrosis is in the first level.18 cases of infants in hydronephrosis is in the second to third level.Others showed most heavily level。There is significant difference ( P<0. 01) in the mean diameter of calculi between urolithiasis with hydronephrosis group (4.05±1.57)mm and urolithiasis without hydronephrosis group(3.22±1.57)mm.Conclusion:1 The ultrasonographic appearance of hydronephrosis has relationship with the different causes.Different ultrasonic characteristics can be observed among physiological separation of renal pelvis,congenital hydronephrosis, and hydronephrosis due to urolithiasis induced by feeding melamine contaminated milk powder.The different ultrasonic characteristics can provide reference to clinical diagnosis and differential diagnosis.2 It is valuable to clinical diagnosis by observe the renal sinus echo-free characteristics and measure the renal pelvis anteroposterior diameter.The anteroposterior diameter is one of reference target to identify the causes of hydronephrosis in infants.3 Whether complicating hydronephrosis in infants with urolithiasis induced by feeding melamine contaminated milk powder has relationship with the mean diameter of calculi. |
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