Analysis Of Prevalence And Related Factors For Congenital Anomalies Of The Kidneys And Urinary Tract

Congenital Anomalies of the Kidneys and Urinary Tract(CAKUT)refers to a series of diseases that include anatomical abnormalities of the urinary system.It is reported that it accounts for about 30%to 40%of congenital malformations in prenatal examinations,which is the primary cause of chronic kidney disease in infants and preschoolers..Some studies have found that the related factors of CAKUT include non-hereditary and hereditary factors and have different views on each factor.Objective:To obtain the prevalence of CAKUT in the region and analyze the related factors of CAKUT occurrence,to provide a basis for the development of tracking system and intervention measures.Method:1.Participants:Neonates who were born in the obstetrics department of Zhongshan Boai Hospital of Southern Medical University from August 2019 to January 2020 and their mother.Inclusion criteria:(1)case group:Neonates diagnosed with CAKUT by urinary ultrasound within one week;normal group:Neonates with normal urinary ultrasound within one week;Exclusion criteria:combined with other congenital malformations:such as congenital heart disease,digestive tract malformations,neural tube deformity and others.2.Fetuses between 22 and 26 weeks were examined by three-dimensional prenatal ultrasound and were examined by urinary ultrasound within one week after birth.The renal,ureteral and bladder structures was performed and the anteroposterior diameter was measured by ultrasound.(2)Collect related factors through hospital management system,outpatient information system and hospital inspection system.The information include family history,maternal factors,fetal factors.The maternal factors contains maternal age,gestational blood glucose,gestational blood pressure,infection and medication taking during pregnancy,smoking habits,any alcohol abuse,natural pregnancy or assisted reproductive technology and others.The fetal factors contains data about the gender,his/her gestational age,single or multiple and birth weight.(3)The incidence of CAKUT was calculated and the difference of positive rate between fetus and neonate was compared.To analyze the influencing factors of CAKUT.3.Statistical methods:Chi-square test is used for univariate analysis,and logistic regression method was used for multivariate analysis.Result:1.From August 2019 to January 2020,there were 4537 neonates born in the obstetrics department of our hospital,and 2887 neonates who completed ultrasound screening,the screening rate was 62.6%.The total number of patients finally included in the study was 2838 cases,192 cases in the case group and 2646 cases in the normal group.In this study,the prevalence of CAKUT was 6.7%.The common types were dilatation of the renal pelvis(159 cases,82.8%),abnormal bladder echo(13 cases,6.8%),and renal cysts(8 cases,4.2%),of which 94.3%(150/159)renal pelvis dilation was mild(the anteroposterior diameter was 5 to 9.9 mm),Male:Female=1.94:1.2.The relevant factors of CAKUT are premature delivery(P=0.01,OR2.06;95%C11.25-3.42),male(P<0.001,OR1.59;95%CI 1.16-2.17),and reproductive system infection during maternal pregnancy(P=0.02,OR0.26;95%CI0.08-0.84).3.The gestational diabetes mellitus,twins,and abnormal birth weight of neonates(<2500g or>4000g)were different between the two groups in univariate analysis(P<0.05),and the risk of the case group was higher.There were no statistically significant differences between the two groups in the multi-factor analysis of maternal age,gestational hypertension,gestational diabetes mellitus,pregnancy drug history,family history,artificial reproduction technology,twins,and abnormal birth weight of neonates(P>0.05).4.The positive rates of CAKUT for prenatal three-dimensional ultrasound and early postnatal ultrasound respectively were 2.7%(78/2887)and 6.7%(192/2887).Fetal three-dimensional color Doppler ultrasound screening was CAKUT but postnatal ultrasound was normal accounted for 51 cases.Fetal three-dimensional color Doppler ultrasound screening was normal but postnatal ultrasound found CAKUT accounted for 161 cases.Conclusions:1.The prevalence of CAKUT in this study was 6.7%,and the common types were dilatation of the renal pelvis,abnormal bladder echo and renal cysts.2.The high risk factors factors of CAKUT are premature delivery,male;Gestational diabetes,twins,and abnormal birth weight of newborns are high risk factors.3.CAKUT has a high prevalence,the positive rate of CAKUT varies greatly between intrauterine and postnatal,and routine urinary ultrasound examination is of great significance after birth.