DILATACIÓN DEL SISTEMA

EXCRETOR Dra. Lina Cadavid A.

Radióloga Pediátrica Hospital Pablo Tobón Uribe / IMEDI Docente Universidad CES / U de A

Medellín - Colombia

2014

• American College of Radiology (ACR) • American Institute of Ultrasound in

Medicine (AIUM) • American Society of Pediatric

Nephrology (ASPN) • Society for Fetal Urology (SFU) • Society for Maternal-Fetal Medicine

(SMFM) • Society for Pediatric Urology (SPU) • SPR • Society of Radiologists in Ultrasound

(SRU)

Dilatación del sistema excretor UTD (Urinary Tract Dilation)

Dilatación del sistema excretor

• 40,000 - 50,000/ año

• Dilatación presente 1-2% eco prenatal

Swenson DW, Darge K, Ziniel SI et al. Characterizing upper urinary tract dilation on ultrasound: a survey of North American pediatric radiologists’ practices. Pediatr Radiol. 2015;45(5):686-94

Nguyen HT, Herndon CD, Cooper C, Gatti J, Kirsch A, Kokorowski P, et al. The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol 2010;6:212e31.

Hamilton BE, Martin JA, Ventura SJ (2013) Births: preliminary data for 2012. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. Natl Vital Stat Rep 62:1–20

Dilatación del sistema excretor UTD (Urinary Tract Dilation)

Vivier PH, et al. Standardization of pediatric uroradiological terms: a multidisciplinary European glossary. Pediatr Radiol. 2018 Feb;48(2):291-303.

Chow JS, et al. Classification of pediatric urinary tract dilation: the new language. Pediatr Radiol (2017) 47:1109–1115

Dilatación del sistema excretor

Nguyen HT, et al. Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). Journal of Pediatric Urology. 2014

ECO

AP mm

Cálices Centrales Perféricos

Cortical Parénquima

mm Parénquima

Uréter

Vejiga

Dilatación del sistema excretor

Imaging recommendations in paediatric uroradiology: minutes of the ESPR workgroup session on urinary tract infection, fetal hydronephrosis, urinary tract ultrasonography and voiding cystourethrography, Barcelona, Spain, June 2007. Pediatr Radiol (2008) 38:138–145 H.T. Nguyen et al.Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). Journal of Pediatric Urology. 2014

Prenatal Bajo riesgo A1

16-27s AP 4-7 mm > 28s AP 7-10 mm

Cálices centrales

Eco 32 s

Eco posnatal

> 48 h * / 1 y 6 meses

Riesgo alto A2-A3 16-27 s AP > 7 mm >28 s AP > 10 mm Cálices periféricos,

cortical/parénquima AN, uréter y vejiga AN, oligohidramnios

Eco 4-6 s

Eco posnatal >48 h -1 mes

Nefrología-urología

Dilatación del sistema excretor

Diámetro AP ≥10 mm Posnatal

Dilatación del sistema excretor

Diámetro AP ≥10 mm

Dilatación del sistema excretor

AP 10-15 mm

Cálices centrales

Riesgo Bajo P1

AP > 15 mm

Cálices periféricos

Uréter

Riesgo intermedio P2

AP > 15 mm

Cálices

Cortical parénquima AN

Uréter vejíga AN

Riesgo Alto P3

Nguyen HT, et al.Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). Journal of Pediatric Urology. 2014

Dilatación del sistema excretor

Nguyen HT, et al.Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). Journal of Pediatric Urology. 2014

P1 P2 P3

Eco 1-6 meses 1-3 meses 1 mes

Cisto ≅ ≅ SI

Profilaxis ≅ ≅ SI

M. nuclear NO ≅ ≅

≅ Criterio Médico

Chow

JS &

Dar

ge K

. Mul

tidis

cipl

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y con

sens

us o

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e cl

assi

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and

pos

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al u

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y tr

act d

ilatio

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(UTD

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stem

). Pe

diat

r Rad

iol (

2015

) 45:

787–

789

Dilatación del sistema excretor

G I AP 10 - 15 mm, Riesgo P1

G II

AP 10 - 15 mm, cálices centrales, Riesgo P1

Dilatación del sistema excretor

Dilatación del sistema excretor

G III

AP >15 mm, Riesgo P2

Dilatación del sistema excretor

G IV

G V

AP >15 mm, Riesgo P3

Riccabona EM et al. European Society of Paediatric Radiology abdominal imaging task force recommendations in paediatric uroradiology, part IX: Imaging in anorectal and cloacal malformation, imaging in childhood ovarian torsion, and efforts in standardising paediatric uroradiology terminology. Pediatr Radiol (2017) 47:1369–1380

Fernbach SK, Maizels M, Conway JJ. Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr Radiol 1993; 23:478– 480)

Dilatación grados

Dilatación del sistema excretor

• Pelvis extrarrenal ✗ • Prono ✓ • Supino • Post Qx • Dilatación ureteral sola no esta incluida • Ecografía normal no excluye reflujo • Sistema de clasificación / riesgo uropatía

Riccabona EM et al. European Society of Paediatric Radiology abdominal imaging task force recommendations in paediatric uroradiology, part IX: Imaging in anorectal and cloacal malformation, imaging in childhood ovarian torsion, and efforts in standardising paediatric uroradiology terminology. Pediatr Radiol (2017) 47:1369–1380

Chow JS, et al. Classification of pediatric urinary tract dilation: the new language. Pediatr Radiol (2017) 47:1109–1115

Diámetro AP ≥7 mm Posnatal ?

Gracias!!! linacadavid6@gmail.com