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
inar
y con
sens
us o
n th
e cl
assi
ficat
ion
of a
nten
atal
and
pos
tnat
al u
rinar
y tr
act d
ilatio
n
(UTD
cla
ssifi
catio
n sy
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!!! [email protected]