Oleksandr DOBROVANOV1,2, Karol KRÁLINSKÝ3,4

1Klinika pre deti a dorast A. Getlíka LF SZU a UNB, NsP sv. Cyrila a Metoda, Bratislava, prednostka doc. MUDr. K. Furková, CSc., mim. prof.
2Vysoká škola zdravotníctva a sociálnej práce sv. Alžbety, n.o.
3II. detská klinika SZU, DFNsP, Banská Bystrica, prednosta prof. MUDr. K. Králinský, PhD.
4Fakulta zdravotníctva SZU v Bratislave so sídlom v Banskej Bystrici

SUMMARY
Background: Congenital malformations of the urinary tract occur in 1 – 3 % of all pregnancies and are diagnosed by prenatal and postnatal sonographic diagnosis. The incidence of congenital kidney and urinary tract defects in Slovakia is 3,9 / 1000 live births. The aim of sonographic diagnosis is to identify pathology prior to the development of serious complications such as urinary tract infection, urinary stone formation, renal dysfunction or insufficiency. In many cases, the sonographic detection of dilatations of the uropoietic tract is a transient or physiological phenomenon and is of no clinical relevance. However, this pathology in some cases is a serious and life-threatening condition, such as the posterior urethral valves and other types of obstructive uropathy. These conditions have a significant level of morbidity and even mortality. In many cases, the etiology of dilatations of the uropoietic tract cannot be determined before birth, and postnatal diagnosis using different types of imaging is required. In some developed countries, only prenatal diagnosis is preferred for the identification of urinary tract dilatations due to its high level. The aim of our effort was to compare the effectiveness and sensitivity of prenatal and postnatal diagnostics in the diagnosis of congenital malformations of the urinary system in the Slovak Republic over the last decades, to underline the importance of postnatal sonographic screening.

Patients and methods: Data on postnatal sonographic screening of congenital developmental malformations of the urinary system in and including 2017 were identified and updated using a questionnaire survey, 38,496 newborns were involved, representing 66.5 % of the total population of 57,969 newborns in 2017. Other statistical data the data were provided by the National Health Information Center. Statistical data on the proportion of prenatal diagnosis in the diagnosis of congenital developmental urinary tract diagnosis for the years 1995, 2000, 2005, 2008 and 2013 – 2016 were provided from the National Register of Congenital Defects. The χ2-test and t-test were applied to assess the sensitivity differences.
Results: The study showed a low sensitivity of prenatal diagnosis with its maximum in 2016, reaching 32.3 % (average 24.4 %) and a minimum in 2005 – 2008 (8.0 – 8.4 %), that the sensitivity of postnatal diagnostics for selected years has always been a stable indicator and reaches 99.6 %.
Conclusion: Comparing the specific prenatal and postnatal screening of congenital kidney developmental defects in neonates in Slovakia is the notion that prenatal screening does not currently meet our expectations, although it works quite well in large cities. Meanwhile, it has low sensitivity and cannot detect all congenital kidney developmental defects in newborns. That is why in Slovakia the main goal of postnatal neonatal kidney screening is to diagnose developmental defects that have not been detected prenatally and need to be addressed at neonatal or early infancy.
Key words: kidney, postnatal diagnosis, prenatal diagnosis, screening, Slovakia, sonography.
Lek obz, 2020, 69 (4): 130 – 133