Abstract: Background　Congenital anomalies of the kidney and the urinary tract（CAKUT） is a structural congenital malformation diagnosed in newborns，which is the primary cause of end-stage renal disease in children and adolescents.Objective　 To analyze the incidence of CAKUT in high-risk neonates based on an ultrasound-screening study of the CAKUT in this population，to explore the appropriate subjects and patterns for CAKUT screening.Methods　4 883 high-risk neonates who were born in Weifang Maternal and Child Health Hospital and Anqiu Women and Children's Hospital from July 2012 to July 2014 were selected for ultrasound screening of urinary malformations after getting permission from their parents.The results of screening were analyzed and summarized.The identified CAKUT was classified.And the children with congenital hydronephrosis were followed up regularly.Results　A total of 242 cases of CAKUT were detected，accounting for 4.96%.The detection rate of CAKUT in the neonates delivered in Anqiu Women and Children's Hospital was higher than that of those delivered in Weifang Maternal and Child Health Hospital〔5.43%（225/4 146） vs 2.31%（17/737）；χ2=12.934，P<0.05〕.The male to female ratio of neonates with CAKUT was 2.27∶1.The detection rate of CAKUT in male neonates was higher than that of female neonates〔6.52%（168/2 575） vs 3.21%（74/2 308）；χ2=28.447，P<0.05〕.A total of 230 children with hydronephrosis were screened out，accounting for 95.04% of children with CAKUT，and 205 cases with grade Ⅰ，23 with grade Ⅱ，and 2 with grade Ⅲother types of CAKUT were found in 12 cases（3 cases of renal duplication anomaly，3 cases of cystic renal lesions，2 cases of absence of the kidney，2 cases of ectopic kidney and 2 cases of renal dysplasia）．One-year follow-up showed that the pyelonephrosis in those cases of gradeⅠ andⅡ disappeared spontaneously，and the pyelonephrosis of gradeⅢ cases disappeared after receiving conservative treatment.The 12 cases with other 4 types of CAKUT were transferred to Pediatric Renal Clinic，Weifang Maternal and Child Health Hospital for further follow-up.Two of them were lost to follow up，other 10 cases were found with normal renal functions，urinalysis results and growth and development.Conclusion　The prevalence of CAKUT in high-risk neonates is 4.96% in Weifang，which is higher than that of most domestic and foreign studies.Hydronephrosis is the most common type of CAKUT，and the prognosis is good.It is necessary for high-risk infants to undergo ultrasound screening of urinary malformations after birth.For those with severe hydronephrosis or other types of CAKUT，early referral is suggested.Moreover，improved three-level referral system helps to deliver effective preventive interventions as soon as possible.

Key words: Neonatology, Congenital abnormalities, Urogenital abnormalities, Hydronephrosis, Ultrasonography

摘要： 背景　儿童先天性肾脏及尿路畸形（CAKUT）是一种先天性结构畸形，是导致儿童及青少年终末期肾病的首要原因。目的　本研究通过对高危新生儿进行CAKUT超声筛查，分析高危新生儿CAKUT的发生情况，探讨开展CAKUT超声筛查的适宜对象及模式。方法　选取潍坊市妇幼保健院、安丘市妇幼保健院2012年7月—2014年7月出生的父母同意接受超声筛查的4 883例高危新生儿进行CAKUT超声检查，对筛查结果进行分析，将筛查出的CAKUT进行分类并定期随访。结果　两家医院共筛查出242例CAKUT患儿，CAKUT检出率为4.96%。安丘市妇幼保健院CAKUT检出率（5.43%，225/4 146）高于潍坊市妇幼保健院（2.31%，17/737）（χ2=12.934，P<0.05）。筛查出168例CAKUT男婴，74例CAKUT女婴，男女比例为2.27∶1，男婴CAKUT检出率（6.52%，168/2 575）高于女婴（3.21%，74/2 308）（χ2=28.447，P<0.05）。共筛查出肾积水患儿230例，占CAKUT患儿的95.04%，包括Ⅰ度205例、Ⅱ度23例、Ⅲ度2例；其他CAKUT类型患儿12例，包括重复肾3例、肾囊性病变3例、单侧肾缺如2例、异位肾2例、肾发育不全2例。随访1年，Ⅰ、Ⅱ度肾积水患儿肾积水自行消失，Ⅲ度肾积水患儿给予保守治疗后肾盂扩张消失。其他CAKUT类型患儿均转入潍坊市妇幼保健院儿科肾脏门诊进一步随访，其中2例失访，余随访发现患儿肾功能均正常。结论　潍坊地区高危新生儿的泌尿系统畸形超声筛查中CAKUT检出率为4.96%，较国内外筛查结果偏高。且肾积水最为常见，预后良好。高危儿出生后有必要进行CAKUT超声筛查，对严重肾积水及其他CAKUT类型患儿及早转诊，完善三级转诊机制，有助于尽早采取有效的预防干预措施。

关键词: 新生儿学, 先天畸形, 泌尿生殖系统畸形, 肾盂积水, 超声检查