Ultrasound Imaging of Renal Cysts in Children

The Modified Bosniak Classification for Intermediate and High-Risk Renal Cysts

Background Renal cysts are uncommon among the pediatric population, and their transformation into malignant lesions is also uncommon. Early detection can prevent further complications and protect renal function. Bosniak classification is a computed tomography-based classification for renal cysts developed for adults. Children are more susceptible to CT radiation. Therefore, a modified Bosniak classification for children based on the ultrasound (US) can be used if it shows reliability and accuracy. Aim To apply the modified Bosniak classification system among children with renal cysts. Methods This was a retrospective study that was conducted on pediatric patients who underwent surgery for intermediate and high-risk complex renal cysts in Prince Sultan Military Medical City, Riyadh, Saudi Arabia using radiological information from 2009 to 2022. The collected data included demographics, medical history, radiological findings, and characteristics of renal cysts. SPSS Statistics v. 22 (IBM Corp., Armonk, NY) was used to analyze the data. Results There were 40 children included in the study based on the US-modified Bosniak classification. Around 26.3% of patients had class I and 39.5% had class II renal cysts. Histopathology showed that 10% had Wilms tumor, and 15% had benign lesions. There were significant correlations between pathology findings and US findings (p=0.004), and CT findings (p=0.016). Conclusion The modified Bosniak classification based on the US is sensitive, specific, and sufficiently accurate in the classification of renal cysts among children. Also, the size of the renal cysts can be a diagnostic marker of differentiation of benign and malignant cysts with high sensitivity and specificity.

Medullary sponge kidney: unusual finding in kidney transplant recipient

Background

Medullary sponge kidney is generally considered a benign condition, gold standard for the diagnosis is urography but it has almost been replaced by UroCT that did not present the same sensibility. Although it is really rare, our sonography’s findings were consistent with medullary sponge kidney in the transplanted kidneys.

Case presentation

A 45-year-old woman with a long history of double-kidney transplantation complained of frequent urinary tract infections, a history of vague loin pain and came to our attention for sonography follow-up. Her kidney function was normal, we did not find signs of infections in the transplanted kidneys and urinary findings were normal. Curiously, the transplanted kidneys came from a newborn and the patient received a double-kidney transplantation in order to guarantee a satisfactory renal function.

Conclusions

Despite a long history of kidney transplantation, genetic disease should not be forgotten when symptoms and images recall to specific inherited alterations. Sonography has to be considered in diagnostic path of kidney cystic disease.

Point-of-care ultrasound in pediatric nephrology

Point-of-care ultrasound (POCUS) has evolved in recent years in clinical practice, helping in early bedside diagnosis of important etiologies. Many medical schools and training programs are integrating POCUS into their curriculum. Especially with the technological advances of newer handheld ultrasound devices, POCUS has now become a component adjunct to clinical examination, in the clinic and bedside in critical care units. The diagnostic utility of POCUS lies both in early identification of critical kidney disease, and also extra-renal pathologies from a focused cardiac ultrasound, lung ultrasound, and integrated fluid assessment. There is a need to incorporate POCUS in training in pediatric nephrology and establish competency standard criteria. This review shall cover how POCUS helps in enhancing patient care in pediatric kidney disorders and critical children, and the recent advances.

Two Siblings Showing a Mild Phenotype of Joubert Syndrome with a Specific CEP290 Variant

Joubert syndrome (JS) is a genetic neurodevelopmental disorder characterized by lower brainstem dysplasia and cerebellar vermis agenesis termed molar tooth sign (MTS), psychomotor retardation, abnormal respiratory pattern in infancy, and oculomotor abnormalities. Arima syndrome (AS), which is a severe form of JS, is characterized by severe psychomotor retardation, congenital visual impairment, progressive renal dysfunction, and lower brainstem dysplasia from early infancy. Numerous patients with AS expire in early childhood. Recently, c.6012-12T> A in the CEP290 gene was reported as a specific variant of AS. Herein, we report the cases of two siblings showing a phenotype of JS with compound heterozygous mutations (c.6012-12T > A / c.5924delT) in the CEP290 gene. The older sister (aged 19 years) had hypotonia, hypertelorism, and anteverted nares since birth. As a neonate, she developed a transient abnormal respiratory pattern and nystagmus, and brain magnetic resonance imaging (MRI) showed MTS. The younger sister (aged 13 years) exhibited mild hypotonia and pendular nystagmus as a neonate; MRI revealed MTS. Both sisters had psychomotor retardation, oculomotor dysfunction, and bilateral renal cysts with normal renal function. They can walk and have simple conversation. They do not meet the diagnostic criteria for AS, and their symptoms were milder than those of previously reported cases with this specific mutation. This report indicates the expanding spectrum of the CEP290 variant.