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Gu SL, Yang XQ, Zhai YH, Xu WL, Guo WX, Shen T. Clinical characteristics of patients with prenatal hydronephrosis in early postnatal period: a single center retrospective study. BMC Pediatr 2023; 23:235. [PMID: 37173710 PMCID: PMC10176811 DOI: 10.1186/s12887-023-04063-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The study aims to investigate the clinical characteristics of early postnatal period in children with prenatal hydronephrosis (HN) in our single center for 8 years. STUDY DESIGN The clinical data of 1137 children with prenatal HN from 2012 to 2020 were retrospectively analyzed in our center. Variables of our study mainly included different malformations and urinary tract dilation (UTD) classification, and main outcomes were recurrent hospitalization, urinary tract infection (UTI), jaundice, and surgery. RESULTS Among the 1137 children with prenatal HN in our center, 188 cases (16.5%) were followed-up in early postnatal period, and 110 cases (58.5%) were found malformations. The incidence of recurrent hospitalization (29.8%) and UTI (72.5%) were higher in malformation, but the incidence of jaundice (46.2%) was higher in non-malformation(P < 0.001). Furthermore, UTI and jaundice were higher in vesicoureteral reflux (VUR) than those in uretero-pelvic junction obstruction (UPJO) (P < 0.05). Meanwhile, Children with UTD P2 and UTD P3 were prone to recurrent UTI, but UTD P0 was prone to jaundice (P < 0.001). In addition, 30 cases (16.0%) of surgery were all with malformations, and the surgical rates of UTD P2 and UTD P3 were higher than those of UTD P0 and UTD P1 (P < 0.001). Lastly, we concluded that the first follow-up should be less than 7 days, the first assessment should be 2 months, and the follow up should be at least once every 3 months. CONCLUSION Children with prenatal HN have been found many malformations in early postnatal period, and with high-grade UTD were more prone to recurrent UTI, even to surgery. So, prenatal HN with malformations and high-grade UTD should be followed up in early postnatal period regularly.
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Affiliation(s)
- Song-Lei Gu
- Department of Pediatrics, Women and Children's Hospital of Xiamen University, School of Medicine, Xiamen University, Zhenhai road 10, Xiamen, 361003, China
| | - Xiao-Qing Yang
- Department of Pediatrics, Women and Children's Hospital of Xiamen University, School of Medicine, Xiamen University, Zhenhai road 10, Xiamen, 361003, China
| | - Yi-Hui Zhai
- Department of Nephrology, Children's Hospital of Fudan University, Wanyuan road 399, Shanghai, 201102, China
| | - Wen-Li Xu
- Department of Pediatrics, Women and Children's Hospital of Xiamen University, School of Medicine, Xiamen University, Zhenhai road 10, Xiamen, 361003, China
| | - Wen-Xing Guo
- Department of Pediatrics, Women and Children's Hospital of Xiamen University, School of Medicine, Xiamen University, Zhenhai road 10, Xiamen, 361003, China
| | - Tong Shen
- Department of Pediatrics, Women and Children's Hospital of Xiamen University, School of Medicine, Xiamen University, Zhenhai road 10, Xiamen, 361003, China.
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Staub E. Current and potential methods to assess kidney structure and morphology in term and preterm neonates. Anat Rec (Hoboken) 2023. [PMID: 36883787 DOI: 10.1002/ar.25195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/25/2023] [Accepted: 02/21/2023] [Indexed: 03/09/2023]
Abstract
After birth, the kidney structure in neonates adapt to the functional demands of extrauterine life. Nephrogenesis is complete in the third trimester, but glomeruli, tubuli, and vasculature mature with the rapidly increasing renal blood flow and glomerular filtration. In preterm infants, nephrogenesis remains incomplete and maturation is slower and may be aberrant. This structural and functional deficit has life-long consequences: preterm born individuals are at higher risk for chronic kidney disease and arterial hypertension later in life. This review assembles the literature on existing and potential methods to visualize neonatal kidney structure and morphology and explore their potential to longitudinally document the developmental deviation after preterm birth. X-rays with and without contrast, fluoroscopy and computed tomography (CT) involve relevant ionizing radiation exposure and, apart from CT, do not provide sufficient structural details. Ultrasound has evolved into a safe and noninvasive high-resolution imaging method which is excellent for longitudinal observations. Doppler ultrasound modes can characterize and quantify blood flow to and through the kidneys. Microvascular flow imaging has opened new possibilities of visualizing previously unseen vascular structures. Recent advances in magnetic resonance imaging display renal structure and function in unprecedented detail, but are offset by the logistical challenges of the imaging procedure and limited experience with the new techniques in neonates. Kidney biopsies visualize structure histologically, but are too invasive and remain anecdotal in newborns. All the explored methods have predominantly been examined in term newborns and require further research on longitudinal structural observation in the kidneys of preterm infants.
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Affiliation(s)
- Eveline Staub
- Department of Neonatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- University of Sydney Northern Clinical School, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Bildgebende Untersuchungen bei der Ureterabgangsstenose. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01651-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Ulusoy O, Aydın E, Ateş O, Hakgüder G, Özer E, Olguner M, Miraç Akgür F. Clues for the early loss of renal function in congenital hydronephrosis: Analysis of renal pelvis collagen ratio, diuresis renography and upper urinary tract morphology. J Pediatr Urol 2022; 19:197.e1-197.e7. [PMID: 36464563 DOI: 10.1016/j.jpurol.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 09/30/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Diagnosing real urinary obstruction and surgical decision making for the operative correction of urinary obstruction, are still problematic in congenital hydronephrosis (CH). Compliance of the renal pelvis is one of the important defense mechanisms of renal parenchyma against urinary obstruction. We observed early loss of function in some cases of CH with low and moderate anteroposterior diameter of the renal pelvis (APDRP). OBJECTIVE To evaluate structural properties of the renal pelvic tissue of patients with CH and the relation of these structural properties with renal function and Anteroposterior diameter of the renal pelvis. STUDY DESIGN Ureteropelvic junction (UPJ) excised during UPJ obstruction operations from 2013 to 2019 were evaluated histopathologically. The patients were divided into the two groups according to initial renal function, i.e. group with initial preoperative differential renal function (DRF) less than 35% and group with initial DRF greater than 35%. The percentage of collagen to whole tissue area were analyzed using image processing program. The relationship between DRF and tissue collagen ratio, SFU and APDRP was evaluated. RESULTS There were 5 patients in the DRF <35% group and 16 patients in the DRF >35% group. However, APDRP's of the DRF <35% group were also significantly lower than the DRF >35% group. The collagen distribution in the muscle layer was more prominent in the DRF <35% group. Proportionally, percentage of collagen stained surface was significantly higher in DRF <35% group. DISCUSSION There are numerous histopathological studies evaluating the cause of UPJ obstruction. Besides these studies that are oriented to etiology, there are many studies comparing the histopathological changes at UPJ with surgical outcome and prognosis. In the present study, we found that renal pelvis collagen ratio was significantly increased in patients with lower APDRP and with severe renal function loss. This increase in the collagen content in the renal pelvis have been shown to affect the compliance negatively and decrease APDRP, which leads to a faster loss of renal function. Thus, pelvic structural changes accompanying UPJ obstruction may aggravate urinary obstructive process. CONCLUSION Increased renal pelvis collagen ratio negatively affects the expansion of the renal pelvis, which is one of the protective mechanisms of the renal parenchyma, and may be one of the triggering mechanisms of early loss of renal function.
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Affiliation(s)
- Oktay Ulusoy
- Department of Pediatric Surgery, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey.
| | - Efil Aydın
- Department of Pediatric Surgery, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Oğuz Ateş
- Department of Pediatric Surgery, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey; Division of Pediatric Urology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Gülce Hakgüder
- Department of Pediatric Surgery, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey; Division of Pediatric Urology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Erdener Özer
- Department of Pathology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Mustafa Olguner
- Department of Pediatric Surgery, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey; Division of Pediatric Urology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Feza Miraç Akgür
- Department of Pediatric Surgery, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey; Division of Pediatric Urology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
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Abimbola O, Smith BD, Gurjar M, Ross SS. Outcomes of intermediate-risk hydronephrosis in pediatric patients. J Pediatr Urol 2022; 19:196.e1-196.e6. [PMID: 36473783 DOI: 10.1016/j.jpurol.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 10/02/2022] [Accepted: 10/06/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE Hydronephrosis is a common antenatal diagnosis and is present in approximately 1-5% of pregnancies. The urinary tract dilation (UTD) classification system was introduced in 2014 and stratifies post-natal hydronephrosis risk into three groups: low-risk (P1), intermediate-risk (P2), and high-risk (P3). Recommendations for P3 hydronephrosis have been established, whereas those for P1 and P2 UTD are often left to the discretion of providers with P1 considered low-grade and less concerning significant pathology. Given the obscure nature of P2 hydronephrosis, we sought to determine the natural history and outcomes of pediatric patients with P2 hydronephrosis within a single institution. MATERIALS AND METHODS Children <18 years old diagnosed with hydronephrosis between January 2015 and December 2018 were identified by ICD-9 and ICD-10 codes. Patients with P1 hydronephrosis, P3 hydronephrosis, known vesicoureteral reflux, complex anomalies (ex. Posterior urethral valve), neurological impairments, neurogenic bladder secondary to spinal abnormalities, and <6 months of follow-up were excluded. The development of urinary tract infection (UTI; ≥100 000 CFU/mL of bacterial growth, UA > 10 WBCs/hpf with fever >38C), need for surgical intervention (impaired renal function, worsening hydronephrosis, and/or delayed drainage on diuretic renography), and stability of hydronephrosis were collected retrospectively. RESULTS Eighty-seven patients [105 renal units (RU)] were included. Twenty-six patients (30%) were female and 61 (70%) were male. Of the male patients, 30 (49%) of them were circumcised. The median age at initial evaluation was 1 month, and the median duration of follow-up was 13 months. Thirty-four (32%) RU had complete resolution, 24 (23%) improved to P1 hydronephrosis, 33 (31%) remained stable, and 14 (13%) progressed to P3 hydronephrosis. The median duration to resolution and improvement was 8.5 months and 5 months, respectively. Eleven (11%) RU required surgical intervention, 10 of which underwent pyeloplasty, with a median duration to intervention of 9 months. Fifty-five patients (63%) received antibiotic prophylaxis (amoxicillin or sulfamethoxazole-trimethoprim) for a median duration of 5 months. Nine patients (10%) developed a UTI, 3 of which were taking antibiotic prophylaxis at the time of infection. CONCLUSIONS Intermediate-risk hydronephrosis diagnosed in the pediatric population will either improve, resolve, or remain stable during 1-year follow-up in 87% of RU. Only 11% of RU required surgical intervention, and 19% of patients developed a UTI in the absence of antibiotic prophylaxis. These findings will assist with counseling parents concerning the importance of follow-up imaging and monitoring for UTI. However, the low risk of surgical intervention is encouraging and should be discussed with the children's caretakers.
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Affiliation(s)
- Obafunbi Abimbola
- Department of Urology, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
| | - Benjamin D Smith
- Department of Radiology, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
| | - Megan Gurjar
- Department of Urology, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
| | - Sherry S Ross
- Department of Urology, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
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Nguyen HT, Phelps A, Coley B, Darge K, Rhee A, Chow JS. 2021 update on the urinary tract dilation (UTD) classification system: clarifications, review of the literature, and practical suggestions. Pediatr Radiol 2022; 52:740-751. [PMID: 34981177 DOI: 10.1007/s00247-021-05263-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 11/21/2021] [Accepted: 12/10/2021] [Indexed: 11/27/2022]
Abstract
In 2014, a multidisciplinary consensus on the classification of pre- and postnatal urinary tract dilation (UTD classification) was developed. Its goal was to provide a standardized system for evaluating and reporting urinary tract dilation both in the prenatal and postnatal periods. In this review, we summarize insights learned from the implementation of the UTD classification system since its inception, providing clarifications on common points of confusion. In addition, we review current literature in the clinical validation of the UTD classification system to provide credence for its use in managing fetuses and children with urinary tract dilation.
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Affiliation(s)
- Hiep T Nguyen
- Banner Children's Specialist, Urology, Banner Desert Children's Hospital, 1432 S. Dobson Road, #501, Mesa, AZ, 85202, USA.
| | - Andrew Phelps
- Department of Radiology, Oregon Health & Science University, Portland, OR, USA
| | - Brian Coley
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kassa Darge
- Department of Radiology, Perelman School of Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Audrey Rhee
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Jeanne S Chow
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA
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Melo FF, Vasconcelos MA, Mak RH, Silva ACSE, Dias CS, Colosimo EA, Silva LR, Oliveira MCL, Oliveira EA. Postnatal urinary tract dilatation classification: improvement of the accuracy in predicting kidney injury. Pediatr Nephrol 2022; 37:613-623. [PMID: 34453601 DOI: 10.1007/s00467-021-05254-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The grading of urinary tract dilatation (UTD) on postnatal sonography is a fundamental step to establish rational management for infants with antenatal hydronephrosis (ANH). The aim of this study was to compare the prediction accuracy of UTD grading systems for relevant clinical outcomes. In addition, we propose a refinement of the UTD classification by adding quantitative measurements and evaluate its impact on accuracy. METHODS Between 1989 and 2019, 447 infants diagnosed with isolated AHN were prospectively followed. The events of interest were surgical interventions and kidney injury. Comparison of performance of the grading systems and the impact on the accuracy of a modified UTD classification (including the size of the kidney parenchyma) was assessed by the area under the receiver-operating characteristic curve (AUC). RESULTS Of 447 infants, 131 (29%) underwent surgical intervention and 26 (5.8%) had developed kidney injury. The median follow-up time was 9 years (IQ range, 7-12 years). The performance for detecting the need for surgical intervention was excellent for all grading systems (AUC > 0.90). However, for predicting kidney injury, the modified UTD classification exhibited significant improvement in accuracy (AUC = 0.913, 95%CI, 0.883-0.937) as compared with UTD classification (AUC = 0.887, 95%CI, 0.854-0.915) (P = 0.027). CONCLUSIONS Our study confirms that the hydronephrosis grading systems provide excellent accuracy in discriminating patients who need surgical intervention among infants with AHN. Our findings suggest that the inclusion of kidney parenchymal thickness to UTD classification might increase the accuracy for predicting infants who may develop kidney injury. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Fernanda F Melo
- Pediatric Nephrourology Division, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), R Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil
| | - Mariana A Vasconcelos
- Pediatric Nephrourology Division, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), R Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil
| | - Robert H Mak
- Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California, San Diego, La Jolla, CA, USA
| | - Ana Cristina Simões E Silva
- Pediatric Nephrourology Division, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), R Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil
| | - Cristiane S Dias
- Pediatric Nephrourology Division, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), R Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil
| | - Enrico A Colosimo
- Department of Statistics, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ludmila R Silva
- Pediatric Nephrourology Division, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), R Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil
| | - Maria Christina L Oliveira
- Pediatric Nephrourology Division, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), R Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil
| | - Eduardo A Oliveira
- Pediatric Nephrourology Division, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), R Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil. .,Visiting Scholar, Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California, San Diego, La Jolla, CA, USA.
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Vincent K, Murphy HJ, Twombley KE. Urinary Tract Dilation in the Fetus and Neonate. Neoreviews 2022; 23:e159-e174. [PMID: 35229134 DOI: 10.1542/neo.23-3-e159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Urinary tract dilation (UTD), previously known as hydronephrosis, is the most common congenital condition identified on prenatal ultrasonography. UTD can be physiologic and resolve spontaneously or can be caused by various congenital anomalies of the urinary tract, which can lead to renal failure if not treated properly. In 2014, a multidisciplinary consensus group established UTD definitions, a classification system, and a standardized scheme for perinatal evaluation. Various imaging modalities are available to help diagnose the cause of UTD in fetuses and neonates and to help identify those patients who may benefit from fetal or early postnatal intervention. In this article, we will review the diagnosis and quantification of antenatal and postnatal UTD based on the UTD classification system, outline the imaging studies available to both evaluateUTD and determine its cause, briefly review the most common causes of UTD in the fetus and neonate, outline management strategies for UTD including the role for fetal intervention and prophylactic antibiotics, and report on the outcome and prognosis in patients with UTD.
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Affiliation(s)
- Katherine Vincent
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Heidi J Murphy
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Katherine E Twombley
- Division of Pediatric Nephrology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC
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Yalçınkaya F, Özçakar ZB. Management of antenatal hydronephrosis. Pediatr Nephrol 2020; 35:2231-2239. [PMID: 31811536 DOI: 10.1007/s00467-019-04420-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 11/04/2019] [Accepted: 11/08/2019] [Indexed: 02/06/2023]
Abstract
Antenatal hydronephrosis (AHN) is the most frequently detected abnormality by prenatal ultrasonography. Differential diagnosis of AHN includes a wide variety of congenital abnormalities of the kidney and urinary tract ranging from mild abnormalities such as transient or isolated AHN to more important ones as high-grade congenital vesicoureteral reflux or ureteropelvic junction obstruction. It is well known that the outcome depends on the underlying etiology. Various grading systems have been proposed for the classification of AHN on prenatal and postnatal ultrasonography. Mild isolated AHN represents up to 80% of cases, is considered to be benign, and majority of them resolve, stabilize, or improve during follow-up. Controversies exist regarding the diagnosis and management of some important and severe causes of AHN such as high-grade vesicoureteral reflux and ureteropelvic junction obstruction. Current approach is becoming increasingly conservative during diagnosis and follow-up of these patients with less imaging and close follow-up. However, there is still no consensus regarding the clinical significance, postnatal evaluation, and management of infants with AHN. The aim of this review is to discuss the controversies and provide an overview on the management of AHN.
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Affiliation(s)
- Fatoş Yalçınkaya
- Department of Pediatrics, Division of Pediatric Nephrology, Ankara University School of Medicine, Ankara, Turkey. .,Çocuk Hastanesi, Çocuk Nefroloji B.D, Ankara Üniversitesi Tıp Fakültesi, Dikimevi, 06100, Ankara, Turkey.
| | - Z Birsin Özçakar
- Department of Pediatrics, Division of Pediatric Nephrology, Ankara University School of Medicine, Ankara, Turkey
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Agard H, Massanyi E, Albertson M, Anderson M, Alam M, Lyden E, Del Rio CV. The different elements of the Urinary Tract Dilation (UTD) Classification System and their capacity to predict findings on mercaptoacetyltriglycine (MAG3) diuretic renography. J Pediatr Urol 2020; 16:686.e1-686.e6. [PMID: 32888887 DOI: 10.1016/j.jpurol.2020.07.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/27/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The UTD Classification System risk stratifies postnatal UTD into three groups: low risk (UTD P1), intermediate risk (UTD P2), and high risk (UTD P3). In the original consensus document, a functional scan is not recommended for UTD P1 and is left to the discretion of the clinician for UTD P2 and P3. OBJECTIVE This study aims to understand which patients with postnatal urinary tract dilation would benefit from a functional study. We investigated how different elements of the UTD classification system predict differential renal function (DRF) and diuretic half-life (T½) on MAG3 scan in infants undergoing evaluation for prenatally detected UTD. STUDY DESIGN This is a multicenter retrospective chart review of infants 6 months of age or younger evaluated for prenatal UTD, correlating their first MAG3 scan and first postnatal renal ultrasound (RUS). Multivariable logistic regression was used to find UTD elements predictive of DRF < 40% and/or T½ > 20 min. RESULTS A total of 517 patients met study criteria. Median age at time of RUS and MAG3 renal scan was 48 days (IGR 31-81) and 63 days (IQR 45-98), respectively. DRF < 40% was found in 6% of kidneys with UTD P2 and 35% of kidneys with UTD P3. T½ > 20 min was found in 31% of kidneys with UTD P2 and 79% of kidneys with UTD P3. An abnormal ureter (OR 2.7, 95% CI 1.2-6.0) and parenchymal thinning (OR 16, 95% CI 5.8-41.4) were significant at predicting DRF < 40%. Parenchymal thinning (OR 3.0, 95% CI 1.5-6.1) also predicted T½ > 20 min, as did each cm increase in the anterior-posterior renal pelvic diameter (APRPD) (OR 4.8, 95% CI 3.0-7.7). DISCUSSION The UTD system discriminates well and correlates with the likelihood of finding adverse features on diuretic renography. Patients in the UTD P3 high-risk category had a significantly higher incidence of decreased differential renal function and delayed drainage than those in UTD P1 and P2. Of the individual components of the UTD Classification system, the presence of parenchymal thinning was the most important factor in predicting both decreased differential renal function and delayed drainage. CONCLUSION Given the high incidence of poor function and delayed drainage seen in the UTD P3 group, we believe a functional study should be recommended in the evaluation of these patients. Our findings support leaving the performance of a functional study at the discretion of the physician for UTD P2.
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Affiliation(s)
- Hannah Agard
- Department of Urology, Cleveland Clinic Akron General, 1 Akron General Avenue, Akron, OH, USA.
| | - Eric Massanyi
- Pediatric & Adolescent Urology, Inc./Akron Children's Hospital, 215 West Bowery Street, Akron, OH, USA.
| | - Megan Albertson
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI, USA; Department of Radiology, University of Nebraska Medical Center, 42nd and Emile, Omaha, NE, USA.
| | - Matthew Anderson
- Department of Biostatistics, University of Nebraska Medical Center College of Public Health 42nd and Emile, Omaha, NE, USA
| | - Morshed Alam
- Department of Biostatistics, University of Nebraska Medical Center College of Public Health 42nd and Emile, Omaha, NE, USA
| | - Elizabeth Lyden
- Department of Biostatistics, University of Nebraska Medical Center College of Public Health 42nd and Emile, Omaha, NE, USA
| | - Carlos Villanueva Del Rio
- Phoenix Children's Urology/Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ, USA; Children's Hospital & Medical Center/University of Nebraska Medical Center, 8200 Dodge Street, Omaha, NE, USA.
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More SS, Lazarus J, Brink A. Renal cortical transit time as a predictor for pyeloplasty in pediatric patients with unilateral hydronephrosis. World J Nucl Med 2020; 19:341-346. [PMID: 33623502 PMCID: PMC7875046 DOI: 10.4103/wjnm.wjnm_11_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/07/2020] [Accepted: 05/01/2020] [Indexed: 11/15/2022] Open
Abstract
Majority of patients with unilateral hydronephrosis (HN) detected on ultrasound do not require pyeloplasty. The measurement of the cortical transit time (CTT) has been demonstrated by several authors to predict the need for patients who may require pyeloplasty. The study aimed to assess if CTT would have predicted a drop in differential renal function (DRF) in patients with unilateral HN on the affected side and to assess whether CTT would differ on the first renogram between those patients who had a pyeloplasty and those who did not have a pyeloplasty. Sixty-eight patients with at least two renograms with unilateral HN with a normal contralateral kidney were observed retrospectively. The CTT was recorded for each kidney. Renograms were processed three times to measure the DRF. The mean of the three DRF measurements was used for analysis. The mean CTT of the left and right hydronephrotic kidneys was 6.0 min and 6.7 min, respectively. The relationship between CTT and DRF as well as CTT and anterior posterior diameter in the first renogram of those patients who did not have a pyeloplasty was statistically significant (P < 0.05). In the 20 patients who had a pyeloplasty, there was a drop of more than 10% in the DRF of three patients. No significant difference was found in CTT or DRF when comparing the group who had surgery against the group who did not have surgery. The current study was unable to demonstrate in our series of patients that CTT can predict a drop in DRF in those patients who would require pyeloplasty.
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Affiliation(s)
- Stuart S More
- Division of Nuclear Medicine, Groote Schuur Hospital and Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - John Lazarus
- Division of Urology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Anita Brink
- Division of Nuclear Medicine, Groote Schuur Hospital and Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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Han JH, Song SH, Lee JS, Nam W, Kim SJ, Park S, Kim KS. Best ultrasound parameter for prediction of adverse renal function outcome after pyeloplasty. Int J Urol 2020; 27:775-782. [PMID: 32613678 DOI: 10.1111/iju.14299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/26/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the clinical value of preoperative ultrasound parameters for post-pyeloplasty outcomes in pediatric patients with ureteropelvic junction obstruction. METHODS The medical records of 187 pediatric and adolescent patients who underwent pyeloplasty as a result of ureteropelvic junction obstruction between 2010 and 2016 were retrospectively reviewed. The severity of hydronephrosis was measured by the Society for Fetal Urology grade, anteroposterior pelvic diameter, urinary tract dilation, hydronephrosis index, and the hydronephrosis area to renal parenchyma ratio at 3, 6 and 12 months. Adverse renal function outcome was defined as ≥10% decrease in postoperative differential renal function compared with preoperative values. RESULTS Of the 187 patients, preoperative hydronephrosis was categorized as Society for Fetal Urology grade 3 in 26 patients (13.9%) and grade 4 in 161 patients (86.1%). No surgical failures, defined as requirement of repeat surgery or deterioration of hydronephrosis grade, were noted. The mean changes in Society for Fetal Urology grade, anteroposterior pelvic diameter, urinary tract dilation and hydronephrosis area to renal parenchyma ratio showed similar trends of recovery during the follow-up period. In total, 19 patients (10.2%) showed >10% decrease in differential renal function during follow up (mean 42 months). Multivariate logistic regression analysis showed that the hydronephrosis area-to-renal parenchyma ratio was the only significant prognostic factor for adverse renal function outcome (hazard ratio 1.806, 95% confidence interval 1.210-2.859, P = 0.005). Receiver operating characteristic analysis showed that the hydronephrosis area-to-renal parenchyma ratio was the most significant predictive value (area under the curve 0.711, 95% confidence interval 0.618-0.804, P = 0.006). CONCLUSIONS Pediatric patients with high hydronephrosis area-to-renal parenchyma ratio values before surgery are more likely to show renal function decline after pyeloplasty.
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Affiliation(s)
- Jae Hyeon Han
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Hoon Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Je Seong Lee
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wook Nam
- Department of Urology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Sung Jin Kim
- Department of Urology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Sungchan Park
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kun Suk Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Viteri B, Calle-Toro JS, Furth S, Darge K, Hartung EA, Otero H. State-of-the-Art Renal Imaging in Children. Pediatrics 2020; 145:peds.2019-0829. [PMID: 31915193 PMCID: PMC6993529 DOI: 10.1542/peds.2019-0829] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2019] [Indexed: 12/31/2022] Open
Abstract
Imaging modalities for diagnosing kidney and urinary tract disorders in children have developed rapidly over the last decade largely because of advancement of modern technology. General pediatricians and neonatologists are often the front line in detecting renal anomalies. There is a lack of knowledge of the applicability, indications, and nephrotoxic risks of novel renal imaging modalities. Here we describe the clinical impact of congenital anomalies of the kidneys and urinary tract and describe pediatric-specific renal imaging techniques by providing a practical guideline for the diagnosis of kidney and urinary tract disorders.
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Affiliation(s)
- Bernarda Viteri
- Division of Nephrology, Department of Pediatrics and .,Division of Body Imaging, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Juan S. Calle-Toro
- Division of Body Imaging, Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Susan Furth
- Division of Nephrology, Department of Pediatrics and,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kassa Darge
- Division of Body Imaging, Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erum A. Hartung
- Division of Nephrology, Department of Pediatrics and,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hansel Otero
- Division of Body Imaging, Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Ucar AK, Kurugoglu S. Urinary Ultrasound and Other Imaging for Ureteropelvic Junction Type Hydronephrosis (UPJHN). Front Pediatr 2020; 8:546. [PMID: 33042907 PMCID: PMC7526330 DOI: 10.3389/fped.2020.00546] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/29/2020] [Indexed: 12/14/2022] Open
Abstract
Ultrasound is the main imaging study used to diagnose ureteropelvic junction (UPJ) obstruction. On ultrasound, abnormal dilatation of the pelvicalyceal system of varying degrees is seen, whereas the ureter is normal in caliber. A properly performed study provides essential information regarding laterality, renal size, thickness, and architecture of the renal cortex and degree of dilatation of the pelvicalyceal system. Doppler ultrasound may identify a crossing vessel, when present. This imaging method also has been used differentiating obstructive from non-obstructive hydronephrosis by renal arterial resistive index measurements. Abdominal radiographs may show soft tissue fullness, bulging of the flank, and displacement of bowel loops from the affected side. The voiding/micturating cystourethrogram helps exclude other causes of upper tract dilatation, including vesicoureteral reflux, urethral valves, and ureteroceles. Computerized Tomography angiography with multiplanar reformation and three-dimensional images may be used to depict suspected crossing vessels as a cause of UPJ obstruction in older children and adults. Magnetic Resonance Urography has progressed significantly in recent years due to the development of both hardware and software that are used to generate high-resolution images. This imaging technique currently allows for the detailed assessment of urinary tract anatomy, while also providing information regarding renal function, including differential renal function, and the presence or absence of obstructive uropathy.
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Affiliation(s)
- Ayse Kalyoncu Ucar
- Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Sebuh Kurugoglu
- Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
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Hurt L, Wright M, Demmler J, VanDerVoort J, Morris S, Brook F, Tucker D, Chapman M, Francis NA, Daniel R, Fone D, Brophy S, Paranjothy S. Mild-to-moderate renal pelvis dilatation identified during pregnancy and hospital admissions in childhood: An electronic birth cohort study in Wales, UK. PLoS Med 2019; 16:e1002859. [PMID: 31361739 PMCID: PMC6667131 DOI: 10.1371/journal.pmed.1002859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/21/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a growing contributor to the global burden of noncommunicable diseases. Early diagnosis and treatment can reduce the severity of kidney damage and the need for dialysis or transplantation. It is not known whether mild-to-moderate renal pelvis dilatation (RPD) identified at 18-20 weeks gestation is an early indicator of renal pathology. The aim of this follow-up to the Welsh Study of Mothers and Babies was to assess the risk of hospital admission in children with mild-to-moderate antenatal RPD compared with children without this finding. We also examined how the natural history of the RPD (whether the dilatation persists in later pregnancy or postpartum) or its characteristics (unilateral versus bilateral) changed the risk of hospital admission. METHODS/FINDINGS This population-based cohort study included singleton babies born in Wales between January 1, 2009, and December 31, 2011 (n = 22,045). We linked ultrasound scan data to routinely available data on hospital admissions from the Patient Episode Database for Wales (PEDW). The outcome was a hospital admission for urinary tract causes (defined by an expert study steering group) in the first three years of life. We used Cox regression to model time to first hospital admission, according to whether there was evidence of RPD at the fetal anomaly scan (FAS) and/or evidence of dilatation in later investigations, adjusting for other predictors of admission. We used multiple imputation with chained equations to impute values for missing data. We included 21,239 children in the analysis. The risk of at least one hospital admission was seven times greater in those with RPD (n = 138) compared with those without (n = 21,101, conditional hazard ratio [cHR] 7.23, 95% confidence interval [CI] 4.31-12.15, p < 0.001). The risk of hospital admission was higher in children with RPD at the FAS and later dilatation (cHR 25.13, 95% CI 13.26-47.64, p < 0.001) and in children without RPD at the FAS who had later dilatation (cHR 62.06, 95% CI 41.10-93.71, p < 0.001) than in children without RPD (n = 21,057). Among children with RPD at the FAS but no dilatation in later pregnancy or postpartum, we did not find an association with hospital admissions (cHR 2.16, 95% CI 0.69-6.75, p = 0.185), except when the initial dilatation was bilateral (cHR 4.77, 95% CI 1.17-19.47, p = 0.029). Limitations of the study include small numbers in subgroups (meaning that these results should be interpreted with caution), that less severe outcomes (such as urinary tract infections [UTIs] managed in the community or in outpatients) could not be included in our analysis, and that obtaining records of radiological investigations later in pregnancy and postpartum was challenging. Our conclusions were consistent after conducting sensitivity analyses to account for some of these limitations. CONCLUSIONS In this large population-based study, children with RPD at the FAS had higher rates of hospital admissions when there was persistent dilatation in later pregnancy or postpartum. Our results can be used to improve counselling of parents and develop care pathways for antenatal screening programmes, including protocols for reporting and further investigation of RPD.
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Affiliation(s)
- Lisa Hurt
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Melissa Wright
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Joanne Demmler
- Swansea University Medical School, Swansea, United Kingdom
| | - Judith VanDerVoort
- Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, United Kingdom
| | - Susan Morris
- Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, United Kingdom
| | - Fiona Brook
- Aneurin Bevan University Health Board, Caerleon, Newport, United Kingdom
| | - David Tucker
- Congenital Anomaly Register and Information Service, Singleton Hospital, Swansea, United Kingdom
| | - Maria Chapman
- Antenatal Screening Wales, Public Health Wales, Cardiff, United Kingdom
| | - Nick A. Francis
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Rhian Daniel
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - David Fone
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Sinead Brophy
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Shantini Paranjothy
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, United Kingdom
- * E-mail:
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Rater reliability of postnatal urinary tract dilation consensus classification. Pediatr Radiol 2018; 48:1606-1611. [PMID: 29926146 DOI: 10.1007/s00247-018-4173-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/17/2018] [Accepted: 06/07/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND A multidisciplinary urinary tract dilation (UTD) classification system was published in 2014 to standardize definitions and renal/bladder ultrasound image interpretation. OBJECTIVE To evaluate intra- and inter-rater reliability of this system on postnatal RBUS. MATERIALS AND METHODS Renal/bladder US of 60 infants (<12 months) with urinary tract dilation were anonymized, retrospectively reviewed and scored twice using the UTD classification system by a pediatric urologist and four pediatric radiologists. Exams included supine and prone images of each kidney. Raters recorded the anterior posterior renal pelvis diameter in each position; and when present calyceal dilation (central and peripheral), ureteral dilation, parenchymal and bladder abnormalities. A UTD score was given to each kidney based on these components. RESULTS Intraclass correlation (ICC) of anterior posterior renal pelvis diameter measures was 0.99 (P<0.001). Intra-rater reliability for the anterior posterior renal pelvis diameter of each kidney was high, with ICC >0.95 (P<0.001). Inter-rater kappa values for UTD scores of both kidneys ranged from 0.60 to 0.77 (P <0.001). Intra-rater kappa values for UTD scores of both kidneys ranged from 0.74 to 0.92 (P <0.001). Of the six categories comprising the UTD score, discrepancy between raters was highest for interpretation of central and peripheral calyceal dilation. CONCLUSION Present inter- and intra-rater reliability findings were similar to those previously reported for grading systems for urinary tract dilation. Across these studies, kappa values are generally lower than the 0.8 cut-off advocated for medical measures. Here, calyceal dilation commonly determined the kidney UTD score and was also the source of greatest discrepancy between raters. Improving consistency of calyceal dilation interpretation may improve UTD consensus score reliability.
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Nguyen HB. Expert opinion: "1 Voice": Learn Urinary Tract Dilation (UTD) classification to assess fetal & newborn urological ultrasound findings. J Pediatr Urol 2017; 13:563. [PMID: 29248274 DOI: 10.1016/j.jpurol.2017.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 11/10/2017] [Indexed: 10/18/2022]
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