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Nhungo CJ, Mwakalukwa KR, Wambura EP, Kibona HG, Mushi FA, Msangi NS, Maro IM, Kimu NM, Nyongole OV, Mkony CA. Surgical management of high-grade vesicoureteral reflux in an 18-month-old female with a solitary kidney: A case report from a resource-limited setting. Clin Case Rep 2024; 12:e9132. [PMID: 38966288 PMCID: PMC11222966 DOI: 10.1002/ccr3.9132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/23/2024] [Accepted: 06/13/2024] [Indexed: 07/06/2024] Open
Abstract
Key Clinical Message Conservative nonsurgical therapy ensures that the resolution is nearly 80% for vesicoureteral reflux grades I and II and 30%-50% for vesicoureteral reflux grades III and V within 4-5 years of follow-up. Open surgical reimplantation of ureters of grades IV and V is a highly successful procedure, with reported correction rates ranging from 95% to 99% regardless of the severity of vesicoureteral reflux. Abstract Patients with vesicoureteral reflux present with a wide range of severity. With an incidence of approximately 1%, vesicoureteral reflux is a relatively common urological abnormality in children. Postnatal diagnosis of vesicoureteral reflux is typically made following a diagnosis of a urinary tract infection and less frequently following family screening. Voiding cystourethrograms remain the gold standard for diagnosing vesicoureteral reflux. To preserve the kidney and prevent the need for potential renal replacement therapy, infants with a single kidney require significantly more assessments and prompt decision-making. Surgical correction is advised for patients with vesicoureteral reflux grades IV and V, while vesicoureteral reflux grades I, II, and III are managed conservatively.
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Affiliation(s)
- Charles John Nhungo
- Department of Surgery, School of MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Kelvin Richard Mwakalukwa
- Department of Surgery, School of MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Erasto Phares Wambura
- Department of Surgery, School of MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | | | - Fransia Arda Mushi
- Department of Surgery, School of MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | | | | | - Njiku Marko Kimu
- Department of UrologyMuhimbili National HospitalDar es salaamTanzania
| | - Obadia Venance Nyongole
- Department of Surgery, School of MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Charles A. Mkony
- Department of Surgery, School of MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
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2
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Gulyuz A, Tekin M. The Diagnostic Efficacy of and Requirement for Postnatal Ultrasonography Screening for Congenital Anomalies of the Kidney and Urinary Tract. Diagnostics (Basel) 2023; 13:3106. [PMID: 37835849 PMCID: PMC10572234 DOI: 10.3390/diagnostics13193106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND We aimed to investigate the efficacy of postnatal ultrasonography in detecting congenital anomalies of the kidneys and urinary tract in term infants without prenatal history of congenital anomalies of the kidneys and urinary tract. METHODS In this retrospective cohort study, we reviewed the records of term infants between six weeks and three months of age who underwent urinary tract ultrasonography during routine pediatric care. RESULTS Congenital anomalies of the kidneys and urinary tract were detected on prenatal ultrasonography in 75 of the 2620 patients included in the study. Congenital anomalies of the kidneys and urinary tract were detected via postnatal USG in 46 (1.8%) of 2554 patients without anomalies on prenatal USG screening. The most common anomaly was hydronephrosis (69.6%). Thirty-two cases of hydronephrosis, three cases of renal agenesis, four cases of horseshoe kidney, one case of MCDK, and two cases of duplex systems which were not detected on prenatal USG were detected on postnatal USG. On the other hand, 29 (1.1%) cases with mild or moderate hydronephrosis on prenatal ultrasonography did not have hydronephrosis on postnatal ultrasonography. CONCLUSIONS In our study, approximately one-third of the cases of hydronephrosis, unilateral renal agenesis, duplex systems, horseshoe kidney, and ectopic kidney were not detected in prenatal ultrasonography screening. Therefore, we believe that in addition to prenatal ultrasonography screening, postnatal ultrasonography screening of all children for urinary tract anomalies would be beneficial.
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Affiliation(s)
- Abdulgani Gulyuz
- Department of Pediatrics, School of Medicine, Turgut Ozal University, 06560 Malatya, Turkey;
| | - Mehmet Tekin
- Department of Pediatrics, School of Medicine, Inonu University, 44280 Malatya, Turkey
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3
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Valavi E, Nickavar A, Parsamanesh M. Reliability of Sonography for the Prediction of Vesicoureteral Reflux in Children With Mild Hydronephrosis. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021. [DOI: 10.1177/8756479321990642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Postnatal evaluation of vesicoureteral reflux (VUR) remains controversial in patients with antenatal hydronephrosis (HN). The objective of this study was to identify the significance of mild postnatal HN as a marker of VUR and its severity. Materials and Methods: Sonographic findings of 248 children (351 kidneys) with persistent postnatal HN were evaluated for the incidence and severity of primary VUR. Results: The majority of patients had mild (67.8%) HN, followed by moderate (27.6%) and severe (4.6%) HN. VUR was identified in 14.7% of patients with mild HN, 18.5% of patients with moderate HN, and 18.7% of patients with severe HN. About 11.44% of patients with mild HN had low-grade VUR, followed by moderate (45.71 %) and severe grades (42.85%). Conclusion: A large number (89%) of patients with mild HN had moderate to severe VUR. In this cohort, renal sonography was not a reliable method for the prediction of VUR and its severity in patients with mild postnatal HN. However, it was reliable for high grades of VUR. These results are limited due to the study design and the inability to generalize these findings. These results should be replicated across other multiple clinics, thereby recruiting more variety of patients, to validate these study recommendations.
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Affiliation(s)
- Ehsan Valavi
- Pediatric Nephrology Department, Chronic Renal Failure Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Azar Nickavar
- Pediatric Nephrology Department, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Parsamanesh
- Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Brown BP, Simoneaux SF, Dillman JR, Rigsby CK, Iyer RS, Alazraki AL, Bardo DME, Chan SS, Chandra T, Dorfman SR, Garber MD, Moore MM, Nguyen JC, Peters CA, Shet NS, Siegel A, Waseem M, Karmazyn B. ACR Appropriateness Criteria® Antenatal Hydronephrosis-Infant. J Am Coll Radiol 2020; 17:S367-S379. [PMID: 33153550 DOI: 10.1016/j.jacr.2020.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/01/2020] [Indexed: 12/28/2022]
Abstract
Antenatal hydronephrosis is the most frequent urinary tract anomaly detected on prenatal ultrasonography. It occurs approximately twice as often in males as in females. Most antenatal hydronephrosis is transient with little long-term significance, and few children with antenatal hydronephrosis will have significant obstruction, develop symptoms or complications, and require surgery. Some children will be diagnosed with more serious conditions, such as posterior urethral valves. Early detection of obstructive uropathy is necessary to mitigate the potential morbidity from loss of renal function. Imaging is an integral part of screening, diagnosis, and monitoring of children with antenatal hydronephrosis. Optimal timing and appropriate use of imaging can reduce the incidence of late diagnoses and prevent renal scarring and other complications. In general, follow-up neonatal ultrasound is recommended for all cases of antenatal hydronephrosis, while further imaging, including voiding cystourethrography and nuclear scintigraphy, is recommended for moderate or severe cases, or when renal parenchymal or bladder wall abnormalities are suspected. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Brandon P Brown
- Riley Hospital for Children and Indiana University School of Medicine, Indianapolis, Indiana.
| | | | | | - Cynthia K Rigsby
- Panel Chair, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ramesh S Iyer
- Panel Vice-Chair, Seattle Children's Hospital, Seattle, Washington
| | - Adina L Alazraki
- Children's Healthcare of Atlanta and Emory University, Atlanta, Georgia
| | | | | | | | | | - Matthew D Garber
- Wolfson Children's Hospital, Jacksonville, Florida; American Academy of Pediatrics
| | - Michael M Moore
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Jie C Nguyen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Craig A Peters
- UT Southwestern Medical Center, Dallas, Texas; Society for Pediatric Urology
| | - Narendra S Shet
- Children's National Hospital, Washington, District of Columbia
| | - Alan Siegel
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Muhammad Waseem
- Lincoln Medical Center, Bronx, New York; American College of Emergency Physicians
| | - Boaz Karmazyn
- Specialty Chair, Riley Hospital for Children Indiana University, Indianapolis, Indiana
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5
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Bakalis S, Cao K, Graham R, Cuckow P, Johal N, Winyard P, Pandya P, Desai D. Outcomes of urinary tract abnormalities diagnosed by the routine third trimester scan. Eur J Obstet Gynecol Reprod Biol 2020; 250:150-154. [PMID: 32442840 DOI: 10.1016/j.ejogrb.2020.05.008] [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: 01/08/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study is to determine the incidence of congenital abnormalities of the kidneys and urinary tract (CAKUT) detected for the first time in an unselected population undergoing a routine third trimester scan between 30-34 week's gestation. METHODS This was a retrospective analysis of 8562 routine third trimester ultrasound scans during which the fetal anatomy was evaluated, and, any structural abnormalities detected, recorded onto a fetal database which was subsequently analysed for CAKUT. All postnatal records of antenatally diagnosed CAKUT were obtained and analysed for diagnosis and management. RESULTS There were 26 cases of urological abnormalities detected for the first time in the third trimester. The most frequent abnormality was unilateral renal pelvis dilatation (73%). Postnatal ultrasound confirmed abnormalities in 19 (73%) newborns, with two (8%) resolving antenatally and four (15%) postnatally. The overall incidence of new CAKUT detected by the third trimester scan was 0.22% (19/8562) with a male to female ratio of 1:1.6. Four patients required surgery, two received cystoscopic injection of Deflux with circumcision, one received cystoscopic valve ablation and one patient received a staged hypospadias repair. CONCLUSION Routine third trimester scanning is already performed in many countries with proposed benefits primarily directed towards the monitoring of fetal growth and late pregnancy malpresentation. For healthcare systems that still utilize two routine scans, debate is ongoing as to the value of introducing a routine third trimester scan. The ability to detect additional and potentially missed CAKUT is a further benefit, which in isolation is likely of too small an impact to merit implementation. However, the combination of fetal structural assessment, growth velocity monitoring and fetal presentation evaluation presents a strong case for inclusion in an antenatal screening program. The findings of this study highlight the importance of a detailed fetal structural evaluation at each antenatal ultrasound scan.
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Affiliation(s)
- Spyros Bakalis
- Department of Obstetrics, Fetal and Maternal Medicine, Guy's and St Thomas NHS Trust, London, UK.
| | - Kevin Cao
- Department of Urology, Great Ormond Street Hospital for Children, London, UK
| | - Radha Graham
- Department of Obstetrics and Gynaecology, Homerton University Hospital, London, UK
| | - Peter Cuckow
- Department of Urology, Great Ormond Street Hospital for Children, London, UK
| | - Nav Johal
- Department of Urology, Great Ormond Street Hospital for Children, London, UK
| | - Paul Winyard
- Department of Nephrology, Great Ormond Street Hospital for Children, London, UK
| | - Pranav Pandya
- Fetal Medicine Unit, University College London Hospital, London, UK
| | - Divyesh Desai
- Department of Urology, Great Ormond Street Hospital for Children, London, UK
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6
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Miyakita H, Hayashi Y, Mitsui T, Okawada M, Kinoshita Y, Kimata T, Koikawa Y, Sakai K, Satoh H, Tokunaga M, Naitoh Y, Niimura F, Matsuoka H, Mizuno K, Kaneko K, Kubota M. Guidelines for the medical management of pediatric vesicoureteral reflux. Int J Urol 2020; 27:480-490. [PMID: 32239562 PMCID: PMC7318347 DOI: 10.1111/iju.14223] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/10/2020] [Indexed: 12/27/2022]
Abstract
Urinary tract infection is a bacterial infection that commonly occurs in children. Vesicoureteral reflux is a major underlying precursor condition of urinary tract infection, and an important disorder in the field of pediatric urology. Vesicoureteral reflux is sometimes diagnosed postnatally in infants with fetal hydronephrosis diagnosed antenatally. Opinions vary regarding the diagnosis and treatment of vesicoureteral reflux, and diagnostic procedures remain debatable. In terms of medical interventions, options include either follow‐up observation in the hope of possible spontaneous resolution of vesicoureteral reflux with growth/development or provision of continuous antibiotic prophylaxis based on patient characteristics (age, presence/absence of febrile urinary tract infection, lower urinary tract dysfunction and constipation). Furthermore, there are various surgical procedures with different indications and rationales. These guidelines, formulated and issued by the Japanese Society of Pediatric Urology to assist medical management of pediatric vesicoureteral reflux, cover the following: epidemiology, clinical practice algorithm for vesicoureteral reflux, syndromes (dysuria with vesicoureteral reflux, and bladder and rectal dysfunction with vesicoureteral reflux), diagnosis, treatment (medical and surgical), secondary vesicoureteral reflux, long‐term prognosis and reflux nephropathy. They also provide the definition of bladder and bowel dysfunction, previously unavailable despite their close association with vesicoureteral reflux, and show the usefulness of diagnostic tests, continuous antibiotic prophylaxis and surgical intervention using site markings.
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Affiliation(s)
- Hideshi Miyakita
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Tokai University Oiso Hospital, Oiso, Kanagawa, Japan
| | - Yutaro Hayashi
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Takahiko Mitsui
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, University of Yamanashi Graduate School of Medical Sciences, Chuo, Yamanashi, Japan
| | - Manabu Okawada
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatric General and Urogenital Surgery, Juntendo University Hospital, Tokyo, Japan
| | - Yoshiaki Kinoshita
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatric Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Takahisa Kimata
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatrics, Kansai Medical University, Hirakata, Osaka, Japan
| | - Yasuhiro Koikawa
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Fukuoka City Medical Center of Sick Children, Fukuoka, Japan
| | - Kiyohide Sakai
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Miyagi Children's Hospital, Sendai, Miyagi, Japan
| | - Hiroyuki Satoh
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology and Kidney Transplantation, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Masatoshi Tokunaga
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Tokai University Oiso Hospital, Oiso, Kanagawa, Japan
| | - Yasuyuki Naitoh
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Fumio Niimura
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatrics, Tokai University School of Medicine, Hiratsuka, Kanagawa, Japan
| | - Hirofumi Matsuoka
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kentaro Mizuno
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Kazunari Kaneko
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatrics, Kansai Medical University, Hirakata, Osaka, Japan
| | - Masayuki Kubota
- Committee for the Formulation of Medical Management Guidelines for Pediatric Vesicoureteral Reflex, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatric Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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7
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Kurtz MP, Nelson CP. Urology Mythbusters: should hydronephrosis grade be used to decide which newborns should undergo voiding cystourethrogram? J Pediatr Urol 2019; 15:93-96. [PMID: 30442542 DOI: 10.1016/j.jpurol.2018.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/02/2018] [Accepted: 10/09/2018] [Indexed: 12/19/2022]
Abstract
In this episode of Mythbusters the premise that among infants with prenatally identified urinary tract dilation (UTD), voiding cystourethrogram (VCUG) should be performed in those with higher grade UTD but not in those with lower grade UTD is critically examined. It is concluded that severity of dilation is not strongly associated with risk of vesicoureteral reflux or other anomalies diagnosed by VCUG. Therefore, using hydronephrosis grade to decide which infants with UTD should undergo VCUG is not evidence based.
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Affiliation(s)
- Michael P Kurtz
- Boston Children's Hospital and Harvard Medical School, Boston MA United States
| | - Caleb P Nelson
- Boston Children's Hospital and Harvard Medical School, Boston MA United States.
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8
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Chiodini B, Ghassemi M, Khelif K, Ismaili K. Clinical Outcome of Children With Antenatally Diagnosed Hydronephrosis. Front Pediatr 2019; 7:103. [PMID: 30984723 PMCID: PMC6449796 DOI: 10.3389/fped.2019.00103] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/05/2019] [Indexed: 01/29/2023] Open
Abstract
Fetal renal pelvis dilation is a common condition, which is observed in 1-4. 5% of pregnancies. In many cases, this finding resolves spontaneously. However, sometimes it may be a signal of significant urinary tract pathologies. The main abnormalities found after birth are uretero-pelvic junction stenosis, primary vesicoureteral reflux, megaureter, duplex kidneys, and posterior urethral valves, with uretero-pelvic junction stenosis and primary vesicoureteral reflux accounting for most of the cases. Diagnosis, management, and prognosis at short and longer term of these conditions will be reviewed in this article.
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Affiliation(s)
- Benedetta Chiodini
- Department of Pediatric Nephrology, Hôpital des Enfants Reine-Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Mehran Ghassemi
- Department of Medical Imaging, Hôpital des Enfants Reine-Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Karim Khelif
- Department of Pediatric Urology, Hôpital des Enfants Reine-Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Khalid Ismaili
- Department of Pediatric Nephrology, Hôpital des Enfants Reine-Fabiola, Université Libre de Bruxelles, Brussels, Belgium
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9
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Duin LK, Nijhuis JG, Scherjon SA, Vossen M, Willekes C. Comparison of conventional versus three-dimensional ultrasound in fetal renal pelvis measurement and their potential prediction of neonatal uropathies. J Matern Fetal Neonatal Med 2015; 29:2494-9. [PMID: 26430907 DOI: 10.3109/14767058.2015.1090970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To establish a threshold value for fetal renal pelvis dilatation measured by automatic volume calculation (SonoAVC) in the third trimester of pregnancy to predict neonatal uropathies, and to compare these results with conventional antero-posterior (AP) measurement, fetal kidney 3D volume and renal parenchymal thickness. METHODS In a prospective cohort study, 125 fetuses with renal pelvis AP diameter of ≥5 mm both at 20 weeks of gestation and in the third trimester, underwent an additional 3D volume measurement of the fetal kidney in the third trimester. Receiver operating characteristic (ROC) curves for establishing threshold values for fetal renal pelvis volume, AP measurement, fetal kidney volume and renal parenchymal thickness to predict neonatal uropathies were analyzed. Also, sensitivity, specificity, area under the curve (AUC) and likelihood ratios were calculated. RESULTS A cut-off point of 1.58 cm³ was identified in the third trimester of pregnancy (AUC 0.865 (95% CI 0.789-0.940), sensitivity 76.3%, specificity 87.4%, LR+ 6.06, LR- 0.27) for measurements with SonoAVC. A cut-off value of 11.5 mm was established in the third trimester of pregnancy (AUC 0.828 (95% CI 0.737-0.918), sensitivity 71.1%, specificity 85.1%, LR+ 4.77, LR- 0.34) for the conventional AP measurement. A cut-off point for fetal kidney volume was calculated at 13.29 cm³ (AUC 0.769 (95% CI 0.657-0.881), sensitivity 71%, specificity 66%, LR+ 2.09, LR- 0.44). For renal parenchymal thickness, a cut-off point of 8.4 mm was established (AUC 0.216 (95% CI 0.117-0.315), sensitivity 31.6%, specificity 32.6%, LR+ 0.47, LR- 2.10). CONCLUSION This study demonstrates that 3D fetal renal pelvis volume measurements and AP measurements both have a good and comparable diagnostic performance, fetal renal volume a fair accuracy and renal parenchymal thickness a poor accuracy in predicting postnatal renal outcome.
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Affiliation(s)
- L K Duin
- a Department of Obstetrics and Gynecology , University Medical Center , Groningen , the Netherlands and
| | - J G Nijhuis
- b Department of Obstetrics and Gynecology , Maastricht University Medical Center , Maastricht , the Netherlands
| | - S A Scherjon
- a Department of Obstetrics and Gynecology , University Medical Center , Groningen , the Netherlands and
| | - M Vossen
- b Department of Obstetrics and Gynecology , Maastricht University Medical Center , Maastricht , the Netherlands
| | - C Willekes
- b Department of Obstetrics and Gynecology , Maastricht University Medical Center , Maastricht , the Netherlands
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10
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Chou CY, Chen LC, Cheong ML, Tsai MS. Frequency of postnatal hydronephrosis in infants with a renal anterior–posterior pelvic diameter > 4 mm on midtrimester ultrasound. Taiwan J Obstet Gynecol 2015; 54:554-8. [DOI: 10.1016/j.tjog.2015.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 02/06/2015] [Indexed: 11/27/2022] Open
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11
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Meaning of ureter dilatation during ultrasonography in infants for evaluating vesicoureteral reflux. Eur J Radiol 2014; 84:307-11. [PMID: 25497867 DOI: 10.1016/j.ejrad.2014.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 10/26/2014] [Accepted: 11/11/2014] [Indexed: 11/21/2022]
Abstract
PURPOSE To investigate the meaning of ureter dilatation during ultrasonography (US) in infants for evaluating vesicoureteral reflux (VUR). MATERIALS AND METHODS We retrospectively reviewed abdominal US images of infants who were diagnosed with urinary tract infection (UTI group) or only hydronephrosis without UTI (control group). Hydronephrosis (graded 0-4) and ureter dilatation (present or absent) were evaluated on each side with US. Voiding cystourethrography (VCUG) within 3 months time interval with US was also reviewed and VUR was graded (0-5) on each side. Hydronephrosis, ureter dilatation, and VUR were then compared between the two groups. RESULTS Four hundred and three infants (142 in the UTI group and 261 in the control group) were included and VCUG was performed in 129 infants (68 in UTI and 61 in control groups). VUR grades were not different between the two groups (p=0.252). Hydronephrosis grade was not related to VUR in either group (p>0.05). However, ureter dilatation had a significant relationship with VUR in the UTI group (p=0.015), even among patients with a high-grade VUR (p=0.005). Whereas, ureter dilatation was not associated with VUR in the control group (p=0.744). The relationship between ureter dilatation and VUR was different between the two groups for both all grades (p=0.014) and high-grade (p=0.004) VUR. Ureter dilatation had 66.7% sensitivity, 80.3% specificity, and 79.4% accuracy for evaluating high-grade VUR in the UTI group. CONCLUSION Ureter dilatation on US can be a helpful finding for detecting VUR in infants with UTI, but not infants without UTI.
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12
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Mohammadjafari H, Rafiei A, Abedi M, Aalaee A, Abedi E. The role of urinary TIMP1 and MMP9 levels in predicting vesicoureteral reflux in neonates with antenatal hydronephrosis. Pediatr Nephrol 2014; 29:871-8. [PMID: 24389602 DOI: 10.1007/s00467-013-2693-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 11/01/2013] [Accepted: 11/05/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND Antenatal hydronephrosis (AH) is commonly found on evaluation of pregnant women and 20-30 % of neonates have vesicoureteral reflux (VUR). In order to diagnose VUR, we required invasive testing and exposure of the neonate to radiation. The concentrations of a matrix metalloproteinase, MMP9, and its inhibitor TIMP1, were analyzed in hydronephrotic newborns with VUR and were compared to those without reflux. METHODS The neonates with a history of prenatal hydronephrosis were enrolled in two groups based on imaging study results, the neonates with VUR and without VUR. Neonates with a normal prenatal history and postnatal ultrasound were placed in a third group. We measured the random urinary levels of MMP9, TIMP1, and creatinine, their cut-off values and the MMP9/Cr and MMP9/TIMP1/Cr ratio was calculated, and an ROC curve was drawn. RESULTS Sixty-nine neonates were enrolled in three groups; 27 patients (20 male, seven female) with AH and VUR were in group 1, 23 neonates (19 male, four female) without VUR were placed in group 2, and 19 (15 male, four female) acted as controls in group 3. The differences between the three groups and the normal and total hydronephrotic groups were statistically significant for MMP9, the MMP9/Cr, MMP9/TIMP1, and MMP9/TIMP1/Cr ratios. The urinary TIMP1 and TIMP1/Cr ratios were not significantly different between the groups. A cut-off value of MMP9 was measured as 358.5 ng/ml (sensitivity [sens] 74 %, specificity [spec] 78 %) and was used to compare groups 1 and 2. For groups 2 and 3, this cut-off was 181.00 pg/ml (sens 91 %, spec 89 %). The cut-off values measured for the MMP9/TIMP1 ratio were 30.32 (sens 70 %, spec 61 %) and 9.85 (sens 96 %, spec 89 %) to compare groups 1 and 2, and 2 and 3, respectively. We found no valuable cut-offs for the TIMP1 and TIMP1/Cr values. There was no difference between neonates with mild, moderate, and severe VUR according to urinary biomarker concentrations. CONCLUSIONS Evaluation of urinary levels of MMP9, or the MMP9/Cr, MMP9/TIMP1, or MMP9/TIMP1/Cr ratios may help us to differentiate the newborns with hydronephrosis and VUR from those without reflux.
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Affiliation(s)
- Hamid Mohammadjafari
- Department of Pediatrics, Cellular and Molecular Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran,
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Rasouly HM, Lu W. Lower urinary tract development and disease. WILEY INTERDISCIPLINARY REVIEWS. SYSTEMS BIOLOGY AND MEDICINE 2013; 5:307-42. [PMID: 23408557 PMCID: PMC3627353 DOI: 10.1002/wsbm.1212] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Congenital anomalies of the lower urinary tract (CALUT) are a family of birth defects of the ureter, the bladder, and the urethra. CALUT includes ureteral anomaliesc such as congenital abnormalities of the ureteropelvic junction (UPJ) and ureterovesical junction (UVJ), and birth defects of the bladder and the urethra such as bladder-exstrophy-epispadias complex (BEEC), prune belly syndrome (PBS), and posterior urethral valves (PUVs). CALUT is one of the most common birth defects and is often associated with antenatal hydronephrosis, vesicoureteral reflux (VUR), urinary tract obstruction, urinary tract infections (UTI), chronic kidney disease, and renal failure in children. Here, we discuss the current genetic and molecular knowledge about lower urinary tract development and genetic basis of CALUT in both human and mouse models. We provide an overview of the developmental processes leading to the formation of the ureter, the bladder, and the urethra, and different genes and signaling pathways controlling these developmental processes. Human genetic disorders that affect the ureter, the bladder and the urethra and associated gene mutations are also presented. As we are entering the postgenomic era of personalized medicine, information in this article may provide useful interpretation for the genetic and genomic test results collected from patients with lower urinary tract birth defects. With evidence-based interpretations, clinicians may provide more effective personalized therapies to patients and genetic counseling for their families.
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Affiliation(s)
- Hila Milo Rasouly
- Renal Section, Department of Medicine, Boston University Medical Center, Boston, MA 02118, USA
| | - Weining Lu
- Renal Section, Department of Medicine, Boston University Medical Center, Boston, MA 02118, USA
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Sinha A, Bagga A, Krishna A, Bajpai M, Srinivas M, Uppal R, Agarwal I. Revised guidelines on management of antenatal hydronephrosis. Indian J Nephrol 2013; 23:83-97. [PMID: 23716913 PMCID: PMC3658301 DOI: 10.4103/0971-4065.109403] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Widespread antenatal screening has resulted in increased detection of anomalies of the kidneys and urinary tract. The present guidelines update the recommendations published in 2000. Antenatal hydronephrosis (ANH) is transient and resolves by the third trimester in almost one-half cases. The presence of oligohydramnios and additional renal or extrarenal anomalies suggests significant pathology. All patients with ANH should undergo postnatal ultrasonography; the intensity of subsequent evaluation depends on anteroposterior diameter (APD) of the renal pelvis and/or Society for Fetal Urology (SFU) grading. Patients with postnatal APD exceeding 10 mm and/or SFU grade 3-4 should be screened for upper or lower urinary tract obstruction and vesicoureteric reflux (VUR). Infants with VUR should receive antibiotic prophylaxis through the first year of life, and their parents counseled regarding the risk of urinary tract infections. The management of patients with pelviureteric junction or vesicoureteric junction obstruction depends on clinical features and results of sequential ultrasonography and radionuclide renography. Surgery is considered in patients with increasing renal pelvic APD and/or an obstructed renogram with differential renal function <35-40% or its subsequent decline. Further studies are necessary to clarify the role of prenatal intervention, frequency of follow-up investigations and indications for surgery in these patients.
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Affiliation(s)
- A. Sinha
- Department of Pediatrics, Division of Nephrology, All India Institute of Medical Sciences, Ansari Nagar, India
| | - A. Bagga
- Department of Pediatrics, Division of Nephrology, All India Institute of Medical Sciences, Ansari Nagar, India
| | - A Krishna
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Ansari Nagar, India
| | - M. Bajpai
- Max Institute of Pediatrics and Pediatric Surgery, Vellore, Tamil Nadu, India
| | - M. Srinivas
- Max Institute of Pediatrics and Pediatric Surgery, Vellore, Tamil Nadu, India
| | - R. Uppal
- Uppal Radiology Center, Christian Medical College, Vellore, Tamil Nadu, India
| | - I. Agarwal
- Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India
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Drnasin K, Saraga-Babić M, Saraga M. Clinical importance of pyelocalyceal dilation diagnosed by postnatal ultrasonographic screening of the urinary tract. Med Sci Monit 2013; 19:125-31. [PMID: 23419315 PMCID: PMC3628897 DOI: 10.12659/msm.883786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Ultrasonographic (US) screening of the urinary tract (UT) in infants was used to determine if there is a connection between the frequency of pyelocaliceal dilation (PCD) in asymptomatic infants with normal antenatal US screening and occurrence of congenital anomalies of kidney and urinary tract (CAKUT) and urinary tract infections (UTI). Material/Methods US screening of the UT was performed on 1000 healthy infants, 7 days to 6 months old. Two subgroups of kidneys were described: subgroup 1 contained kidneys with anterior posterior pelvic diameter (APPD) of 5–9.9 mm, and subgroup 2 with APPD over 10 mm. US examinations and methods for detection of UTI and CAKUT were used. Results PCD was found in 74 infants (7.4%): 1.9% of infants had CAKUT, and 8.4% had UTI. In subgroup 1, CAKUT was found in 4 (6.3%) and UTI in 9 (14.3%) infants. In subgroup 2, CAKUT was found in 6 (54.5%), and UTI in 4 (36.4%) infants. Conclusions Mild PCD significantly increases the risk for CAKUT but not for UTI. Moderate to severe PCD significantly increases risk for both CAKUT and UTI. The postnatal US screening of UT is recommended for improved detection of PCD and associated CAKUT. Indirectly, postnatal US screening of UT can help in detecting people at risk for UTI in the first year of life, and therefore help prevent possible kidney damage.
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Tekgül S, Riedmiller H, Hoebeke P, Kočvara R, Nijman RJ, Radmayr C, Stein R, Dogan HS. EAU Guidelines on Vesicoureteral Reflux in Children. Eur Urol 2012; 62:534-42. [DOI: 10.1016/j.eururo.2012.05.059] [Citation(s) in RCA: 205] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 05/25/2012] [Indexed: 11/28/2022]
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Melo BF, Aguiar MB, Bouzada MCF, Aguiar RL, Pereira AK, Paixão GM, Linhares MC, Valerio FC, Simões E Silva AC, Oliveira EA. Early risk factors for neonatal mortality in CAKUT: analysis of 524 affected newborns. Pediatr Nephrol 2012; 27:965-72. [PMID: 22402647 DOI: 10.1007/s00467-012-2107-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 12/14/2011] [Accepted: 12/15/2011] [Indexed: 01/26/2023]
Abstract
BACKGROUND Congenital abnormalities of the kidney and urinary tract (CAKUT) are significant causes of morbidity. The aim of the study was to determine predictive factors of mortality in newborns with CAKUT. METHODS All 29,653 consecutive newborns hospitalized in a tertiary neonatal unit between 1996 and 2006 were evaluated. The main outcome was neonatal mortality. The variables analyzed as risk factors were maternal age, first pregnancy, low birth weight (LBW), prematurity, oligohydramnios, and CAKUT associated with other malformations (Associated CAKUT). RESULTS CAKUT was detected in 524 newborns, with an overall prevalence of 17.7 per 1,000 live births. A total of 325 (62%) cases were classified as urinary tract dilatation, 79 (15.1%) as renal cystic disease, and 120 (22.9%) as other subgroups. In the urinary tract dilatation subgroup, independent risk factors for early mortality were Associated CAKUT [odds ratio (OR) 20.7], prematurity (OR 4.5) LBW (OR 3.8), oligohydramnios (OR 3.0), and renal involvement (OR 3.0). In the renal cystic disease subgroup, two variables remained associated with neonatal mortality: LBW (OR 12.3) and Associated CAKUT (OR 21.4). CONCLUSION The presence of extrarenal anomalies was a strong predictor of poor outcome in a larger series of infants with CAKUT.
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Affiliation(s)
- Batielhe F Melo
- Division of Genetics, Department of Pediatrics, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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Diagnostic Value of Anteroposterior Diameter of Fetal Renal Pelvis During Second and Third Trimesters in Predicting Postnatal Surgery Among Korean Population: Useful Information for Antenatal Counseling. Urology 2012; 79:1132-7. [DOI: 10.1016/j.urology.2012.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Revised: 01/06/2012] [Accepted: 01/06/2012] [Indexed: 11/21/2022]
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Gokce I, Biyikli N, Tugtepe H, Tarcan T, Alpay H. Clinical spectrum of antenatally detected urinary tract abnormalities with respect to hydronephrosis at postnatal ultrasound scan. Pediatr Surg Int 2012; 28:543-52. [PMID: 22426549 DOI: 10.1007/s00383-012-3072-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2012] [Indexed: 12/25/2022]
Abstract
AIM The purpose of this study was to compare the outcome of infants having antenatally detected urinary tract abnormalities (AUTAs) with respect to the presence of hydronephrosis in postnatal ultrasonography (US) examination. PATIENTS AND METHODS Between January 1999 and October 2009, 256 infants diagnosed with AUTAs were prospectively followed. Infants were divided into two groups according to the presence of hydronephrosis in postnatal US examination: Group 1, infants with hydronephrosis; Group 2, infants without hydronephrosis (including renal cyst, agenesis, ectopic kidney). The events of interest were the presence and diagnoses of uropathy, AUTA resolution, urinary tract infection (UTI), development of renal parenchymal defects (RPDs)--focal or global scarring, dysplasia--, acute kidney injury (AKI) and chronic kidney disease (CKD), and the need for surgery and dialysis treatment. RESULTS The most commonly detected underlying abnormalities were ureteropelvic junction obstruction (44.8 %), vesicoureteral reflux (VUR) (30.0 %) and megaureter (9.5 %) in patients with postnatal hydronephrosis. On the other hand, multicystic dysplastic kidney (43.5 %), renal agenesis (19.4 %) and VUR (19.4 %) were mostly encountered abnormalities in patients without postnatal hydronephrosis. RPDs were significantly more common among patients with postnatal hydronephrosis compared to those without hydronephrosis (37 vs. 21 %, P = 0.02). The incidence of UTI and VUR was higher in infants with postnatal hydronephrosis than in infants without hydronephrosis. There was no statistically significant difference in terms of the development of AKI and CKD and the need for surgery and dialysis treatment between patients with hydronephrosis and those without hydronephrosis. CONCLUSION Infants with AUTAs should be investigated postnatally. The findings from this study will help to identify the natural history and outcome of infants with AUTAs according to the postnatal US parameters.
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Affiliation(s)
- Ibrahim Gokce
- Division of Pediatric Nephrology, Department of Pediatrics, Marmara University Medical Faculty Hospital, Istanbul, Turkey.
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Gökaslan F, Yalçınkaya F, Fitöz S, Özçakar ZB. Evaluation and Outcome of Antenatal Hydronephrosis: A Prospective Study. Ren Fail 2012; 34:718-21. [DOI: 10.3109/0886022x.2012.676492] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Quirino IG, Diniz JSS, Bouzada MCF, Pereira AK, Lopes TJ, Paixão GM, Barros NN, Figueiredo LC, Cabral ACV, Simões e Silva AC, Oliveira EA. Clinical course of 822 children with prenatally detected nephrouropathies. Clin J Am Soc Nephrol 2012; 7:444-51. [PMID: 22266574 DOI: 10.2215/cjn.03400411] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES With the advent of fetal screening ultrasonography, the detection of congenital anomalies of the kidney and urinary tract (CAKUT) in utero has permitted early management of these conditions. This study aims to describe the clinical course of a large cohort of patients with prenatally detected nephrouropathies. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In this retrospective cohort study, 822 patients were prenatally diagnosed with CAKUT and systematically followed up at a tertiary Renal Unit for a median time of 43 months. Variables included in the analysis were sex, laterality, fetal ultrasonography (isolated versus associated hydronephrosis), and presence/absence of nephrouropathies. The events of interest were urinary tract infection, surgical interventions, hypertension, CKD, and death. Survival analyses were performed to evaluate time until occurrence of the events of interest. RESULTS Urinary tract infection occurred in 245 (29.8%) children, with higher risk in females (hazard ratio=1.30, 95% confidence interval=1.02-1.70, P=0.05); 22 patients (2.7%) had hypertension, and 49 (6%) patients developed CKD. The risk of CKD was greater in patients with associated hydronephrosis (hazard ratio=5.20, 95% confidence interval=2.90-9.30, P<0.001). Twelve patients (1.5%) died during follow-up. Death was significantly associated with being born during the first period of the study (hazard ratio=6.00, 95% confidence interval=1.60-22.50, P<0.001), associated hydronephrosis (hazard ratio=9.30, 95% confidence interval=2.90-29.30, P<0.001), and CKD (hazard ratio=170.00, 95% confidence interval=41.00-228.00, P<0.001). CONCLUSIONS In our series, the clinical course of prenatally detected CAKUT was heterogeneous, and those infants with associated hydronephrosis at baseline were identified as a high-risk subgroup.
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Affiliation(s)
- Isabel G Quirino
- Pediatric Nephrology Unit, Department of Pediatrics, National Institute of Science and Technology of Molecular Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Wang H, Li Q, Liu J, Mendelsohn C, Salant DJ, Lu W. Noninvasive assessment of antenatal hydronephrosis in mice reveals a critical role for Robo2 in maintaining anti-reflux mechanism. PLoS One 2011; 6:e24763. [PMID: 21949750 PMCID: PMC3176762 DOI: 10.1371/journal.pone.0024763] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 08/17/2011] [Indexed: 02/01/2023] Open
Abstract
Antenatal hydronephrosis and vesicoureteral reflux (VUR) are common renal tract birth defects. We recently showed that disruption of the Robo2 gene is associated with VUR in humans and antenatal hydronephrosis in knockout mice. However, the natural history, causal relationship and developmental origins of these clinical conditions remain largely unclear. Although the hydronephrosis phenotype in Robo2 knockout mice has been attributed to the coexistence of ureteral reflux and obstruction in the same mice, this hypothesis has not been tested experimentally. Here we used noninvasive high-resolution micro-ultrasonography and pathological analysis to follow the progression of antenatal hydronephrosis in individual Robo2-deficient mice from embryo to adulthood. We found that hydronephrosis progressed continuously after birth with no spontaneous resolution. With the use of a microbubble ultrasound contrast agent and ultrasound-guided percutaneous aspiration, we demonstrated that antenatal hydronephrosis in Robo2-deficient mice is caused by high-grade VUR resulting from a dilated and incompetent ureterovesical junction rather than ureteral obstruction. We further documented Robo2 expression around the developing ureterovesical junction and identified early dilatation of ureteral orifice structures as a potential fetal origin of antenatal hydronephrosis and VUR. Our results thus demonstrate that Robo2 is crucial for the formation of a normal ureteral orifice and for the maintenance of an effective anti-reflux mechanism. This study also establishes a reproducible genetic mouse model of progressive antenatal hydronephrosis and primary high-grade VUR.
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Affiliation(s)
- Hang Wang
- Renal Section, Department of Medicine, Boston University Medical Center, Boston, Massachusetts, United States of America
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qinggang Li
- Renal Section, Department of Medicine, Boston University Medical Center, Boston, Massachusetts, United States of America
- Department of Nephrology, PLA General Hospital, Beijing, China
| | - Juan Liu
- Renal Section, Department of Medicine, Boston University Medical Center, Boston, Massachusetts, United States of America
| | - Cathy Mendelsohn
- Department of Urology, Columbia University, New York, New York, United States of America
| | - David J. Salant
- Renal Section, Department of Medicine, Boston University Medical Center, Boston, Massachusetts, United States of America
| | - Weining Lu
- Renal Section, Department of Medicine, Boston University Medical Center, Boston, Massachusetts, United States of America
- * E-mail:
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Bibliography. Female urology. Current world literature. Curr Opin Urol 2011; 21:343-6. [PMID: 21654401 DOI: 10.1097/mou.0b013e3283486a38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Urinary levels of TGF β-1 and of cytokines in patients with prenatally detected nephrouropathies. Pediatr Nephrol 2011; 26:739-47. [PMID: 21331646 DOI: 10.1007/s00467-011-1802-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 12/29/2010] [Accepted: 01/25/2011] [Indexed: 12/18/2022]
Abstract
This study aimed to identify noninvasive biomarkers of clinically significant nephrouropathies in patients with antenatal renal and/or urinary tract alterations. Spot-urine levels of interleukin-6 (IL-6), transforming growth factor-β1 (TGF-β1) and tumor necrosis factor-α (TNF-α) were measured in 100 patients with antenatal detected nephrouropathies. Patients were divided in idiopathic hydronephrosis (n = 47), urinary tract malformations (n = 35), and dysplastic kidneys (n = 18). Urinary concentrations of TGF-β1, IL-6, and TNF-α were compared between groups according to clinical and image findings. Receiver-operating characteristic (ROC) curves were analyzed for the overall diagnostic accuracy of TGF-β1, IL-6, and TNF-α levels in discriminating infants with nephrouropathies. No significant differences in urinary TGF- β1, IL-6, and TNF-α levels were found in the comparison between the groups. TGF-β1 levels tended to be higher in patients with renal hypodysplasia compared to idiopathic hydronephrosis (p = 0.07). Twenty-nine patients had reduced DMSA uptake. In these cases, absolute urinary concentration of TGF-β1 and levels standardized for creatinine were significantly higher than in patients with normal DMSA uptake, while IL6 and TNF-α did not differ between groups. Urinary cytokine measurements were not useful as a screening test for clinically significant nephrouropathies. Conversely, increased concentrations of TGF-β1 pointed out to renal damage as indicated by reduced DMSA uptake.
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