Predicting and Modifying Risk for Development of Renal Failure in Boys with Posterior Urethral Valves

Can Concomitant Bladder Neck Incision and Primary Valve Ablation Reduce Early Re-admission Rate and Secondary Intervention?

Objective:

To assess the effect of bladder neck morphology and its incision (BNI) in patients with posterior urethral valve (PUV) on early reintervention rate.

Patients and methods:

Infants undergoing PUV ablation (PVA) before 24 months of age and had at least 18 months of follow-up, were categorized into three groups according to the bladder neck appearance on baseline radiological and endoscopic examination: group 1; normal bladder neck underwent PVA, group 2; high bladder neck underwent PVA plus BNI, group 3; high bladder neck underwent PVA only. Early reintervention was defined as the need for check cystoscopy because of persistent renal function deterioration, worsening hydronephrosis and/or unsatisfactory VCUG improvement during the 1st six months post primary PVA.

Results:

Between 2000 and 2017, a total of 114 patients underwent PVA and met the study criteria with a median follow-up of 58 (18-230) months. For group 1, 16 (22.9%) patients needed readmission. Check cystoscopy was free and no further intervention was performed in 5(7.5%) and re-ablation was performed in 11(15.7%) patients. For group 2, 3(14.3%) patients needed reintervention. Re-ablation and re-ablation plus BNI were performed in 1(4.8%) and 2(9.5%), respectively. For group 3, cystoscopy was free in 1(4.3%), re-ablation and re-ablation plus BNI were performed 2(8.7%) and 1(4.3%), respectively. There were no significant differences in the re-admission and re-intervention rates among the three study groups (p=0.65 and p=0.50, respectively).

Conclusion:

In morphologically high bladder neck associated PUV, concomitant BNI with PVA doesn’t reduce early re-intervention rate.

Speckle Noise Algorithm-Based Ultrasound Imaging in Evaluating the Therapeutic Effect of Blood Purification on Children with Kidney Failure and Analysis of Its Correlation with Serum Inflammatory Factor Levels

The study focused on the therapeutic effect of clinical treatment on urinary calculi with kidney failure and its relationship with the serum inflammatory factor levels. 90 children with melamine urinary calculi were selected as research subjects. Of them, 52 cases were in group 1 (nonrenal failure), and 38 cases were in group 2 (combined with renal failure). In addition, 35 hospitalized children with no history of melamine-contaminated milk feeding during the same period were used as healthy controls. They all underwent ultrasound imaging examination based on the speckle noise algorithm, and the prognosis was analyzed. It was found that the peak signal-to-noise ratio (PSNR), structural similarity (SSIM), and local edge preservation index (EPI) of the algorithm in this study were significantly greater than other algorithms (P < 0.05). The admission age of the children in group 1 was significantly younger than that of group 2, the bilateral stone rate was significantly higher than that in group 2, and the difference was statistically significant (P < 0.05). Of the 52 children in group 1, the stone disappeared in 25 cases after treatment, the stone was reduced in 20 cases, and the stone remained unchanged in 7 cases. The total effective rate of treatment was 88.46%. Of the 38 cases in group 2, the stone disappeared in 22 cases after treatment, the stone was reduced in 12 cases, and the stone remained unchanged in 4 cases. The total effective rate of treatment was 89.47%. No difference was noted in blood urea nitrogen (BUN), blood creatinine (Cr), TNF-α, and C-reactive protein (CRP) levels in group 1, group 2, and the healthy control group (P > 0.05). Hence, the denoising algorithm in this study has better denoising effects on ultrasound images than traditional algorithms, with higher definition and less noise and artifacts. The clinical treatment of children with urinary calculi and renal failure is highly effective, the renal function and serum inflammatory factor levels return to the normal range, and the inflammatory response is weakened.

Risk Assessment of Severe Congenital Anomalies of the Kidney and Urinary Tract (CAKUT): A Birth Cohort

Recent advances in the early diagnosis of fetal CAKUT with an increase in fetal surgical interventions have led to a growing number of neonatal survivors born with severe renal dysfunction. This, in turn, has required the development of multi-disciplinary treatment paradigms in the individualized management of these infants with advanced stage kidney disease from birth. Early multi-modal management includes neonatal surgical interventions directed toward establishing adequate urine flow, respiratory support with the assessment of pulmonary hypoplasia, and establishing metabolic control to avoid the need for dialysis intervention. The development of specialized imaging to assess for residual renal mass with non-invasive 3-dimensional techniques are rapidly evolving. The use of non-radioactive imaging offers improved safety and allows for early prognostic-based planning including anticipatory guidance for progression to end stage renal disease (ESRD). The trajectory of kidney function during the neonatal period as determined by peak and nadir serum creatinine (SCr) and cystatin C (CysC) during the first months of life provides a guide toward individualized prospective management. This is a single center experience based on a birth cohort of 42 subjects followed prospectively from birth for an average of 6.1 ± 2.8 years at the University of Miami/Holtz Children's Hospital during the past decade. There was an 8:1 male: female ratio. The birth cohort was divided into 3 subgroups according to CKD Stages at the current age: CKD 1-2 (Group 1) (eGFR ≥ 60 ml/min/1.73 m²) (N = 15), CKD stage 3-5 (Group 2) (eGFR ≤ 59 ml/min/1.73 m²) (N = 12), and ESRD-Dialysis and/or Transplantation (Group 3) (N = 15). A neonatal CysC >3.0 mg/L predicted progression to ESRD while a nadir SCr >0.6 mg/dL predicted progression to CKD 3-5 with the highest specificity and sensitivity by ROC-AUC analysis (P < 0.0001). Medical management was directed toward nutritional support with novel formula designs, early introduction of growth hormone and strict control of mineral bone disorder. One of the central aspects of the management was to avoid dialysis for as long as feasible with a primary goal toward pre-emptive transplantation.