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Early detection of ureteropelvic junction obstruction in neonates with prenatal diagnosis of renal pelvis dilatation using 1H NMR urinary metabolomics. Sci Rep 2022; 12:13406. [PMID: 35927301 PMCID: PMC9352869 DOI: 10.1038/s41598-022-17664-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 07/28/2022] [Indexed: 11/25/2022] Open
Abstract
Renal pelvis dilatation (RPD) is diagnosed in utero on prenatal ultrasonography (US) and can resolve spontaneously. However, isolated RPD can also reflect ureteropelvic junction obstruction (UPJO), which requires surgical treatment to prevent progressive renal deterioration. The diagnosis of UPJO can only be confirmed after birth with repeat US and renal isotope studies. 1H Nuclear Magnetic Resonance spectroscopy (NMR) was performed on urine of newborns with prenatally diagnosed unilateral RPD and healthy controls to identify specific urinary biomarkers for UPJO. The original combination of EigenMS normalization and sparse partial-least-squares discriminant analysis improved selectivity and sensitivity. In total, 140 urine samples from newborns were processed and 100 metabolites were identified. Correlation network identified discriminant metabolites in lower concentrations in UPJO patients. Two main metabolic pathways appeared to be impaired in patients with UPJO i.e. amino acid and betaine metabolism. In this prospective study, metabolic profiling of urine samples by NMR clearly distinguishes patients who required surgery for UPJO from patients with transient dilatations and controls. This study will pave the way for the use of metabolomics for the diagnosis of prenatal hydronephrosis in clinical routine.
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Maher J, Gao M, Kelly R, Hutton K, Kodeih H, Schlabritz-Loutsevitch N. Prenatal Diagnosis of a Urinoma and Dilated Azygous Vein. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1049-1051. [PMID: 29027692 DOI: 10.1002/jum.14425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 07/03/2017] [Accepted: 07/11/2017] [Indexed: 06/07/2023]
Affiliation(s)
- James Maher
- Department of Obstetrics and Gynecology, Texas Tech University Health Science Center School of Medicine at the Permian Basin, Odessa, Texas, USA
| | - Mamie Gao
- Department of Obstetrics and Gynecology, Texas Tech University Health Science Center School of Medicine at the Permian Basin, Odessa, Texas, USA
| | - Randall Kelly
- Department of Obstetrics and Gynecology, Texas Tech University Health Science Center School of Medicine at the Permian Basin, Odessa, Texas, USA
| | - Kathryn Hutton
- Department of Obstetrics and Gynecology, Texas Tech University Health Science Center School of Medicine at the Permian Basin, Odessa, Texas, USA
| | - Hanna Kodeih
- Department of Obstetrics and Gynecology, Texas Tech University Health Science Center School of Medicine at the Permian Basin, Odessa, Texas, USA
| | - Natalia Schlabritz-Loutsevitch
- Department of Obstetrics and Gynecology, Texas Tech University Health Science Center School of Medicine at the Permian Basin, Odessa, Texas, USA
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Hamdaoui N, Dabadie A, Lesieur E, Quarello E, Kheiri M, Hery G, Guidicelli B, Bretelle F, Gorincour G. [Ultrasound of the fetal urinary system during the first trimester of pregnancy]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2017; 45:373-380. [PMID: 28552751 DOI: 10.1016/j.gofs.2017.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/02/2017] [Indexed: 12/27/2022]
Abstract
The detection of abnormalities of the fetal urinary system in the first trimester of pregnancy is constantly improving, namely owing to the improved resolution of the image, the use of the endovaginal approach and thanks to sonographers' constant training. The pathological aspects, usually detected in the second trimester of pregnancy, can be suspected early in the first trimester and range from kidneys' cavity dilation to bilateral renal agenesis, polycystic kidney disease, multi-cystic dysplasia and bladder megavessia or bladder exstrophy. A poly-malformative syndrome is to be found out. The detection of an abnormality of the urinary tract requires a close ultrasound check. Very often, the pathological aspects tend to disappear spontaneously. In particular, the non-visualization of the bladder requires repeated examinations during the same session or even a little later in the pregnancy. We will carry out a review of the literature by pointing out the usual and unusual aspects of the fetal urinary system visible in the first trimester and we will as well propose an algorithm describing how to deal with abnormalities of the urinary tract that can be found out at first trimester ultrasound.
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Affiliation(s)
- N Hamdaoui
- Centre de diagnostic prénatal, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France.
| | - A Dabadie
- Service d'imagerie pédiatrique et prénatale, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
| | - E Lesieur
- Centre de diagnostic prénatal, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
| | - E Quarello
- Département d'échographies obstétricales, fondation-hôpital Saint-Joseph, 26, boulevard de Louvain, 13008 Marseille, France; Institut de médecine de la reproduction, 6, rue Rocca, 13008 Marseille, France
| | - M Kheiri
- Service d'imagerie pédiatrique et prénatale, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
| | - G Hery
- Centre de diagnostic prénatal, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France; Service de chirurgie pédiatrique, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
| | - B Guidicelli
- Centre de diagnostic prénatal, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
| | - F Bretelle
- Centre de diagnostic prénatal, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
| | - G Gorincour
- Centre de diagnostic prénatal, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France; Service d'imagerie pédiatrique et prénatale, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
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Said AH, El-Kattan E, Abdel-Hakeem AK, Saleem S. In utero MRI diagnosis of fetal malformations in oligohydramnios pregnancies. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Scalabre A, Demède D, Gaillard S, Pracros JP, Mouriquand P, Mure PY. Prognostic Value of Ultrasound Grading Systems in Prenatally Diagnosed Unilateral Urinary Tract Dilatation. J Urol 2016; 197:1144-1149. [PMID: 27916713 DOI: 10.1016/j.juro.2016.11.103] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE We compared the prognostic value of anteroposterior intrasinus diameter of the renal pelvis, urinary tract dilatation and the Society for Fetal Urology grading system in children with prenatally diagnosed unilateral urinary tract dilatation. MATERIALS AND METHODS All newborns with prenatally diagnosed unilateral urinary tract dilatation, normal bladder and anteroposterior intrasinus diameter 10 mm or greater on the first postnatal ultrasonography were prospectively enrolled from January 2011 to February 2015. Indications for surgery were recurrent febrile urinary tract infections and/or decrease of relative renal function more than 10% on serial isotope studies and/or increasing anteroposterior intrasinus diameter greater than 20% on serial ultrasounds. Sensitivity, specificity and ROC curves were calculated to evaluate the accuracy of anteroposterior intrasinus diameter, urinary tract dilatation and Society for Fetal Urology grading system in determining which children would need surgery within 24 months. RESULTS A total of 57 males and 13 females were included. Of the patients 33 required surgery at a median age of 5 months (IQR 3.8 to 6.4). Urinary tract dilatation remained stable in 14 cases and decreased in 23 with a median followup of 42 months (IQR 25 to 67). Anteroposterior intrasinus diameter, urinary tract dilatation and Society for Fetal Urology scores were all correlated with the need for surgery. Anteroposterior intrasinus diameter with a threshold of 20 mm had the best prognostic value, with a sensitivity of 81.8% and a specificity of 91.7%. CONCLUSIONS Our study confirms that the prognostic value was comparable between anteroposterior intrasinus diameter of the renal pelvis, urinary tract dilatation and Society for Fetal Urology grading system in newborns with prenatally diagnosed unilateral urinary tract dilatation. Anteroposterior intrasinus diameter and abnormal parenchymal thickness are the most important ultrasound criteria to identify children at risk for requiring surgery.
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Affiliation(s)
- Aurélien Scalabre
- Pediatric Surgery Department, Femme Mère Enfant Hospital-University Hospital of Lyon and University Claude Bernard Lyon 1, Lyon, France.
| | - Delphine Demède
- Pediatric Surgery Department, Femme Mère Enfant Hospital-University Hospital of Lyon and University Claude Bernard Lyon 1, Lyon, France
| | - Ségolène Gaillard
- Epicime-Clinical Investigation Center 1407 de Lyon, Inserm, Service de Pharmacologie Clinique, CHU Lyon, Bron, France; Laboratory of Biometrics and Evolutionary Biology, National Center for Scientific Research, UMR 5558, Villeurbanne, France
| | - Jean-Pierre Pracros
- Pediatric Radiology Department, Femme Mère Enfant Hospital-University Hospital of Lyon and University Claude Bernard Lyon 1, Lyon, France
| | - Pierre Mouriquand
- Pediatric Surgery Department, Femme Mère Enfant Hospital-University Hospital of Lyon and University Claude Bernard Lyon 1, Lyon, France
| | - Pierre-Yves Mure
- Pediatric Surgery Department, Femme Mère Enfant Hospital-University Hospital of Lyon and University Claude Bernard Lyon 1, Lyon, France
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A novel approach to evaluating the benefit of post-urinary tract infection renal ultrasonography, using decision curve analysis. Pediatr Nephrol 2016; 31:1631-6. [PMID: 27180177 DOI: 10.1007/s00467-016-3410-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 04/26/2016] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The benefit of post-urinary tract infection (UTI) sonography to detect clinically significant renal abnormalities remains a subject open to debate. Decision curve analysis (DCA) is a novel method for evaluating the clinical usefulness of diagnostic tests. Our objective was to determine, using DCA, the benefit of post-UTI sonography and of post-UTI sonography with biological markers of inflammation to predict the risk of recurrence of febrile UTI in children aged 2 to 24 months without known uropathy. METHODS We retrospectively analyzed all children aged 2 to 24 months, without known uropathy, who presented with a first episode of febrile UTI between 2009 and 2012 and followed them for 30 months. We then used DCA to estimate the benefit of post-UTI sonography or post-UTI sonography + biological markers of inflammation for detecting the risk of recurrence. RESULTS A total of 318 children [144 boys (45.3 %) and 174 girls (54.7 %)], with a mean age of 6.9 ± 5.6 months, were identified. Of these, 210 children presented with a significant inflammation [66.2 %; 95 % confidence interval (CI) 61.0-71.4], and 30 (9.4 %; 95 % CI 6.2-12.6) presented with abnormal post-UTI sonographic findings. Eighteen (5.7 %; 95 % CI 3.1-8.2) children presented with recurrent UTI at 30 months. CONCLUSIONS There were significantly more recurrences in those children who presented with abnormal sonographic findings than in those who did not (relative risk 7.68; 95 % CI 3.03-19.46). However, taking into account the effect of false-positives and false negatives, the DCA revealed that for threshold probabilities of >30 %, at which patients/doctors are concerned about unnecessary interventions (whether tests or treatments), neither post-UTI sonography nor post-UTI sonography + biological markers of inflammation have sufficient value to improve care.
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Carter Ramirez DM, Tu HYV, Braga LH. Ureteropelvic Junction Obstruction by a Long Intraluminal Polyp and a Concurrent Crossing Vein in a Symptomatic 8-Year-old Child. Urology 2015. [PMID: 26199155 DOI: 10.1016/j.urology.2015.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Ureteropelvic junction obstruction due to intrinsic causes is often diagnosed antenatally during routine ultrasonography. Cases of extrinsic obstruction often present later and symptomatically, during childhood. We describe the rare case of an 8-year-old boy with a 2-day history of severe left flank pain, no fevers, and Society of Fetal Urology grade 3 hydronephrosis on ultrasonography. Laparoscopic dismembered pyeloplasty revealed a left ureteropelvic junction obstruction secondary to a large fibroepithelial polyp in the proximal ureter with a concomitant anterior crossing vein. We also provide a focused review of the pertinent published literature.
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Affiliation(s)
| | - Hin Yu Vincent Tu
- Division of Urology, Department of Surgery, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Luis H Braga
- Division of Urology, Department of Surgery, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
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Tourchi A, Kajbafzadeh AM, Ebadi M, Tavangar SM, Jarooghi N. The association between impaired autophagy and the development of congenital ureteropelvic junction obstruction. Urology 2014; 84:1467-74. [PMID: 25440825 DOI: 10.1016/j.urology.2014.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 08/14/2014] [Accepted: 08/19/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To investigate the association between impaired autophagy in smooth muscle cells and the development of congenital ureteropelvic junction (UPJ) obstruction (UPJO). MATERIALS AND METHODS Tissue specimens were obtained from 40 patients with unilateral UPJO and were divided into 3 sections as renal pelvis, site of obstruction, and the ureter distal to obstruction. Control specimens were obtained from the UPJ of 40 age-matched cadavers. Autophagy was evaluated by image analysis techniques for the expression of light chain 3 (LC3) after immunohistochemical staining of LC3 rabbit polyclonal antibody and Western blot analysis; additionally, myocyte apoptosis was determined using terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay, 4',6-diamidino-2-phenylindole staining, and p53 immunohistochemical staining. To assess the possible role of cell senescence, P21 and P16 immunohistochemistry staining was applied. Cellular proliferation was assessed by image analysis of proliferating cell nuclear antigen-stained specimens. RESULTS LC3 expression was significantly increased at the renal pelvis (P <.05). Apoptotic indices of smooth muscle cells and Bcl-2 were significantly greater at the site of UPJO (5.15 ± 0.91) compared with the UPJs of the control group (P <.001). A significant negative correlation was found between TUNEL and LC3 in all sections of the obstructed UPJ complex (P <.05). Proliferating cell nuclear antigen and LC3 were positively correlated in the renal pelvis and UPJ (P <.05); however, no specimen was stained for p16, p21, and p53. CONCLUSION In conclusion, impaired autophagy is associated with the development of congenital UPJO. Nonetheless, further studies are mandated to establish its etiologic role.
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Affiliation(s)
- Ali Tourchi
- Division of Pediatric Urology, Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Abdol-Mohammad Kajbafzadeh
- Department of Pediatric Urology, Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.
| | - Maryam Ebadi
- Department of Pediatric Urology, Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Tavangar
- Department of Pathology, Shariati Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Jarooghi
- Department of Pediatric Urology, Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
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Zhang L, Liu C, Li F, Li X, Sun C, Sun H. Diagnosis of 65 cases of ampullary renal pelvis after postnatal follow-up of 1,167 newborn infants with prenatally suspected hydronephrosis. Exp Ther Med 2014; 9:151-153. [PMID: 25452792 PMCID: PMC4247286 DOI: 10.3892/etm.2014.2076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 10/10/2014] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to assess the morbidity of ampullary renal pelvis (ARP) and document its natural history in post-natal life. A total of 1,167 newborn infants with prenatally suspected hydronephrosis were retrospectively analyzed. Of these, 65 patients were diagnosed with ARP by computed tomography urography (CTU) and/or magnetic resonance urography (MRU). All cases were followed up with ultrasonogrophy at 1, 3, 6 and 12 months after birth, and one case was followed up for 5 years. Changes in the separation of the renal pelvis collection system were recorded. Children with ARP accounted for 5.57% of the total cases (65/1,167) followed-up. No lack of connection between the renal calyces and the renal pelvis was detected. The long-term follow-up revealed that the separation of the renal pelvis collection system did not tend to increase over time. In addition to imaging examinations, long-term follow-up observation is recommended for the accurate diagnosis of pediatric ARP, particularly for differentiation from hydronephrosis.
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Affiliation(s)
- Lei Zhang
- Department of Pediatric Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Chao Liu
- Department of Pediatric Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Fujiang Li
- Department of Pediatric Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Xiang Li
- Department of Pediatric Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Chao Sun
- Department of Pediatric Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Hao Sun
- Department of Pediatric Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
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Fetal Megacystis: Etiologies, Management, and Outcome According to the Trimester. Urology 2014; 84:185-90. [DOI: 10.1016/j.urology.2014.02.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 02/13/2014] [Accepted: 02/15/2014] [Indexed: 11/23/2022]
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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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Yamaçake KGR, Nguyen HT. Current management of antenatal hydronephrosis. Pediatr Nephrol 2013; 28:237-43. [PMID: 22836304 DOI: 10.1007/s00467-012-2240-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 05/31/2012] [Accepted: 05/31/2012] [Indexed: 12/01/2022]
Abstract
The strategy for the management of children with urinary tract anomalies has changed considerably as a result of the development of ultrasound equipment and techniques that allow for detailed fetal evaluation. Hydronephrosis is the most common urogenital anomaly detected, suggesting that an obstructive process may be potentially present. The goal of postnatal management is to identify and treat those patients whose renal function is at risk, while leaving alone the high percentage of patients who are at no risk of renal damage. This management involves a spectrum of radiological, medical, and surgical interventions for diagnosis, surveillance, and treatment. In this article, we review our current understanding of the natural history of antenatal hydronephrosis and its management.
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Affiliation(s)
- Kleiton G R Yamaçake
- Department of Urology, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Hunnewell-353, Boston, MA 02115, USA
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Ryckewaert-D'Halluin A, Le Bouar G, Odent S, Milon J, D'Hervé D, Lucas J, Rouget F, Loget P, Poulain P, Le Gall E, Taque S. Diagnosis of fetal urinary tract malformations: prenatal management and postnatal outcome. Prenat Diagn 2011; 31:1013-20. [DOI: 10.1002/pd.2824] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 06/06/2011] [Accepted: 06/06/2011] [Indexed: 11/07/2022]
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Yang H, Wang Q, Luo J, Li Q, Wang L, Li CC, Zhang G, Xu Z, Tao H, Fan Z. Ultrasound of urinary system and urinary screening in 14 256 asymptomatic children in China. Nephrology (Carlton) 2010; 15:362-7. [PMID: 20470308 DOI: 10.1111/j.1440-1797.2009.01262.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM The aim of this study is to assess the characteristics of urinary system diseases and the role of the ultrasound screening and urinalysis screening for chronic kidney disease (CKD) in asymptomatic children in China. METHODS Between September 2008 and November 2008, 14 256 children excluding those with obvious symptoms and signs were enrolled in our study. All the subjects accepted ultrasound and urinary screening. A case-control study was performed to evaluate the relative risk of having stones in those children exposed to melamine formula. RESULTS Of the enrolled children, 6.10% (869 of 14 256) showed abnormalities, of which 409 (2.87%) were established by ultrasound, 572 (4.01%) by urinalysis and 112 (0.79%) by both ultrasound screening and urinalysis. The abnormalities included congenital anomalies of kidney and urinary tract, urinary stones and/or hydronephrosis, leucocyturia and haematuria and/or proteinuria. Children exposed to melamine formula were 5.17 times as likely to have kidney stones as children exposed to no-melamine formula (95% confidence interval, 3.28-8.14; P < 0.001); the probability of kidney stones in melamine-fed infants were 6.28 times as likely as those no melamine-fed (95% confidence interval, 3.71-10.65; P < 0.001). CONCLUSION Ultrasonography and urinalysis could complement each other and play important roles in the early diagnosis of anomalies of the urinary system, but urinalysis is a more cost-effective screening tool for CKD in children in China. Exposure to melamine-contaminated formula associated with urinary stones, especially in infants, was significantly higher than the control group.
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Affiliation(s)
- Haiping Yang
- Department of Nephroimmunology and Children's Hospital of Chongqing Medical University, 136 Second Zhongshan Road, Yuzhong District, Chongqing 400014, China
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