1
|
Tasaka K, Ota Y, Ota K, Takahashi T, Shimoya K. A case of a blind-ending right ureter first identified intraoperatively during total laparoscopic hysterectomy for uterine adenomyosis and fibroids in a woman with severe ipsilateral kidney hypoplasia. J Obstet Gynaecol Res 2024. [PMID: 38884165 DOI: 10.1111/jog.15992] [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: 03/05/2024] [Accepted: 05/22/2024] [Indexed: 06/18/2024]
Abstract
Detecting ureteral injury-a serious intraoperative and postoperative complication of hysterectomy-is a high level of difficulty if ureteral malformations are not identified preoperatively. A 39-year-old Japanese woman underwent total laparoscopic hysterectomy for uterine adenomyosis. During surgery, ureteral peristalsis was absent on the right side, whereas the left ureter was visible under the peritoneum. Transabdominal ultrasonography failed to locate the right kidney, with cystoscopy showing no flow from the right ureteral orifice. The ureteral tunnel was identified by tracing the vascular path of the internal iliac and uterine arteries, confirming that the corded tissue was the right ureter. Postoperative contrast-enhanced CT revealed severe right kidney atrophy with no contrast effect or connected ureter. Based on intraoperative laparoscopy and postoperative examination, a diagnosis of a unilateral ureteral scar with a proximal blind end and ipsilateral renal dysgenesis was established, marking the first reported instance of endoscopic visualization of this anomaly. In addition to normal pelvic anatomy, surgeons must consider embryological abnormalities to prevent intraoperative complications.
Collapse
Affiliation(s)
- Keitaro Tasaka
- Department of Gynecologic Oncology, Kawasaki Medical School, Okayama, Japan
| | - Yoshiaki Ota
- Department of Gynecologic Oncology, Kawasaki Medical School, Okayama, Japan
| | - Kuniaki Ota
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
- Department of Obstetrics and Gynecology, Tokyo Rosai Hospital, Tokyo, Japan
| | - Toshifumi Takahashi
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | - Koichiro Shimoya
- Department of Gynecologic Oncology, Kawasaki Medical School, Okayama, Japan
| |
Collapse
|
2
|
Yang H, Zhang J, Tang Y, Zhong Q, Qian W, Wang Z, Zhou Z, Zhang Z, Pan W. Genetic analysis of congenital unilateral renal agenesis in children based on next-generation sequencing. Pediatr Res 2024:10.1038/s41390-024-03178-4. [PMID: 38849481 DOI: 10.1038/s41390-024-03178-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 01/04/2024] [Accepted: 03/13/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Congenital unilateral renal agenesis (URA) is a kind of rare birth defect during fetal development with varies clinical phenotypes. The pathogenesis and the relationship between gene and phenotype are still unclear. METHODS Ten URA fetuses were followed up after birth using postnatal renal ultrasound examination to confirm the diagnosis with nine children were URA and one was Renal Ectopy (RE). Trio- WES, CNV- seq were performed with the 10 children and their close relatives. RESULTS There were 3 heterozygous variants of CHD7, PROKR2 and NRIP1 genes were identified in 3 children, respectively. CHD7 (c.2663T>C, p.M888T) is classified as likely pathogenic (LP), PROKR2 (c.685G>C, p.G229R) and NRIP1 (c.2705T>G, p.F902C) are classified as variants of uncertain significance (VUS). CHD7 (c.2663T>C, p.M888T) and PROKR2 (c.685G>C, p.G229R) as URA-related genes may be associated with idiopathic hypogonadotropic hypogonadism (IHH) or CHARGE syndrome (CS), and 3D-protein structure prediction revealed that the two variants may affect the stability in the CHD7 protein or PROKR2 protein, separately. The RE-related gene NRIP1 (c.2705T>G, p.F902C) may be causative of congenital anomalies of the kidneys and urinary tract (CAKUT). CONCLUSIONS Identification of these variants can in exploring the etiology of URA or RE and improve the level of genetic counseling. IMPACTS We performed trio-whole-exome sequencing (trio- WES) and copy number variation sequencing (CNV- seq) in 10 children, including 9 children with Unilateral Renal Agenesis and 1 with Renal Ectopy after birth. The possible pathogenic genes of URA can be screened using prenatal and postnatal diagnosis of URA fetuses and gene detection after birth. Future studies evaluating this association may lead to a better understanding of URA and elucidate exploring the etiology of URA or RE and improve the level of genetic counseling.
Collapse
Affiliation(s)
- Huiru Yang
- Department of Nephrology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jingzhi Zhang
- Prenatal Diagnosis Center in Guizhou Province, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
- School of Public Health, the key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
| | - Yao Tang
- Prenatal Diagnosis Center in Guizhou Province, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Qiang Zhong
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
- Department of Gynecology, Guizhou Hospital of The First Affiliated Hospital, Sun Yat-sen University, Guiyang, China
| | - Wen Qian
- Prenatal Diagnosis Center in Guizhou Province, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Zhengrong Wang
- Prenatal Diagnosis Center in Guizhou Province, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Zunlun Zhou
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Zulong Zhang
- Department of Nephrology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.
| | - Wei Pan
- Prenatal Diagnosis Center in Guizhou Province, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.
| |
Collapse
|
3
|
Mbwambo OJ, Anthony J, Mremi A, Ngowi NB, Mvunta DH. A case report on rare co-occurrence of invasive ovarian mucinous adenocarcinoma, unilateral renal agenesis, and bicornuate uterus: is it a new triad? BMC Womens Health 2024; 24:300. [PMID: 38769573 PMCID: PMC11103989 DOI: 10.1186/s12905-024-03130-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 05/06/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Concomitant invasive ovarian mucinous adenocarcinoma, unilateral renal agenesis and bicornuate uterus is a rare combination. Unilateral renal agenesis has been associated with genital anomalies, such as unicornuate and bicornuate uterus. Furthermore, a wealth of studies has reported the association between unicornuate uterus and ovarian anomalies, such as the absence of an ovary or ectopic ovaries, but rarely has there been a combination of the three to the best of our knowledge. The present case report is the first case presentation with a combination of the three syndromes: ovarian mucinous tumor, unilateral renal agenesis, and bicornuate uterus. CASE PRESENTATION We report the case of a 17-year-old who presented with abdominal distension. On examination, a CT scan revealed a large multicystic abdominal mass on the right side, with an absence of the right kidney while the left kidney was normal in size, appearance, and position. Intraoperatively, massive blood-stained ascitic fluid was evacuated. Additionally, a large whitish polycystic intra-abdominal mass with mucus-like materials and solid areas was attached to the midpoint of the colon and the right ovary, with visible metastasis to the omentum. The uterus was bicornuate. The mass and omentum were taken for histopathology and a diagnosis of invasive ovarian mucinous cystadenocarcinoma with metastasis to the colon and omentum was made after a pathological report. CONCLUSIONS The presence of these conditions in the same individual could potentially complicate medical management and fertility considerations. Thus, a need for a multidisciplinary medical team, including gynecologists, urologists, and oncologists, to address their unique needs and provide appropriate treatment and guidance. Further research and case studies are needed to better understand the possible association and implications of these rare co-occurring conditions.
Collapse
Affiliation(s)
- Orgeness Jasper Mbwambo
- Department of Urology, Kilimanjaro Christian Medical University College (KCMUCO), P. O Box 2240, Moshi, Tanzania
- Department of Urology, Kilimanjaro Christian Medical Centre (KCMC), P. O Box 3010, Moshi, Tanzania
| | - Jonaviva Anthony
- Department of Urology, Kilimanjaro Christian Medical University College (KCMUCO), P. O Box 2240, Moshi, Tanzania
| | - Alex Mremi
- Department of Pathology, Kilimanjaro Christian Medical Centre (KCMC), P. O Box 3010, Moshi, Tanzania
- Department of Pathology, Kilimanjaro Christian Medical University College (KCMUCO), P. O Box 2240, Moshi, Tanzania
| | - Nicholas B Ngowi
- Department of Urology, Kilimanjaro Christian Medical University College (KCMUCO), P. O Box 2240, Moshi, Tanzania
- Department of Urology, Kilimanjaro Christian Medical Centre (KCMC), P. O Box 3010, Moshi, Tanzania
| | - David H Mvunta
- Department of Clinical Oncology, Ocean Road Cancer Institute (ORCI), Barack Obama Drive, P. O Box 3592, Dar es Salaam, Tanzania.
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West, P. O Box 65017, Dar es Salaam, Tanzania.
- Department of Obstetrics and Gynecology, St. Joseph College of Health and Allied Sciences, P. O Box 11007, Dar es Salaam, Tanzania.
| |
Collapse
|
4
|
Flogelova H, Bouchalova K, Smakal O, Halek J, Langova K, Cizkova K. Early diagnosis of solitary functioning kidney: comparing the prognosis of kidney agenesis and multicystic dysplastic kidney. Pediatr Nephrol 2024:10.1007/s00467-024-06360-2. [PMID: 38622348 DOI: 10.1007/s00467-024-06360-2] [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: 12/19/2023] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Individuals with congenital solitary functioning kidney (SFK) are at an increased risk of kidney damage. According to some studies, the risk is higher in unilateral kidney agenesis (UKA) than in unilateral multicystic dysplastic kidney (UMCDK). We hypothesized that with early detection of children with UKA and UMCDK, there would be no difference in the presence of hypertension, proteinuria, and reduced glomerular filtration rate (GFR) between UKA and UMCDK. METHODS Based on a long-term follow-up protocol, we evaluated a cohort of 160 children followed from birth for SFK (84 with UKA and 76 with UMCDK) detected by prenatal or routine neonatal ultrasound screening. Hypertension, proteinuria, and reduced GFR were monitored as markers of kidney damage. We compared the characteristics and outcomes of the subgroups of children with UKA and UMCDK. RESULTS GFR was reduced in 42 (26.2%) children, of whom 41 showed only mild reduction. Hypertension and proteinuria were found in 22 (13.8%) and 14 (8.8%) children, respectively. Combined kidney damage was present in 57 (35.6%) children. The UMCDK and UKA subgroups differed in GFR at final examination, with UMCDK patients being significantly more likely to have normal GFR compared to UKA patients (82% vs. 67%; p = 0.039). CONCLUSIONS One third of the children showed signs of SFK damage, albeit mild. Patients with UKA had reduced GFR significantly more often than those with UMCDK, but did not differ in the rates of hyperfiltration injury or congenital anomalies of the kidneys and urinary tract (CAKUT) in SFK.
Collapse
Affiliation(s)
- Hana Flogelova
- Department of Pediatrics, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Zdravotniku 248/7, 779 00, Olomouc, Czech Republic.
| | - Katerina Bouchalova
- Department of Pediatrics, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Zdravotniku 248/7, 779 00, Olomouc, Czech Republic
| | - Oldrich Smakal
- Department of Urology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Jan Halek
- Department of Neonatology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Katerina Langova
- Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Katerina Cizkova
- Department of Histology and Embryology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| |
Collapse
|
5
|
Martens L, Spath MA, van Beek MA, Willemsen WNP, Kluivers KB. Long-term effects of surgically corrected menstrual outflow obstruction: A case-control study. Int J Gynaecol Obstet 2024; 165:117-124. [PMID: 37962371 DOI: 10.1002/ijgo.15237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE To enhance evidence-based knowledge on long-term sequalae in patients with surgically corrected obstructing Müllerian anomalies. METHODS This long-term case-control study included patients with menstrual outflow obstruction due to congenital anomalies of the uterus or vagina, who were at least 18 years old, and for whom 2 years had elapsed since the first surgery at the start of this study. The control group consisted of women without current gynecological problems. Patients underwent a surgical correction at the Radboud University Medical Center Nijmegen between 1980 and 2013. Of 78 patients approached, 38 (49%) were included in this study. The control group consisted of 54 females. The main outcome measures were pain and health state. The following questionnaires were used: Visual Analogue Scale pain scores, European Quality of Life-5 Dimensions questionnaire (EQ-5D-3L) and the adapted Endometriosis Health Profile questionnaire (EHP-30). RESULTS Patients had higher actual and maximum abdominal pain scores compared with controls (11 vs 0 [P = 0.007] and 48 vs 21 [P = 0.035], respectively). Based on the EQ-5D-3L scores, patients had more pain and discomfort (P = 0.005), more mood problems (P = 0.023), and a poorer subjective health state (P = 0.002) and self-rated health state (P = 0.031). Based on the EHP-30, patients had a significant poorer self-rated health state on four out of five subscales. CONCLUSION In this study, following surgically corrected menstrual obstruction, patients had statistically significant higher abdominal pain scores and a poorer self-rated health state compared with controls.
Collapse
Affiliation(s)
- Lisanne Martens
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marian A Spath
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Monique A van Beek
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Wim N P Willemsen
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Kirsten B Kluivers
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| |
Collapse
|
6
|
Walker EYX, Winyard P, Marlais M. Congenital anomalies of the kidney and urinary tract: antenatal diagnosis, management and counselling of families. Pediatr Nephrol 2024; 39:1065-1075. [PMID: 37656310 PMCID: PMC10899401 DOI: 10.1007/s00467-023-06137-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/02/2023]
Abstract
Congenital anomalies of the kidney and urinary tract are collectively one of the most commonly diagnosed antenatal conditions. Clinicians have several tools available to diagnose anomalies, including imaging, biomarkers, family history and genetic studies. In certain cases, antenatal interventions such as vesico-amniotic shunting may be considered to improve postnatal outcomes.Congenital kidney anomalies detected antenatally can vary in clinical significance from almost no impact postnatally to significant morbidity and perinatal mortality. Prognosis broadly depends on kidney size, structure and amount of amniotic fluid, alongside genetics and family history, and progression on subsequent scans. It is important to counsel parents appropriately using a parent-focused and personalised approach. The use of a multidisciplinary team should always be considered.
Collapse
Affiliation(s)
- Emma Y X Walker
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - Paul Winyard
- UCL Great Ormond Street Institute for Child Health, London, UK
| | - Matko Marlais
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
- UCL Great Ormond Street Institute for Child Health, London, UK.
| |
Collapse
|
7
|
Yuri P, Irzan MA, Ghinorawa T, Solichin MR, Dwianingsih EK. A renal aplasia case mimicking radiologically as unilateral renal agenesis in a child with spina bifida, atresia ani and unilateral undescended testis: a case report. J Med Case Rep 2024; 18:31. [PMID: 38273375 PMCID: PMC10811896 DOI: 10.1186/s13256-023-04330-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 12/20/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND As a result of the failure of embryogenic kidney formation, a condition can occur where not a single kidney appears and this phenomenon is known as unilateral renal agenesis (URA). Both aplastic and dysplastic kidney are different from renal agenesis, atrophy and renal hypoplasia. However, from this case report it can be seen that there are similarities, both radiologically and macroscopically, between cases of unilateral renal aplasia and renal agenesis. CASE PRESENTATION A 2 year old Javanese boy came to the health facility with complaints of recurrent fever and urinary tract symptoms such as dysuria and straining. Computerized Tomography (CT) scan of the abdomen and urography showed agenesis of the left kidney and a probable spina bifida. Cystourethrography examination was done and showed grade 5 voiding, then retrograde pyelography was performed with the diagnosis of unilateral renal agenesis was made because there was no visible left side collecting system even though there was a duplication in the left ureter. The next examination was carried out by histopathology and immunohistochemistry after resection of the left side of the ureter and the diagnosis increasingly pointed towards renal aplasia after primitive renal structures were found. CONCLUSIONS Renal agenesis and aplastic kidney are difficult to differentiate macroscopically and radiologically. Nevertheless, from this case report, we try to provide some interesting points to differentiate cases of unilateral renal agenesis from Renal Dysplasia which presents as unilateral renal aplasia.
Collapse
Affiliation(s)
- Prahara Yuri
- Division of Urology, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Jl. Kesehatan No.1, Yogyakarta, 55281, Indonesia.
| | - Muhammad Anwar Irzan
- Division of Urology, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Jl. Kesehatan No.1, Yogyakarta, 55281, Indonesia
| | - Tanaya Ghinorawa
- Division of Urology, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Jl. Kesehatan No.1, Yogyakarta, 55281, Indonesia
| | - Muchamad Ridotu Solichin
- Department of Anatomical Pathology, Faculty of Medicine, Public Health and Nursing UGM/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Ery Kus Dwianingsih
- Department of Anatomical Pathology, Faculty of Medicine, Public Health and Nursing UGM/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| |
Collapse
|
8
|
Mori T, Nomura O, Mikami N, Hataya H. A Case of Unilateral Renal Agenesis Detected by Abdominal Point-Of-Care Ultrasound. Cureus 2024; 16:e51453. [PMID: 38298313 PMCID: PMC10829426 DOI: 10.7759/cureus.51453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2023] [Indexed: 02/02/2024] Open
Abstract
As the interest in point-of-care ultrasound (POCUS) for investigating pediatric abdominal emergencies has been growing, an increasing number of literatures about abdominal POCUS has been published. We describe a noteworthy instance of a systematic approach using abdominal POCUS for detecting unilateral renal agenesis (URA) in previously healthy children with suspected intussusception. A previously healthy three-year-old girl was brought to our emergency department (ED) due to abdominal pain and bloody diarrhea. POCUS was performed to investigate the presence of intussusception. POCUS was able to rule out intussusception and detect URA. The investigation led the patient to a proper nephrology follow-up. When performing abdominal POCUS to evaluate gastrointestinal pathologies, it is important to pay attention to concomitant congenital anomalies of the kidney and urinary tract (CAKUT).
Collapse
Affiliation(s)
- Takaaki Mori
- Department of Pediatric Emergency Medicine and Critical Care, Tokyo Metropolitan Children's Medical Center, Tokyo, JPN
| | - Osamu Nomura
- Department of Health Sciences Education, Hirosaki University, Hirosaki, JPN
| | - Naoaki Mikami
- Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, JPN
| | - Hiroshi Hataya
- Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, JPN
| |
Collapse
|
9
|
Crofts VL, Forbes T, Grover SR. Chronic, severe abdominal pain in a girl with a renal anomaly: Answers. Pediatr Nephrol 2023; 38:3985-3988. [PMID: 37261516 DOI: 10.1007/s00467-023-06008-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 06/02/2023]
Affiliation(s)
- Victoria L Crofts
- Paediatric and Adolescent Gynaecology, Royal Children's Hospital, Melbourne, VIC, Australia.
| | - Thomas Forbes
- Paediatric Nephrology, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Sonia R Grover
- Paediatric and Adolescent Gynaecology, Royal Children's Hospital, Melbourne, VIC, Australia
| |
Collapse
|
10
|
Walawender L, Becknell B, Matsell DG. Congenital anomalies of the kidney and urinary tract: defining risk factors of disease progression and determinants of outcomes. Pediatr Nephrol 2023; 38:3963-3973. [PMID: 36867265 PMCID: PMC10914409 DOI: 10.1007/s00467-023-05899-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 03/04/2023]
Abstract
Congenital anomalies of the kidney and urinary tract (CAKUT) result from disruptions in normal kidney and urinary tract development during fetal life and collectively represent the most common cause of kidney failure in children worldwide. The antenatal determinants of CAKUT are diverse and include mutations in genes responsible for normal nephrogenesis, alterations in maternal and fetal environments, and obstruction within the normal developing urinary tract. The resultant clinical phenotypes are complex and depend on the timing of the insult, the penetrance of underlying gene mutations, and the severity and timing of obstruction related to the sequence of normal kidney development. Consequently, there is a broad spectrum of outcomes for children born with CAKUT. In this review, we explore the most common forms of CAKUT and those most likely to develop long-term complications of their associated kidney malformations. We discuss the relevant outcomes for the different forms of CAKUT and what is known about clinical characteristics across the CAKUT spectrum that are risk factors of long-term kidney injury and disease progression.
Collapse
Affiliation(s)
- Laura Walawender
- Kidney and Urinary Tract Center, The Abigail Wexner Research Institute at Nationwide Children's, Columbus, OH, USA
- Division of Nephrology and Hypertension, Nationwide Children's Hospital, Columbus, OH, USA
| | - Brian Becknell
- Kidney and Urinary Tract Center, The Abigail Wexner Research Institute at Nationwide Children's, Columbus, OH, USA
- Division of Nephrology and Hypertension, Nationwide Children's Hospital, Columbus, OH, USA
| | - Douglas G Matsell
- University of British Columbia, British Columbia Children's Hospital Research Institute, 4480 Oak Street, Vancouver, BC, Canada.
| |
Collapse
|
11
|
Kyejo W, Mohamed F, Zahran F, Saudin S, Ngowi A, Anselm J, Matillya N, Gachocha G. Incidental right renal agenesis in a 23-year-old patient: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231211711. [PMID: 38022855 PMCID: PMC10655640 DOI: 10.1177/2050313x231211711] [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: 05/22/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Renal agenesis refers to the congenital absence or complete failure of development of one or both kidneys. It occurs when the kidneys fail to form during embryonic development. This case report describes the presentation of a 23-year-old male patient who experienced sporadic episodes of abdominal pain on the right side and occasional episodes of hematuria. Diagnostic investigations, including ultrasonography and magnetic resonance imaging scans, confirmed the diagnosis of right renal agenesis. The management of the patient in this case report involved close monitoring of renal function and regular follow-up visits. Initially, the patient was followed for a period of 3 months and based on the patient's clinical status and any associated risk factors, it was determined that a follow-up schedule of visits every 6 months is appropriate. This interval allows for ongoing assessment of renal function and facilitates early detection of any potential complications or changes in kidney health. This case highlights the importance of early diagnosis, comprehensive management, and long-term monitoring in individuals with renal agenesis.
Collapse
Affiliation(s)
- Willbroad Kyejo
- Department of Family Medicine, Aga Khan University, Dar Es Salaam, Tanzania
| | - Fatma Mohamed
- Department of Family Medicine, Aga Khan University, Dar Es Salaam, Tanzania
| | - Fatma Zahran
- Department of Family Medicine, Aga Khan University, Dar Es Salaam, Tanzania
| | - Sumayyah Saudin
- Department of Family Medicine, Aga Khan University, Dar Es Salaam, Tanzania
| | - Antony Ngowi
- Department of Family Medicine, Aga Khan University, Dar Es Salaam, Tanzania
| | - Juvenalius Anselm
- Department of Family Medicine, Aga Khan University, Dar Es Salaam, Tanzania
| | - Nancy Matillya
- Department of Family Medicine, Aga Khan University, Dar Es Salaam, Tanzania
| | - Gloria Gachocha
- Department of Family Medicine, Aga Khan University, Dar Es Salaam, Tanzania
| |
Collapse
|
12
|
Emmerson MK, Dawson M. 'Grumbling' Midgut Volvulus in an Older Paediatric Patient With Congenital Solitary Kidney: A Case Report. Cureus 2023; 15:e49202. [PMID: 38130574 PMCID: PMC10735324 DOI: 10.7759/cureus.49202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/23/2023] Open
Abstract
Midgut volvulus is a life-threatening condition, with the majority of cases presenting before the first year of life. Congenital gastrointestinal abnormalities can be associated with midgut volvulus; however, similar associations have not been described with congenital renal abnormalities. Congenital solitary kidney (CSK) means that a child is born with only one functional kidney. Here, we describe a case of a five-year-old child with CSK who atypically presents with midgut volvulus. The case highlights how midgut volvulus may present with chronic symptoms in those over the age of one and the importance of upper GI contrast studies for diagnosis of midgut volvulus in this population and suggests CSK along with other causes of solitary kidney as possible risk factors for volvulus.
Collapse
Affiliation(s)
- Matthew K Emmerson
- Paediatric Emergency Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, GBR
| | - Moya Dawson
- Paediatric Emergency Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, GBR
| |
Collapse
|
13
|
Alp A, Saruhan E, Doğan E, Genek DG, Huddam B. Time to Change Our Viewpoints to Assess Renal Risks in Patients with Solitary Kidneys beyond Traditional Approaches? J Clin Med 2023; 12:6885. [PMID: 37959350 PMCID: PMC10649944 DOI: 10.3390/jcm12216885] [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: 09/22/2023] [Revised: 10/26/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
Solitary functioning kidney (SFK) can be defined as the absence or hypofunction of a kidney due to acquired or congenital reasons. A congenital solitary functioning kidney (cSFK) is more common than is an acquired one (aSFK) and is characterized by the anatomical absence (agenesis) or hypofunction (hypoplasia; hypodysplasia) of one kidney from birth. Among the acquired causes, the most important is nephrectomy (Nx) (due to the donor, trauma or mass resection). Patients with SFK are at risk for the development of chronic kidney disease (CKD) in the long term. This risk potential is also significantly affected by hypertension. The relationship between hypertension and subclinical chronic inflammation is a connection that has not yet been fully clarified pathogenetically, but there are many studies highlighting this association. In recent years, studies examining different fibrosis and inflammation biomarkers in terms of the evaluation and prediction of renal risks have become increasingly popular in the literature. Oxidative stress is known to play an important role in homocysteine-induced endothelial dysfunction and has been associated with hypertension. In our study, we aimed to investigate the relationship between ambulatory blood pressure monitoring (ABPM) and urinary/serum fibrosis and inflammatory markers in patients with SFK. We prospectively investigated the relationship between ABPM results and soluble urokinase plasminogen activator receptor (suPAR), procollagen type III N-terminal peptide (PIIINP), homocysteine and other variables in 85 patients with SFK and compared them between cSFK and aSFK groups. In the etiology of SFK, a congenital or acquired origin may differ in terms of the significance of biomarkers. In particular, the serum homocysteine level may be associated with different clinical outcomes in patients with cSFK and aSFK.
Collapse
Affiliation(s)
- Alper Alp
- Department of Nephrology, Faculty of Medicine, Mugla Sıtkı Koçman University, 48000 Mugla, Turkey; (D.G.G.); (B.H.)
| | - Ercan Saruhan
- Department of Medical Biochemistry, Faculty of Medicine, Mugla Sıtkı Koçman University, 48000 Mugla, Turkey;
| | - Emrah Doğan
- Department of Radiology, Faculty of Medicine, Mugla Sıtkı Koçman University, 48000 Mugla, Turkey;
| | - Dilek Gibyeli Genek
- Department of Nephrology, Faculty of Medicine, Mugla Sıtkı Koçman University, 48000 Mugla, Turkey; (D.G.G.); (B.H.)
| | - Bülent Huddam
- Department of Nephrology, Faculty of Medicine, Mugla Sıtkı Koçman University, 48000 Mugla, Turkey; (D.G.G.); (B.H.)
| |
Collapse
|
14
|
Plutecki D, Kozioł T, Bonczar M, Ostrowski P, Skorupa A, Matejuk S, Walocha J, Pękala J, Musiał A, Pasternak A, Koziej M. Renal agenesis: A meta-analysis of its prevalence and clinical characteristics based on 15 641 184 patients. Nephrology (Carlton) 2023; 28:525-533. [PMID: 37254584 DOI: 10.1111/nep.14190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/17/2023] [Accepted: 05/20/2023] [Indexed: 06/01/2023]
Abstract
Our objective was to analyse the newest relevant data on worldwide prevalence and associated symptoms of renal agenesis (RA). This meta-analysis builds on previous systematic reviews to include bilateral RA, its symptoms and data on gender, unilateral RA and anomaly location prevalence. Review of available data included records in English and other languages from PubMed, Embase, ScienceDirect, Web of Science, SciELO, BIOSIS, Current Content Connect Korean Journal Database and Russian Citation Index and Google. A total of 15 641 184 patients were analysed in relation to the prevalence of RA. The pooled prevalence of RA was 0.03% (95% CI: 0.03%-0.04%). Based on 500 subjects, a pooled prevalence of 47.96% (95% CI: 31.55%-64.58%) for unilateral and 52.04% (95% CI: 35.42%-68.45%) for bilateral RA has been set. Our study presents the newest generalized findings on bilateral RA. There appears to be universal disease and symptom prevalence with minor differences between world regions, although quality of future observational research should include genomic data. This will provide even further insight into the prognosis of various renal anomalies and their etiologies.
Collapse
Affiliation(s)
- Dawid Plutecki
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Tomasz Kozioł
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Michał Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Patryk Ostrowski
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Alicja Skorupa
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Szymon Matejuk
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Pękala
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Agata Musiał
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Artur Pasternak
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| |
Collapse
|
15
|
Jørgensen CS, Carstensen R, Awneh H, Frattari AMS, Borch L, Toustrup LB, Hagstrøm S, Kamperis K, Rittig S, Dufek-Kamperis S. GFR measurements and ultrasound findings in 154 children with a congenital solitary functioning kidney. J Pediatr Urol 2023; 19:624.e1-624.e7. [PMID: 37353361 DOI: 10.1016/j.jpurol.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/23/2023] [Accepted: 05/30/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Multicystic dysplastic kidney (MCDK) and unilateral renal agenesis (URA) are the most common reasons for a congenital solitary functioning kidney (SFK). We aimed to assess the presence of abnormalities in the congenital SFK and evaluate kidney function using chrome EDTA (CrEDTA) measurements. METHODS We retrospectively reviewed the medical records of 154 children with MCDK and URA in the period from 2005 to 2022 to analyze results from ultrasound scans and CrEDTA glomerular filtration rate (GFR) examinations. RESULTS Of 154 children with a solitary kidney due to MCDK (62%) or URA (38%), abnormalities on the congenital SFK were found in 13 children (8%). The abnormalities spontaneously resolved in 6 children (46%). The most common abnormality was hydronephrosis. Compensatory hypertrophy was found in 17% of the children within the first 6 months of life. 116 children (90%) had a standard GFR (sdGFR) above 75% of expected for the age. Out of those with a sdGFR below 75% of expected, 3 (23%) had abnormalities in the congenital SFK. There was no difference in sdGFR between children with MCDK and URA. CONCLUSIONS Our study is the first using CrEDTA for GFR measurements and suggests that most children with a congenital SFK due to MCDK or URA have a kidney function within expected for the age. Compensatory hypertrophy of the SFK is found in a minority of children within the first six months of life, suggesting that this process is developing over time. The prevalence of abnormalities in the SFK seems low, however those with abnormalities (e.g. hydronephrosis) are at higher risk of reduced sdGFR.
Collapse
Affiliation(s)
- Cecilie Siggaard Jørgensen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Ronja Carstensen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Hanifa Awneh
- Department of Paediatrics and Adolescent Medicine and Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark.
| | | | - Luise Borch
- Department of Paediatrics and Adolescent Medicine, Gødstrup Hospital, Herning, Denmark; NIDO | Centre for Research and Education, Gødstrup Hospital, Herning, Denmark.
| | - Lise Bols Toustrup
- Department of Paediatrics and Adolescent Medicine, Regional Hospital Central Jutland, Viborg, Denmark.
| | - Søren Hagstrøm
- Department of Paediatrics and Adolescent Medicine and Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark.
| | - Konstantinos Kamperis
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Søren Rittig
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Stephanie Dufek-Kamperis
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Pediatrics and Adolescent Medicine, Randers Regional Hospital, Randers, Denmark.
| |
Collapse
|
16
|
Zhao Z, Shou Y, Bao X, Shao J, Zhu L. Clinical characteristics and offspring developmental malformation of 126 patients with septate uterus. Chin Med J (Engl) 2023; 136:749-751. [PMID: 36939257 PMCID: PMC10129088 DOI: 10.1097/cm9.0000000000002103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Indexed: 03/21/2023] Open
Affiliation(s)
- Zichen Zhao
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Yiran Shou
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Xinmiao Bao
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Jiashen Shao
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Lan Zhu
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| |
Collapse
|
17
|
Nguyen TK, Petrikas M, Chambers BE, Wingert RA. Principles of Zebrafish Nephron Segment Development. J Dev Biol 2023; 11:jdb11010014. [PMID: 36976103 PMCID: PMC10052950 DOI: 10.3390/jdb11010014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/08/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
Nephrons are the functional units which comprise the kidney. Each nephron contains a number of physiologically unique populations of specialized epithelial cells that are organized into discrete domains known as segments. The principles of nephron segment development have been the subject of many studies in recent years. Understanding the mechanisms of nephrogenesis has enormous potential to expand our knowledge about the basis of congenital anomalies of the kidney and urinary tract (CAKUT), and to contribute to ongoing regenerative medicine efforts aimed at identifying renal repair mechanisms and generating replacement kidney tissue. The study of the zebrafish embryonic kidney, or pronephros, provides many opportunities to identify the genes and signaling pathways that control nephron segment development. Here, we describe recent advances of nephron segment patterning and differentiation in the zebrafish, with a focus on distal segment formation.
Collapse
Affiliation(s)
- Thanh Khoa Nguyen
- Department of Biological Sciences, Center for Stem Cells and Regenerative Medicine, Center for Zebrafish Research, Boler-Parseghian Center for Rare and Neglected Diseases, Warren Center for Drug Discovery, University of Notre Dame, Notre Dame, IN 46556, USA
| | - Madeline Petrikas
- Department of Biological Sciences, Center for Stem Cells and Regenerative Medicine, Center for Zebrafish Research, Boler-Parseghian Center for Rare and Neglected Diseases, Warren Center for Drug Discovery, University of Notre Dame, Notre Dame, IN 46556, USA
| | - Brooke E Chambers
- Department of Biological Sciences, Center for Stem Cells and Regenerative Medicine, Center for Zebrafish Research, Boler-Parseghian Center for Rare and Neglected Diseases, Warren Center for Drug Discovery, University of Notre Dame, Notre Dame, IN 46556, USA
| | - Rebecca A Wingert
- Department of Biological Sciences, Center for Stem Cells and Regenerative Medicine, Center for Zebrafish Research, Boler-Parseghian Center for Rare and Neglected Diseases, Warren Center for Drug Discovery, University of Notre Dame, Notre Dame, IN 46556, USA
| |
Collapse
|
18
|
Drummond BE, Ercanbrack WS, Wingert RA. Modeling Podocyte Ontogeny and Podocytopathies with the Zebrafish. J Dev Biol 2023; 11:jdb11010009. [PMID: 36810461 PMCID: PMC9944608 DOI: 10.3390/jdb11010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/11/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
Podocytes are exquisitely fashioned kidney cells that serve an essential role in the process of blood filtration. Congenital malformation or damage to podocytes has dire consequences and initiates a cascade of pathological changes leading to renal disease states known as podocytopathies. In addition, animal models have been integral to discovering the molecular pathways that direct the development of podocytes. In this review, we explore how researchers have used the zebrafish to illuminate new insights about the processes of podocyte ontogeny, model podocytopathies, and create opportunities to discover future therapies.
Collapse
|
19
|
Groen In 't Woud S, Roeleveld N, Westland R, Renkema KY, Steffens MG, Gracchi V, Lilien MR, van Wijk JAE, Feitz WFJ, Schreuder MF, van der Zanden LFM. Uncovering risk factors for kidney injury in children with a solitary functioning kidney. Kidney Int 2023; 103:156-165. [PMID: 36374825 DOI: 10.1016/j.kint.2022.09.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/16/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022]
Abstract
Children with a solitary functioning kidney (SFK) have an increased risk of kidney injury. The exact risk of and risk factors for kidney injury remain unknown, which impedes personalized care. Here, we recruited a nationwide multicenter cohort of 944 patients with SFK to get more insight into this by consenting patients born in 1993-2020 and diagnosed with congenital or acquired SFK before adulthood. The median follow-up was 12.8 years and four indications of kidney injury were studied: urine protein-creatinine ratios, blood pressure, estimated glomerular filtration rate and use of anti-hypertensive/proteinuric medication. For each indicator except medication use, separate cut-off values for any injury and severe injury were used. Survival analyses indicated that at 18 years of age, any or severe kidney injury were present in 75% and 39% of patients with congenital SFK, respectively. Risk factors for kidney injury included kidney agenesis as cause of the SFK, anomalies in the SFK, and high body mass index at last follow-up. Kidney agenesis and being overweight were specifically associated with proteinuria and high blood pressure, whereas anomalies in the SFK were associated with reduced estimated glomerular filtration rates. The high prevalence of kidney injury in patients with SFK emphasizes the need for long-term follow-up, in which lifestyle is an important topic to address. More research into the etiological role of risk factors will help to translate our findings into individualized care strategies. Thus, our study shows that a significant proportion of children with SFK will develop kidney injury over time.
Collapse
Affiliation(s)
- Sander Groen In 't Woud
- Department for Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands; Department of Pediatric Nephrology, Radboudumc Amalia Children's Hospital, Radboud Institute for Molecular Life Sciences, Nijmegen, the Netherlands.
| | - Nel Roeleveld
- Department for Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Rik Westland
- Department of Pediatric Nephrology, Amsterdam UMC-Emma Children's Hospital, Amsterdam, the Netherlands
| | - Kirsten Y Renkema
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Valentina Gracchi
- Department of Pediatric Nephrology, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, the Netherlands
| | - Marc R Lilien
- Department of Pediatric Nephrology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joanna A E van Wijk
- Department of Pediatric Nephrology, Amsterdam UMC-Emma Children's Hospital, Amsterdam, the Netherlands
| | - Wout F J Feitz
- Division of Pediatric Urology, Department of Urology, Radboudumc Amalia Children's Hospital, Radboud Institute for Molecular Life Sciences, Nijmegen, the Netherlands
| | - Michiel F Schreuder
- Department of Pediatric Nephrology, Radboudumc Amalia Children's Hospital, Radboud Institute for Molecular Life Sciences, Nijmegen, the Netherlands
| | - Loes F M van der Zanden
- Department for Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| |
Collapse
|
20
|
Bako D, Köksoy AY, Turmak M. Comparison of axial and coronal axis MRI kidney volume measurement in pediatric congenital solitary kidney. Pediatr Nephrol 2022:10.1007/s00467-022-05858-x. [PMID: 36547734 DOI: 10.1007/s00467-022-05858-x] [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: 08/21/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Accurate estimation of kidney size and volume in the solitary functioning kidney is crucial because of a higher risk of developing kidney injury. MRI is an accurate method and is suitable for kidney volume measurement. Usually, axial axis images and measurement methods are preferred for kidney volume measurements. However, the anteroposterior diameter of the kidney is smaller than the longitudinal diameter, meaning that imaging in the coronal axis could provide needed information in a shorter time, enabling imaging of younger patients without sedation. Therefore, the purpose of this study was to compare coronal and axial axis kidney volume measurement methods and evaluate intra-observer and inter-observer reliability. METHODS Axial axis T2W and coronal axis FIESTA images of kidneys were obtained with 10 mm slice thickness and no slice gap in pediatric patients with congenital solitary kidneys. Free-hand manual tracing was used to calculate volumes in both methods. Images were analyzed by two operators with different levels of experience. The expert operator computed solitary kidney volume twice in both methods for the intra-observer reliability, while the beginner operator's measurements were used for the inter-observer reliability. RESULTS High intra-observer (0.965 for axial and 0.972 for coronal) and inter-observer reliability were revealed (0.964 for axial and 0.963 for the coronal) for both measurement methods. CONCLUSION The coronal plane volume measurement method, which has a significantly shorter examination and post-processing time, is a highly reproducible and reliable method that can enable volume measurement with MRI in younger children, as the imaging time will be shortened. A higher resolution version of the Graphical abstract is available as Supplementary information.
Collapse
Affiliation(s)
- Derya Bako
- Department of Pediatric Radiology, Van Regional Training and Research Hospital, Van Bölge Eğitim Ve Araştırma Hastanesi, Edremit, Van, Turkey.
| | - Adem Yasin Köksoy
- Department of Pediatric Nephrology, Van Regional Training and Research Hospital, Van, Turkey
| | - Mehmet Turmak
- Department of Radiology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| |
Collapse
|
21
|
Adebayo OC, Nkoy AB, van den Heuvel LP, Labarque V, Levtchenko E, Delanaye P, Pottel H. Glomerular hyperfiltration: part 2-clinical significance in children. Pediatr Nephrol 2022:10.1007/s00467-022-05826-5. [PMID: 36472656 DOI: 10.1007/s00467-022-05826-5] [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: 05/09/2022] [Revised: 10/27/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022]
Abstract
Glomerular hyperfiltration (GHF) is a phenomenon that can occur in various clinical conditions affecting the kidneys such as sickle cell disease, diabetes mellitus, autosomal dominant polycystic kidney disease, and solitary functioning kidney. Yet, the pathophysiological mechanisms vary from one disease to another and are not well understood. More so, it has been demonstrated that GHF may occur at the single-nephron in some clinical conditions while in others at the whole-kidney level. In this review, we explore the pathophysiological mechanisms of GHF in relation to various clinical conditions in the pediatric population. In addition, we discuss the role and mechanism of action of important factors such as gender, low birth weight, and race in the pathogenesis of GHF. Finally, in this current review, we further highlight the consequences of GHF in the progression of kidney disease.
Collapse
Affiliation(s)
- Oyindamola C Adebayo
- Center of Vascular and Molecular Biology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Campus Gasthiusberg, 3000 Leuven, Belgium
- Laboratory of Pediatric Nephrology, Department of Development and Regeneration, Katholieke Universiteit Leuven, Campus Gasthiusberg, 3000 Leuven, Belgium
| | - Agathe B Nkoy
- Laboratory of Pediatric Nephrology, Department of Development and Regeneration, Katholieke Universiteit Leuven, Campus Gasthiusberg, 3000 Leuven, Belgium
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Lambertus P van den Heuvel
- Laboratory of Pediatric Nephrology, Department of Development and Regeneration, Katholieke Universiteit Leuven, Campus Gasthiusberg, 3000 Leuven, Belgium
- Department of Pediatric Nephrology, Radboud University Medical Centre, 6500 Nijmegen, The Netherlands
| | - Veerle Labarque
- Center of Vascular and Molecular Biology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Campus Gasthiusberg, 3000 Leuven, Belgium
- Department of Pediatric Hematology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Elena Levtchenko
- Laboratory of Pediatric Nephrology, Department of Development and Regeneration, Katholieke Universiteit Leuven, Campus Gasthiusberg, 3000 Leuven, Belgium
- Department of Pediatric Nephrology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium
- Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France
| | - Hans Pottel
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Campus Kulak, 8500 Kortrijk, Belgium.
| |
Collapse
|
22
|
Costigan CS, Rosenblum ND. Antenatally Diagnosed Kidney Anomalies. Pediatr Clin North Am 2022; 69:1131-1147. [PMID: 36880926 DOI: 10.1016/j.pcl.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Congenital anomalies of the kidney and urinary tract encompass a broad spectrum of developmental conditions that together account for the majority of childhood chronic kidney diseases. Kidney abnormalities are the most commonly diagnosed congenital anomaly in children, and detection of this anomaly is increasing as a result of improved antenatal care and widespread access to more sensitive screening ultrasonography. Most paediatricians will encounter children with congenital kidney anomalies across a wide spectrum of disorders, and a broad understanding of the classification, investigation, and basis of management is important to appropriately direct their care.
Collapse
Affiliation(s)
- Caoimhe S Costigan
- Division of Nephrology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G1X8, Canada
| | - Norman D Rosenblum
- Division of Nephrology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G1X8, Canada; Developmental & Stem Cell Biology Program, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, Physiology, and Laboratory Medicine and Pathobiology, University of Toronto; Peter Gilgan Centre for Research and Learning, 686 Bay Street, 16th Floor, Room 16.9706, Toronto, ON M5G 0A4, Canada.
| |
Collapse
|
23
|
Anatomy and embryology of congenital surgical anomalies: Congenital Anomalies of the Kidney and Urinary Tract. Semin Pediatr Surg 2022; 31:151232. [PMID: 36423515 DOI: 10.1016/j.sempedsurg.2022.151232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Congenital anomalies of the kidney and urinary tract or "CAKUT" describes a spectrum of developmental disorders with a range of associated clinical presentations and functional consequences. CAKUT underlies the majority of chronic kidney disease and kidney replacement therapy requirement in children, but functional deterioration can also emerge in adulthood. Understanding the normal embryological processes involved in kidney development allows us to appreciate the timing and sequence of critical events implicated when things go wrong. In this review, we will describe the normal developmental mechanisms and relate this to what we currently know about the pathological processes involved in various forms of CAKUT. We will also review the proposed etiological factors, in particular genetics, involved in CAKUT.
Collapse
|
24
|
Samanta A, Rahman SM, Vasudevan A, Banerjee S. A novel combination of OHVIRA syndrome and likely causal variant in UMOD gene. CEN Case Rep 2022; 12:249-253. [PMID: 36417174 PMCID: PMC10151291 DOI: 10.1007/s13730-022-00754-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 11/06/2022] [Indexed: 11/25/2022] Open
Abstract
OHVIRA syndrome (or Herlyn-Werner-Wunderlich syndrome) is a rare condition, consisting classically of obstructed hemi-vagina with ipsilateral renal agenesis. It may be associated with complex uterine malformations and more rarely with lower urinary tract anomalies. The contralateral kidney usually has normal function. A genetic etiology of this syndrome has not yet been confirmed. We report a patient who was diagnosed to have unilateral renal agenesis in early childhood, and then presented after menarche with features of OHVIRA syndrome. The contralateral kidney was relatively small and echogenic, and serum creatinine and uric acid were raised. A likely causal variant of the UMOD gene was detected on whole exome sequencing. Genetic studies in more patients with OHVIRA syndrome may elucidate further, whether the association with UMOD gene is causal in nature.
Collapse
Affiliation(s)
- Atraya Samanta
- Department of Pediatrics, Calcutta Medical Research Institute, Kolkata, India
| | - Syed Monajatur Rahman
- Department of Gynaecology and Obstetrics, Calcutta Medical Research Institute, Kolkata, India
| | - Anil Vasudevan
- Department of Pediatric Nephrology, St Johns Medical College Hospital, Bangalore, India
| | - Sushmita Banerjee
- Department of Pediatrics, Calcutta Medical Research Institute, Kolkata, India
| |
Collapse
|
25
|
Unilateral renal agenesis, blind-ended ureter and ectopic ureterocele: An incidental finding on abdominal CT scan. Radiol Case Rep 2022; 17:4252-4256. [PMID: 36120523 PMCID: PMC9471340 DOI: 10.1016/j.radcr.2022.08.039] [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: 08/05/2022] [Revised: 08/09/2022] [Accepted: 08/13/2022] [Indexed: 11/20/2022] Open
Abstract
Congenital renal anomalies are among the most common birth defects. They are often detected antenatally. If not, they can manifest in adulthood with variable clinical presentations. Herein, we present a case of a 72-year-old male patient who was incidentally found to have an extremely rare combination of urinary tract defects comprising: right-sided unilateral renal agenesis, blind ureter, and ectopic ureterocele.
Collapse
|
26
|
Srivastava T, Garola RE, Zhou J, Boinpelly VC, Priya L, Ali MF, Rezaiekhaligh MH, Heruth DP, Novak J, Alon US, Joshi T, Jiang Y, McCarthy ET, Savin VJ, Johnson ML, Sharma R, Sharma M. Prostanoid receptors in hyperfiltration-mediated glomerular injury: Novel agonists and antagonists reveal opposing roles for EP2 and EP4 receptors. FASEB J 2022; 36:e22559. [PMID: 36125047 DOI: 10.1096/fj.202200875r] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/23/2022] [Accepted: 09/07/2022] [Indexed: 11/11/2022]
Abstract
Increased fluid-flow shear stress (FFSS) contributes to hyperfiltration-induced podocyte and glomerular injury resulting in progression of chronic kidney disease (CKD). We reported that increased FFSS in vitro and in vivo upregulates PGE2 receptor EP2 (but not EP4 expression), COX2-PGE2 -EP2 axis, and EP2-linked Akt-GSK3β-β-catenin signaling pathway in podocytes. To understand and use the disparities between PGE2 receptors, specific agonists, and antagonists of EP2 and EP4 were used to assess phosphorylation of Akt, GSK3β and β-catenin in podocytes using Western blotting, glomerular filtration barrier function using in vitro albumin permeability (Palb ) assay, and mitigation of hyperfiltration-induced injury in unilaterally nephrectomized (UNX) mice at 1 and 6 months. Results show an increase in Palb by PGE2 , EP2 agonist (EP2AGO ) and EP4 antagonist (EP4ANT ), but not by EP2 antagonist (EP2ANT ) or EP4 agonist (EP4AGO ). Pretreatment with EP2ANT blocked the effect of PGE2 or EP2AGO on Palb . Modulation of EP2 and EP4 also induced opposite effects on phosphorylation of Akt and β-Catenin. Individual agonists or antagonists of EP2 or EP4 did not induce significant improvement in albuminuria in UNX mice. However, treatment with a combination EP2ANT + EP4AGO for 1 or 6 months caused a robust decrease in albuminuria. EP2ANT + EP4AGO combination did not impact adaptive hypertrophy or increased serum creatinine. Observed differences between expression of EP2 and EP4 on the glomerular barrier highlight these receptors as potential targets for intervention. Safe and effective mitigating effect of EP2ANT + EP4AGO presents a novel opportunity to delay the progression of hyperfiltration-associated CKD as seen in transplant donors.
Collapse
Affiliation(s)
- Tarak Srivastava
- Section of Nephrology, Children's Mercy Hospital and University of Missouri at Kansas City, Kansas City, Missouri, USA.,Midwest Veterans' Biomedical Research Foundation (MVBRF), Kansas City, Missouri, USA.,Department of Oral and Craniofacial Sciences, University of Missouri at Kansas City-School of Dentistry, Kansas City, Missouri, USA
| | - Robert E Garola
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital and University of Missouri at Kansas City, Kansas City, Missouri, USA
| | - Jianping Zhou
- Midwest Veterans' Biomedical Research Foundation (MVBRF), Kansas City, Missouri, USA.,Renal Research Laboratory, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Varun C Boinpelly
- Midwest Veterans' Biomedical Research Foundation (MVBRF), Kansas City, Missouri, USA.,Renal Research Laboratory, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Lakshmi Priya
- Section of Nephrology, Children's Mercy Hospital and University of Missouri at Kansas City, Kansas City, Missouri, USA
| | - Mohammed Farhan Ali
- Section of Nephrology, Children's Mercy Hospital and University of Missouri at Kansas City, Kansas City, Missouri, USA
| | - Mohammad H Rezaiekhaligh
- Section of Nephrology, Children's Mercy Hospital and University of Missouri at Kansas City, Kansas City, Missouri, USA
| | - Daniel P Heruth
- Children's Mercy Research Institute, Children's Mercy Hospital and University of Missouri at Kansas City, Kansas City, Missouri, USA
| | - Jan Novak
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Uri S Alon
- Section of Nephrology, Children's Mercy Hospital and University of Missouri at Kansas City, Kansas City, Missouri, USA
| | - Trupti Joshi
- Department of Health Management and Informatics, University of Missouri, Columbia, Missouri, USA.,Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, Missouri, USA.,Christopher S. Bond Life Sciences Center, University of Missouri, Columbia, Missouri, USA.,MU Institute for Data Science and Informatics, University of Missouri, Columbia, Missouri, USA
| | - Yuexu Jiang
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, Missouri, USA.,Christopher S. Bond Life Sciences Center, University of Missouri, Columbia, Missouri, USA
| | - Ellen T McCarthy
- Department of Internal Medicine, The Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Virginia J Savin
- Renal Research Laboratory, Kansas City VA Medical Center, Kansas City, Missouri, USA.,Department of Internal Medicine, The Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mark L Johnson
- Department of Oral and Craniofacial Sciences, University of Missouri at Kansas City-School of Dentistry, Kansas City, Missouri, USA
| | - Ram Sharma
- Renal Research Laboratory, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Mukut Sharma
- Midwest Veterans' Biomedical Research Foundation (MVBRF), Kansas City, Missouri, USA.,Renal Research Laboratory, Kansas City VA Medical Center, Kansas City, Missouri, USA.,Department of Internal Medicine, The Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas, USA
| |
Collapse
|
27
|
Ali MA, Oyortey MA, Maalman RSE, Donkor YO, Adanu KK, Kyei MY. Solitary kidney functional damage due to caesarean ureteric injury monitored for 2 years after acute management: A case report. Case Rep Womens Health 2022; 36:e00439. [PMID: 36035238 PMCID: PMC9398914 DOI: 10.1016/j.crwh.2022.e00439] [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: 06/19/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 11/21/2022] Open
Abstract
Caesarean section with associated ureteric injuries that damage kidney function is uncommon. Such injury in women with a solitary kidney has far-reaching effects if the diagnosis is delayed. The case report describes the successful acute management with stenting of ureteric damage after caesarean section in a woman with a solitary kidney. A 29-year-old woman presented with anuria, hypertension (174/101 mmHg) and flank pain 3 days after caesarean section. Physical examination was significant for peri-orbital oedema, left flank tenderness, pallor and delirium. A diagnosis of acute kidney injury was confirmed by elevated blood urea and creatinine levels. An ultrasound scan revealed a solitary hydronephrotic left kidney. She had successful acute management at a resource-deprived facility, with normal renal function at a 2-year follow-up. Proteinuria lasted for about three months after surgery. Recovery of solitary kidney function with acute kidney injury due to caesarean section ureteric injury may be associated with prolonged proteinuria without evidence of further functional deterioration. Caesarean ureteric obstruction is rare but consequential. Over 70% are diagnosed late with varied effects on the kidneys. Single kidney damage in a bilateral renal system may be compensated. Solitary kidney damage is a live threatening obstetric complication.
Collapse
|
28
|
Evolution of congenital anomalies of urinary tract in children with and without solitary kidney. Pediatr Res 2022; 92:767-775. [PMID: 34625653 DOI: 10.1038/s41390-021-01781-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/01/2021] [Accepted: 09/17/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND We hypothesized that children with congenital solitary functioning kidney (CSFK) present forms of congenital urinary tract anomalies (CUTA) with higher chance of spontaneous resolution compared with patients with two kidneys. METHODS We retrospectively selected 75 consecutive children with CUTA of the CSFK and 75 matched patients with unilateral CUTA but without CSFK (controls) with prenatal suspicion of unilateral CUTA and early evaluation. We compared the spontaneous CUTA resolution and the prevalence of kidney injury between groups at last follow-up. Patients and controls were clustered under the categories of "severe" and "non-severe" CUTA. RESULTS The mean age at first and last follow-up was 0.17 ± 0.07 and 8.5 ± 5.2 years. Compared with controls, patients with CSFK had lower prevalence of severe CUTA at first evaluation; lower prevalence of febrile urinary tract infections, need of surgical correction, and higher rate of spontaneous CUTA resolution during follow-up; and a similar prevalence of mild kidney injury at last follow-up. CSFK compared with controls presented higher cumulative proportion of spontaneous resolution from severe CUTA (100 vs 41.8%; p < 0.001) and from the single CUTA sub-categories (severe vesicoureteral reflux, non-obstructive hydronephrosis, and megaureter). CONCLUSIONS CSFK patients had lower prevalence of severe forms and better outcomes of their CUTA compared with controls. IMPACT One-third of patients with congenital solitary functioning kidney (CSFK) present congenital urinary tract anomalies (CUTA) and manifest poorer outcomes compared with CSFK without CUTA. CSFK patients had lower prevalence of severe forms and better outcomes of their CUTA in spite of similar prevalence of kidney injury compared with controls. This adds evidence about disturbed nephrogenesis in CSFK patients and emboldens conservative management of many of their non-obstructive CUTA.
Collapse
|
29
|
Fadiloglu E, Zaim OC, Cagan M, Unal C, Beksac MS. Gestational Outcomes of Pregnant Women with Unilateral Congenital Renal Agenesis. Fetal Pediatr Pathol 2022; 41:551-557. [PMID: 33295830 DOI: 10.1080/15513815.2020.1856245] [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] [Indexed: 10/22/2022]
Abstract
ObjectiveWe evaluated if there were more adverse gestational outcomes of pregnant women with unilateral congenital renal agenesis (UCRA). Study design: This single center retrospective case-control study compared maternal complications and neonatal outcomes from 25 women with UCRA to the outcomes of 125 women with two kidneys. Results: UCRA women had lower gestational weeks at birth and higher rates of preterm delivery (p = 0.004 and <0.001; respectively). Mothers had higher rates of preeclampsia and newborns with congenital anomalies and neonatal intensive care unit (NICU) admission (p = 0.009, 0.042, and 0.039; respectively). Unadjusted odds ratios were significantly higher for preterm delivery and for any APGAR score of <7 at the first 10 min and preeclampsia [OR (95% CI):13.5 (4.66-39.05), 31 (3.44-279.32) and 5.76 (1.33-24.84), respectively]. Conclusion: Maternal UCRA is a risk factor for less optimal obstetric and neonatal outcomes.
Collapse
Affiliation(s)
- Erdem Fadiloglu
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Onur Can Zaim
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Murat Cagan
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Canan Unal
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - M Sinan Beksac
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
30
|
Lombel RM, Brakeman PR, Sack BS, Butani L. Urologic Considerations in Pediatric Chronic Kidney Disease. Adv Chronic Kidney Dis 2022; 29:308-317. [PMID: 36084977 DOI: 10.1053/j.ackd.2022.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/20/2022] [Accepted: 02/23/2022] [Indexed: 11/11/2022]
Abstract
Common causes of pediatric ESRD are distinct from those seen in the adult population. In the pediatric population, the most common are congenital anomalies of the kidney and urinary tract (CAKUT), affecting approximately 30% of children with CKD. These structural anomalies often require coordinated care with the pediatric urology team to address voiding issues, bladder involvement, and the potential need for surgical intervention. For pediatric nephrologists and urologists, common CAKUT that are encountered include antenatal hydronephrosis, obstructive uropathies (eg, posterior urethral valves), and vesicoureteral reflux. As more pediatric patients with CAKUT, CKD, and ESRD transition to adult care, it is important for receiving adult nephrologists to understand the clinical presentation, natural history, and prognosis for these diagnoses. This review outlines the diagnosis and potential interventions for these conditions, including strategies to address bladder dysfunction that is often seen in children with CAKUT. A discussion of these management decisions (including surgical intervention) for CAKUT, which are quite common to pediatric nephrology and urology practices, may provide unique learning opportunities for adult nephrologists who lack familiarity with these pediatric conditions.
Collapse
Affiliation(s)
- Rebecca M Lombel
- Division of Pediatric Nephrology, University of Michigan, Ann Arbor, MI.
| | - Paul R Brakeman
- Division of Pediatric Nephrology, University of California, San Francisco, San Francisco, CA
| | - Bryan S Sack
- Division of Pediatric Urology, University of Michigan, Ann Arbor, MI
| | - Lavjay Butani
- Division of Pediatric Nephrology, University of California Davis Medical Center, Sacramento, CA
| |
Collapse
|
31
|
Abstract
Circulating blood is filtered across the glomerular barrier to form an ultrafiltrate of plasma in the Bowman's space. The volume of glomerular filtration adjusted by time is defined as the glomerular filtration rate (GFR), and the total GFR is the sum of all single-nephron GFRs. Thus, when the single-nephron GFR is increased in the context of a normal number of functioning nephrons, single glomerular hyperfiltration results in 'absolute' hyperfiltration in the kidney. 'Absolute' hyperfiltration can occur in healthy people after high protein intake, during pregnancy and in patients with diabetes, obesity or autosomal-dominant polycystic kidney disease. When the number of functioning nephrons is reduced, single-nephron glomerular hyperfiltration can result in a GFR that is within or below the normal range. This 'relative' hyperfiltration can occur in patients with a congenitally reduced nephron number or with an acquired reduction in nephron mass consequent to surgery or kidney disease. Improved understanding of the mechanisms that underlie 'absolute' and 'relative' glomerular hyperfiltration in different clinical settings, and of whether and how the single-nephron haemodynamic and related biomechanical forces that underlie glomerular hyperfiltration promote glomerular injury, will pave the way toward the development of novel therapeutic interventions that attenuate glomerular hyperfiltration and potentially prevent or limit consequent progressive kidney injury and loss of function.
Collapse
|
32
|
Acharya PT, Ponrartana S, Lai L, Vasquez E, Goodarzian F. Imaging of congenital genitourinary anomalies. Pediatr Radiol 2022; 52:726-739. [PMID: 34741177 DOI: 10.1007/s00247-021-05217-2] [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: 04/09/2021] [Revised: 08/12/2021] [Accepted: 10/05/2021] [Indexed: 11/29/2022]
Abstract
Congenital genitourinary anomalies are among the most frequent types of birth defects in neonates. Some anomalies can be a significant cause of morbidity in infancy, while others remain asymptomatic even until adulthood and can be at times the only manifestation of a complex systemic disease. The spectrum of these anomalies results from the developmental insults that can occur at various embryologic stages, and an understanding of the formation of the genitourinary system is helpful in the evaluation and treatment of a child with a congenital genitourinary anomaly. Imaging plays an essential role in the diagnosis of congenital genitourinary anomalies and treatment planning. In this article, we highlight the embryologic and characteristic imaging features of various congenital genitourinary anomalies, demonstrate the utility of different imaging modalities in management, and review specific imaging modalities and protocols for image optimization.
Collapse
Affiliation(s)
- Patricia T Acharya
- Department of Radiology, Children's Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #81, Los Angeles, CA, 90027, USA. .,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. .,Loma Linda University School of Medicine, Loma Linda, CA, USA.
| | - Skorn Ponrartana
- Department of Radiology, Children's Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #81, Los Angeles, CA, 90027, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lillian Lai
- Department of Radiology, Children's Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #81, Los Angeles, CA, 90027, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Evalynn Vasquez
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Urology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Fariba Goodarzian
- Department of Radiology, Children's Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #81, Los Angeles, CA, 90027, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
33
|
Khan K, Ahram DF, Liu YP, Westland R, Sampogna RV, Katsanis N, Davis EE, Sanna-Cherchi S. Multidisciplinary approaches for elucidating genetics and molecular pathogenesis of urinary tract malformations. Kidney Int 2022; 101:473-484. [PMID: 34780871 PMCID: PMC8934530 DOI: 10.1016/j.kint.2021.09.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/15/2021] [Accepted: 09/30/2021] [Indexed: 12/28/2022]
Abstract
Advances in clinical diagnostics and molecular tools have improved our understanding of the genetically heterogeneous causes underlying congenital anomalies of kidney and urinary tract (CAKUT). However, despite a sharp incline of CAKUT reports in the literature within the past 2 decades, there remains a plateau in the genetic diagnostic yield that is disproportionate to the accelerated ability to generate robust genome-wide data. Explanations for this observation include (i) diverse inheritance patterns with incomplete penetrance and variable expressivity, (ii) rarity of single-gene drivers such that large sample sizes are required to meet the burden of proof, and (iii) multigene interactions that might produce either intra- (e.g., copy number variants) or inter- (e.g., effects in trans) locus effects. These challenges present an opportunity for the community to implement innovative genetic and molecular avenues to explain the missing heritability and to better elucidate the mechanisms that underscore CAKUT. Here, we review recent multidisciplinary approaches at the intersection of genetics, genomics, in vivo modeling, and in vitro systems toward refining a blueprint for overcoming the diagnostic hurdles that are pervasive in urinary tract malformation cohorts. These approaches will not only benefit clinical management by reducing age at molecular diagnosis and prompting early evaluation for comorbid features but will also serve as a springboard for therapeutic development.
Collapse
Affiliation(s)
- Kamal Khan
- Center for Human Disease Modeling, Duke University, Durham, North Carolina, USA.,Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA (current address)
| | - Dina F. Ahram
- Division of Nephrology, Columbia University, New York, USA
| | - Yangfan P. Liu
- Center for Human Disease Modeling, Duke University, Durham, North Carolina, USA
| | - Rik Westland
- Division of Nephrology, Columbia University, New York, USA.,Department of Pediatric Nephrology, Amsterdam UMC- Emma Children’s Hospital, Amsterdam, NL
| | | | - Nicholas Katsanis
- Center for Human Disease Modeling, Duke University, Durham, North Carolina, USA; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA (current address); Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA; Department of Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
| | - Erica E. Davis
- Center for Human Disease Modeling, Duke University, Durham, North Carolina, USA.,Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA (current address).,Department of Pediatrics and Department of Cell and Molecular Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,To whom correspondence should be addressed: ADDRESS CORRESPONDENCE TO: Simone Sanna-Cherchi, MD, Division of Nephrology, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA; Phone: 212-851-4925; Fax: 212-851-5461; . Erica E. Davis, PhD, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA; Phone: 312-503-7662; Fax: 312-503-7343; , Nicholas Katsanis, PhD, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA; Phone: 312-503-7339; Fax: 312-503-7343;
| | - Simone Sanna-Cherchi
- Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, New York, USA.
| |
Collapse
|
34
|
Knoers NVAM. The term CAKUT has outlived its usefulness: the case for the defense. Pediatr Nephrol 2022; 37:2793-2798. [PMID: 35867161 PMCID: PMC9489570 DOI: 10.1007/s00467-022-05678-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 11/26/2022]
Abstract
Congenital anomalies of the kidney and urinary tract form a spectrum of congenital structural disorders that are generally known under the term CAKUT. The term CAKUT was introduced 20 years ago and has been used extensively in literature since. Prof. Woolf has made a plea for abandoning this term in his "case for the prosecution." Here, I advocate for the continued use of CAKUT as an umbrella term for these related congenital kidney and urinary tract abnormalities. I explain why the term CAKUT accurately and usefully defines this group of related structural disorders with prenatal origin and why it makes sense to continue grouping these disorders given accumulating evidence for shared etiology of CAKUT phenotypes and the importance of grouping CAKUT phenotypes in genetic counseling.
Collapse
Affiliation(s)
- Nine V A M Knoers
- Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands.
| |
Collapse
|
35
|
La Scola C, Ammenti A, Bertulli C, Bodria M, Brugnara M, Camilla R, Capone V, Casadio L, Chimenz R, Conte ML, Conversano E, Corrado C, Guarino S, Luongo I, Marsciani M, Marzuillo P, Meneghesso D, Pennesi M, Pugliese F, Pusceddu S, Ravaioli E, Taroni F, Vergine G, Peruzzi L, Montini G. Management of the congenital solitary kidney: consensus recommendations of the Italian Society of Pediatric Nephrology. Pediatr Nephrol 2022; 37:2185-2207. [PMID: 35713730 PMCID: PMC9307550 DOI: 10.1007/s00467-022-05528-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/13/2022]
Abstract
In recent years, several studies have been published on the prognosis of children with congenital solitary kidney (CSK), with controversial results, and a worldwide consensus on management and follow-up is lacking. In this consensus statement, the Italian Society of Pediatric Nephrology summarizes the current knowledge on CSK and presents recommendations for its management, including diagnostic approach, nutritional and lifestyle habits, and follow-up. We recommend that any antenatal suspicion/diagnosis of CSK be confirmed by neonatal ultrasound (US), avoiding the routine use of further imaging if no other anomalies of kidney/urinary tract are detected. A CSK without additional abnormalities is expected to undergo compensatory enlargement, which should be assessed by US. We recommend that urinalysis, but not blood tests or genetic analysis, be routinely performed at diagnosis in infants and children showing compensatory enlargement of the CSK. Extrarenal malformations should be searched for, particularly genital tract malformations in females. An excessive protein and salt intake should be avoided, while sport participation should not be restricted. We recommend a lifelong follow-up, which should be tailored on risk stratification, as follows: low risk: CSK with compensatory enlargement, medium risk: CSK without compensatory enlargement and/or additional CAKUT, and high risk: decreased GFR and/or proteinuria, and/or hypertension. We recommend that in children at low-risk periodic US, urinalysis and BP measurement be performed; in those at medium risk, we recommend that serum creatinine also be measured; in high-risk children, the schedule has to be tailored according to kidney function and clinical data.
Collapse
Affiliation(s)
- Claudio La Scola
- Pediatric Nephrology and Dialysis, Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Massarenti 11, 40138, Bologna, Italy.
| | - Anita Ammenti
- Pediatric Multi-Specialistic Unit, Poliambulatorio Medi-Saluser, Parma, Italy
| | - Cristina Bertulli
- grid.6292.f0000 0004 1757 1758Pediatric Nephrology and Dialysis, Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Massarenti 11, 40138 Bologna, Italy
| | - Monica Bodria
- grid.419504.d0000 0004 1760 0109Division of Nephrology, Dialysis, Transplantation, and Laboratory On Pathophysiology of Uremia, Istituto G. Gaslini, Genova, Italy
| | | | - Roberta Camilla
- grid.432329.d0000 0004 1789 4477Pediatric Nephrology Unit, Regina Margherita Department, Azienda Ospedaliero-Universitaria Città Della Salute E Della Scienza, Torino, Italy
| | - Valentina Capone
- Pediatric Nephrology, Dialysis and Transplant Unit. Fondazione Ca’ Granda IRCCS, Policlinico Di Milano, Milano, Italy
| | - Luca Casadio
- Unità Operativa Complessa Di Pediatria E Neonatologia, Ospedale Di Ravenna, AUSL Romagna, Ravenna, Italy
| | - Roberto Chimenz
- Unità Operativa Di Nefrologia Pediatrica Con Dialisi, Azienda Ospedaliero-Universitaria G. Martino, Messina, Italy
| | - Maria L. Conte
- grid.414614.2Department of Pediatrics, Infermi Hospital, Rimini, Italy
| | - Ester Conversano
- grid.418712.90000 0004 1760 7415Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Trieste, Italy
| | - Ciro Corrado
- Pediatric Nephrology, “G. Di Cristina” Hospital, Palermo, Italy
| | - Stefano Guarino
- grid.9841.40000 0001 2200 8888Department of Woman, Child and of General and Specialized Surgery, Università Degli Studi Della Campania “Luigi Vanvitelli, Napoli, Italy
| | - Ilaria Luongo
- Unità Operativa Complessa Di Nefrologia E Dialisi, AORN Santobono – Pausilipon, Napoli, Italy
| | - Martino Marsciani
- grid.414682.d0000 0004 1758 8744Unità Operativa Di Pediatria E Terapia Intensiva Neonatale-Pediatrica, Ospedale M Bufalini, Cesena, Italy
| | - Pierluigi Marzuillo
- grid.9841.40000 0001 2200 8888Department of Woman, Child and of General and Specialized Surgery, Università Degli Studi Della Campania “Luigi Vanvitelli, Napoli, Italy
| | - Davide Meneghesso
- grid.5608.b0000 0004 1757 3470Unità Operativa Complessa Di Nefrologia Pediatrica - Dialisi E Trapianto, Dipartimento Di Salute Della Donna E del Bambino, Azienda Ospedaliero-Universitaria Di Padova, Padova, Italy
| | - Marco Pennesi
- grid.418712.90000 0004 1760 7415Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Trieste, Italy
| | - Fabrizio Pugliese
- grid.7010.60000 0001 1017 3210Pediatric Nephrology Unit, Department of Pediatrics, Marche Polytechnic University, Ancona, Italy
| | | | - Elisa Ravaioli
- grid.414614.2Department of Pediatrics, Infermi Hospital, Rimini, Italy
| | - Francesca Taroni
- Pediatric Nephrology, Dialysis and Transplant Unit. Fondazione Ca’ Granda IRCCS, Policlinico Di Milano, Milano, Italy
| | - Gianluca Vergine
- grid.414614.2Department of Pediatrics, Infermi Hospital, Rimini, Italy
| | - Licia Peruzzi
- grid.432329.d0000 0004 1789 4477Pediatric Nephrology Unit, Regina Margherita Department, Azienda Ospedaliero-Universitaria Città Della Salute E Della Scienza, Torino, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit. Fondazione Ca’ Granda IRCCS, Policlinico Di Milano, Milano, Italy ,grid.4708.b0000 0004 1757 2822Giuliana and Bernardo Caprotti Chair of Pediatrics, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| |
Collapse
|
36
|
Outcomes of solitary functioning kidneys-renal agenesis is different than multicystic dysplastic kidney disease. Pediatr Nephrol 2021; 36:3673-3680. [PMID: 33954810 DOI: 10.1007/s00467-021-05064-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/16/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Multicystic dysplastic kidney (MCDK) disease and unilateral renal agenesis (URA) are well-known causes of a solitary functioning kidney (SFK) and are associated with long-term kidney injury. The aims of this study were to characterize the natural history of SFK at our center, define the risk factors associated with chronic kidney injury, and identify distinguishing features between URA and MCDK that predict outcome. METHODS This was a retrospective cohort study of 230 SFK patients. We compared MCDK (n=160) and URA (n=70) according to clinical features at diagnosis and kidney outcomes over follow-up. Univariate and multivariate binary regression analysis was used to determine independent risk factors for chronic kidney injury, defined as the composite outcome of hypertension, proteinuria, or chronic kidney disease (eGFR <60 mL/min/1.73m2). RESULTS URA had a higher prevalence of comorbid genetic syndromes (15 vs. 6%, p=0.04), non-renal anomalies (39 vs. 11%, p<0.001), and congenital anomalies of the kidney and urinary tract (CAKUT) (51 vs. 26%, p<0.001) than MCDK. Over follow-up, URA experienced more hypertension (19 vs. 3%, p=0.002), proteinuria (12 vs. 3%, p=0.03), and the composite outcome (19 vs. 6%, p=0.003) than MCDK. Independent risk factors for chronic kidney injury included CAKUT (OR 5.01, p=0.002) and URA (OR 2.71, p=0.04). CONCLUSIONS In our population, URA was more likely to have associated syndromes or anomalies, and to have worse outcomes over time than MCDK. URA diagnosis was an independent risk factor for chronic kidney injury. Our results will be used to develop a standardized clinical pathway for SFK management. A higher resolution version of the Graphical abstract is available as Supplementary information.
Collapse
|
37
|
Groen In't Woud S, van der Zanden LFM, Schreuder MF. Risk stratification for children with a solitary functioning kidney. Pediatr Nephrol 2021; 36:3499-3503. [PMID: 34137930 DOI: 10.1007/s00467-021-05168-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sander Groen In't Woud
- Department of Pediatric Nephrology, 804, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Amalia Children's Hospital, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.,Department for Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Loes F M van der Zanden
- Department for Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Michiel F Schreuder
- Department of Pediatric Nephrology, 804, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Amalia Children's Hospital, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.
| |
Collapse
|
38
|
Wei MZ, Yan ZJ, Jiang JH, Jia XL. Atypical granular cell tumor of the urinary bladder: A case report. World J Clin Cases 2021; 9:8453-8460. [PMID: 34754853 PMCID: PMC8554444 DOI: 10.12998/wjcc.v9.i28.8453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/14/2021] [Accepted: 07/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Granular cell tumor (GCT) is a neurogenic tumor mainly occurring in the head and neck. GCT in the genitourinary system is extremely rare and only sporadic cases of urinary bladder GCT have been reported. Most urinary bladder GCT cases are benign and only two malignant cases have been reported. Due to its rarity, no consensus criteria for the treatment of urinary bladder GCT are available at present.
CASE SUMMARY A 62-year-old Chinese woman was found to have a urinary bladder tumor without any clinical manifestations on physical examination. Cystoscopy revealed a semispherical shaped lesion measuring approximately 4.0 cm in diameter at the junction of the left wall and roof of the bladder, which was covered with normal bladder mucosa. Computed tomography scan demonstrated a high-density lesion on the left wall of the bladder, measuring approximately 2.9 cm × 2.4 cm with clear boundaries. Contrast-enhanced pelvic magnetic resonance imaging revealed a space-occupying lesion on the left wall of the bladder (non-mucosal origin/ external pressure), which was preliminarily suspected to be a desmoplastic fibroma or leiomyoma. In the context of the above findings, a pre-operative diagnosis of bladder leiomyoma was made. The patient consequently underwent a laparoscopic partial cystectomy. The resected bladder mass looked yellowish and well-demarcated, measuring 4.0 cm × 3.5 cm and infiltrated the muscular layer. The diagnosis of urinary bladder GCT was finally made by postoperative pathology, with positive immunohistochemical S-100 staining and negative pancytokeratin. The patient has been followed for 6 mo so far, with no tumor recurrence detected.
CONCLUSION This case highlights the biological feature and differential diagnosis of urinary bladder GCT at the pathological and molecular levels. Transurethral resection of the bladder tumor and partial cystectomy are recommended in most urinary bladder GCT cases, while radical cystectomy is recommended in malignant cases.
Collapse
Affiliation(s)
- Ming-Ze Wei
- Department of Urology, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315000, Zhejiang Province, China
| | - Ze-Jun Yan
- Department of Urology, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315000, Zhejiang Province, China
| | - Jun-Hui Jiang
- Department of Urology, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315000, Zhejiang Province, China
| | - Xiao-Long Jia
- Department of Urology, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo 315000, Zhejiang Province, China
| |
Collapse
|
39
|
Nephrotic Syndrome Associated with Hydronephrosis and Unilateral Renal Agenesis. ARS MEDICA TOMITANA 2021. [DOI: 10.2478/arsm-2020-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
We reported a case of nephrotic syndrome in a child presenting undiagnosed hydronephrosis and unilateral renal agenesis in a 3 years and 9 months old male patient presenting features of nephrotic syndrome, with left hydronephrosis and unilateral renal agenesis. The association of nephrotic syndrome with congenital anomalies is extremely rare. The importance of this unusual combination was discussed respecting the literature.
Collapse
|
40
|
Alfandary H, Haskin O, Goldberg O, Dagan A, Borovitz Y, Levi S, Davidovits M, Erlich T, Landau D, Pleniceanu O. Is the prognosis of congenital single functioning kidney benign? A population-based study. Pediatr Nephrol 2021; 36:2837-2845. [PMID: 33619660 DOI: 10.1007/s00467-021-04980-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/18/2021] [Accepted: 02/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND We investigated the risk of kidney injury among adolescents with and without a congenital single functioning kidney (SFK). METHODS This retrospective study is based on a medical evaluation database of 17-year-old Israeli conscripts, born during 1989-1999. Those with congenital SFK diagnosis, verified by a pediatric nephrologist's review of the original military medical committee classifications, were compared to the rest of the cohort. Kidney injury (KI) was defined as proteinuria, high blood pressure (BP), or estimated glomerular filtration rate (eGFR) < 90 ml/min/1.73 m2 prior to army recruitment. Risk factors for KI were examined using logistic regression. RESULTS Of 979,630 screened candidates, 353 were diagnosed with SFK. The yearly incidence of SFK gradually increased in the first years of the study, reaching a plateau in 1995 (5.5 ± 1.2/10,000 births/year). The male to female ratio was 2.7:1. Concomitant genital malformations were documented in 5.5% of those with SFK. KI was more prevalent in the SFK than the control group (42.2% vs. 23.5%, p < 0.001). All three components of KI were more common in the SFK than the control group: high BP (31.7% vs. 23.1%, p < 0.001), proteinuria (18.2% vs. 0.4%, p < 0.001), and eGFR <90 ml/min/1.73m2 (12.0% vs 0.1%, p < 0.001). Multivariate analysis of the SFK group revealed associations of higher mean BMI, male sex, and smaller ultrasonographic kidney length with KI. CONCLUSIONS This large population-based study documents a significant risk for KI among adolescents with SFK. Obesity represents a major modifiable risk factor for KI, implicating the need for closer follow-up in this group during childhood.
Collapse
Affiliation(s)
- Hadas Alfandary
- Institute of Nephrology, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petach Tikva, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Orly Haskin
- Institute of Nephrology, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Goldberg
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Amit Dagan
- Institute of Nephrology, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Borovitz
- Institute of Nephrology, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shelly Levi
- Institute of Nephrology, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miriam Davidovits
- Institute of Nephrology, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Erlich
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University, Jerusalem, Israel
- Urology Department, Sheba Medical Center, Ramat Gan, Israel
| | - Daniel Landau
- Institute of Nephrology, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oren Pleniceanu
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University, Jerusalem, Israel
- The Nephrology Research Lab, Institute of Nephrology and Hypertension, Sheba Medical Center, Tel Hashomer, Israel
| |
Collapse
|
41
|
Retrospective evaluation of children with unilateral renal agenesis. Pediatr Nephrol 2021; 36:2847-2855. [PMID: 33723672 DOI: 10.1007/s00467-021-05027-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/16/2021] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Children born with unilateral renal agenesis (URA) are thought to have a risk of developing hypertension, proteinuria, and progressive chronic kidney disease (CKD). The present study aimed to evaluate the long-term prognosis and clinical characteristics of children with URA. METHODS The study included 171 patients aged < 18 years diagnosed as URA who were followed-up for ≥ 1 year and 121 healthy controls matched for age, gender, and BMI. RESULTS Median age at diagnosis was 2 years (IQR: 1 month-16 years) and the incidence of URA in males (65.4%) was higher than in females. Among the patients, 21 (12.2%) had other urinary system anomalies. It was noted that 2.3% of the patients had proteinuria, 15.2% had hyperfiltration, and 2.9% had CKD. Hypertension based on ambulatory blood pressure monitoring (ABPM) was diagnosed in 18 (10.5%) of the patients, of whom 10 had masked hypertension. Diastolic blood pressure in the URA patients was significantly higher than in the healthy controls. The incidence of hypertension and CKD was significantly higher in the patients with other urinary system anomalies. CONCLUSIONS Patients with a single functional kidney should be periodically evaluated throughout their lifetime for urine protein, blood pressure, and kidney functions. The most remarkable finding of this study is the importance of the use of ABPM for evaluating blood pressure in pediatric URA patients, especially for the detection of masked hypertension and the non-dipper phenomenon, which cannot be achieved with office blood pressure measurement.
Collapse
|
42
|
Hutchinson KA, Halili L, Guerra A, Geier P, Keays M, Guerra L. Renal function in children with a congenital solitary functioning kidney: A systematic review. J Pediatr Urol 2021; 17:556-565. [PMID: 33752977 DOI: 10.1016/j.jpurol.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/19/2021] [Accepted: 03/01/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Abnormal renal development that results in lack of function or development of one of two kidneys is known as congenital solitary functioning kidney (CSFK). Two well characterized sub-categories of CFSK are unilateral renal agenesis (URA) and multicystic dysplastic kidney (MCDK). This systematic review sought to evaluate the change in renal function in children ≤18 years old with a CSFK as a result of URA or MCDK. METHODS A literature search in MEDLINE and Embase was conducted (1946 to July 13, 2020). All relevant articles were retrieved and evaluated based on pre-selected criteria by two independent researchers. Data was then extracted from variables of interest and conflicts were resolved by a third researcher. The primary outcome was renal function, and the secondary outcomes were proteinuria and hypertension. RESULTS Forty-five studies were included, of which 49% (n = 22) were retrospective and/or 58% (n = 26) were cohort studies. A combined total of 2148 and 885 patients were diagnosed with MCDK or URA, respectively. The proportion of children with worsened renal function at follow-up was found to be 8.4% (95% CI: 5.2%-13.4%). Among the studies reporting renal function as a group mean or median at follow-up, 84% (21/25) had a GFR/CrCl above 90 (mL/min/1.73 m2/ml/min). In terms of secondary outcomes, the proportion of children with proteinuria and hypertension was found to be 10.1% (95% CI: 6.9%-14.6%) and 7.4% (95% CI: 5.0%-10.9%), respectively. CONCLUSION The risk of developing proteinuria (10.1%), hypertension (7.4%), and/or worsened renal function (8.4%) for children with CFSK as a result of MCDK or URA is low. However, the level of evidence in the literature is weak. Further research is needed to identify the predisposing factors that may differentiate the small subset of children with CSFK at a higher risk of developing adverse renal outcomes.
Collapse
Affiliation(s)
- Kelly Ann Hutchinson
- Department of Surgery, Division of Urology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Lyra Halili
- Department of Surgery, Division of Urology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Andre Guerra
- Department of Chemical Engineering, McGill University, Montreal, Quebec, Canada
| | - Pavel Geier
- Department of Pediatrics, Division of Nephrology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Melise Keays
- Department of Surgery, Division of Urology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Luis Guerra
- Department of Surgery, Division of Urology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
| |
Collapse
|
43
|
Pande N, Sathe K, Save S, Shetty D. Chronic kidney disease in a child-an unusual crossroad: Answers. Pediatr Nephrol 2021; 36:1963-1965. [PMID: 33151403 DOI: 10.1007/s00467-020-04795-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/18/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Nivedita Pande
- Department of Pediatrics, Topiwala National Medical College and B. Y. L. Nair Charitable Hospital, Mumbai, India.
| | - Kiran Sathe
- Department of Pediatrics, Topiwala National Medical College and B. Y. L. Nair Charitable Hospital, Mumbai, India.,Sir H N Reliance Foundation Hospital, Mumbai, India
| | - Sushma Save
- Department of Pediatrics, Topiwala National Medical College and B. Y. L. Nair Charitable Hospital, Mumbai, India
| | - Dev Shetty
- Department of Radiology, Topiwala National Medical College and B. Y. L. Nair Charitable Hospital, Mumbai, India
| |
Collapse
|
44
|
Cobb MB, Wu W, Attipoe EM, Johnson AC, Garrett MR. Nephron-deficient HSRA rats exhibit renal injury with age but have limited renal damage from streptozotocin-induced hyperglycemia. Am J Physiol Renal Physiol 2021; 320:F1093-F1105. [PMID: 33843272 PMCID: PMC8285653 DOI: 10.1152/ajprenal.00487.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 04/05/2021] [Accepted: 04/05/2021] [Indexed: 01/13/2023] Open
Abstract
Hypertension and diabetes are the greatest factors influencing the progression of chronic kidney disease (CKD). Investigation into the role of nephron number in CKD alone or with hypertension has revealed a strong inverse relationship between the two; however, not much is known about the connection between nephron number and diabetic kidney disease. The heterogeneous stock-derived model of unilateral renal agenesis (HSRA) rat, a novel model of nephron deficiency, provides a unique opportunity to study the association between nephron number and hypertension and diabetes on CKD. HSRA rats exhibit failure of one kidney to develop in 50-75% of offspring, whereas the remaining offspring are born with two kidneys. Rats born with one kidney (HSRA-S) develop significant renal injury with age compared with two-kidney littermates (HSRA-C). The induction of hypertension as a secondary stressor leads to significantly more renal injury in HSRA-S compared with HSRA-C rats and nephrectomized HSRA-C (HSRA-UNX) rats. The present study sought to address the hypothesis that nephron deficiency in the HSRA rat would hasten renal injury in the presence of a secondary stressor of hyperglycemia. HSRA animals did not exhibit diabetes-related traits at any age; thus, streptozotocin (STZ) was used to induce hyperglycemia in HSRA-S, HSRA-C, and HSRA-UNX rats. STZ- and vehicle-treated animals were followed for 15 wk. STZ-treated animals developed robust hyperglycemia, but in contrast to the response to hypertension, neither HSRA-S nor HSRA-UNX animals developed proteinuria compared with vehicle treatment. In total, our data indicate that hyperglycemia from STZ alone does not have a significant impact on the onset or progression of injury in young one-kidney HSRA animals.NEW & NOTEWORTHY The HSRA rat, a novel model of nephron deficiency, provides a unique opportunity to study the association between nephron number and confounding cardiovascular complications that impact kidney health. Although hypertension was previously shown to exacerbate renal injury in young HSRA animals, diabetic hyperglycemia did not lead to worse renal injury, suggesting that nephron number has limited impact on kidney injury, at least in this model.
Collapse
Affiliation(s)
- Meredith B Cobb
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Wenjie Wu
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Esinam M Attipoe
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Ashley C Johnson
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Michael R Garrett
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
- Department of Medicine (Nephrology), University of Mississippi Medical Center, Jackson, Mississippi
- Department of Pediatrics (Genetics), University of Mississippi Medical Center, Jackson, Mississippi
| |
Collapse
|
45
|
Srivastava T, Heruth DP, Duncan RS, Rezaiekhaligh MH, Garola RE, Priya L, Zhou J, Boinpelly VC, Novak J, Ali MF, Joshi T, Alon US, Jiang Y, McCarthy ET, Savin VJ, Sharma R, Johnson ML, Sharma M. Transcription Factor β-Catenin Plays a Key Role in Fluid Flow Shear Stress-Mediated Glomerular Injury in Solitary Kidney. Cells 2021; 10:cells10051253. [PMID: 34069476 PMCID: PMC8159099 DOI: 10.3390/cells10051253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/06/2021] [Accepted: 05/14/2021] [Indexed: 01/21/2023] Open
Abstract
Increased fluid flow shear stress (FFSS) in solitary kidney alters podocyte function in vivo. FFSS-treated cultured podocytes show upregulated AKT-GSK3β-β-catenin signaling. The present study was undertaken to confirm (i) the activation of β-catenin signaling in podocytes in vivo using unilaterally nephrectomized (UNX) TOPGAL mice with the β-galactosidase reporter gene for β-catenin activation, (ii) β-catenin translocation in FFSS-treated mouse podocytes, and (iii) β-catenin signaling using publicly available data from UNX mice. The UNX of TOPGAL mice resulted in glomerular hypertrophy and increased the mesangial matrix consistent with hemodynamic adaptation. Uninephrectomized TOPGAL mice showed an increased β-galactosidase expression at 4 weeks but not at 12 weeks, as assessed using immunofluorescence microscopy (p < 0.001 at 4 weeks; p = 0.16 at 12 weeks) and X-gal staining (p = 0.008 at 4 weeks; p = 0.65 at 12 weeks). Immunofluorescence microscopy showed a significant increase in phospho-β-catenin (Ser552, p = 0.005) at 4 weeks but not at 12 weeks (p = 0.935) following UNX, and the levels of phospho-β-catenin (Ser675) did not change. In vitro FFSS caused a sustained increase in the nuclear translocation of phospho-β-catenin (Ser552) but not phospho-β-catenin (Ser675) in podocytes. The bioinformatic analysis of the GEO dataset, #GSE53996, also identified β-catenin as a key upstream regulator. We conclude that transcription factor β-catenin mediates FFSS-induced podocyte (glomerular) injury in solitary kidney.
Collapse
Affiliation(s)
- Tarak Srivastava
- Section of Nephrology, Children’s Mercy Hospital and University of Missouri at Kansas City, Kansas City, MO 64108, USA; (M.H.R.); (L.P.); (M.F.A.); (U.S.A.)
- Midwest Veterans’ Biomedical Research Foundation (MVBRF), Kansas City, MO 64128, USA; (J.Z.); (V.C.B.); (M.S.)
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri at Kansas City, Kansas City, MO 64108, USA;
- Correspondence: ; Tel.: +1-816-234-3010; Fax: +1-816-302-9919
| | - Daniel P. Heruth
- Children’s Mercy Research Institute, Children’s Mercy Hospital and University of Missouri at Kansas City, Kansas City, MO 64108, USA;
| | - R. Scott Duncan
- School of Biological Sciences, University of Missouri at Kansas City, Kansas City, MO 64108, USA;
| | - Mohammad H. Rezaiekhaligh
- Section of Nephrology, Children’s Mercy Hospital and University of Missouri at Kansas City, Kansas City, MO 64108, USA; (M.H.R.); (L.P.); (M.F.A.); (U.S.A.)
| | - Robert E. Garola
- Department of Pathology and Laboratory Medicine, Children’s Mercy Hospital and University of Missouri at Kansas City, Kansas City, MO 64108, USA;
| | - Lakshmi Priya
- Section of Nephrology, Children’s Mercy Hospital and University of Missouri at Kansas City, Kansas City, MO 64108, USA; (M.H.R.); (L.P.); (M.F.A.); (U.S.A.)
| | - Jianping Zhou
- Midwest Veterans’ Biomedical Research Foundation (MVBRF), Kansas City, MO 64128, USA; (J.Z.); (V.C.B.); (M.S.)
- Kansas City VA Medical Center, Kansas City, MO 64128, USA; (V.J.S.); (R.S.)
| | - Varun C. Boinpelly
- Midwest Veterans’ Biomedical Research Foundation (MVBRF), Kansas City, MO 64128, USA; (J.Z.); (V.C.B.); (M.S.)
- Kansas City VA Medical Center, Kansas City, MO 64128, USA; (V.J.S.); (R.S.)
| | - Jan Novak
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL 35487, USA;
| | - Mohammed Farhan Ali
- Section of Nephrology, Children’s Mercy Hospital and University of Missouri at Kansas City, Kansas City, MO 64108, USA; (M.H.R.); (L.P.); (M.F.A.); (U.S.A.)
| | - Trupti Joshi
- Department of Health Management and Informatics, University of Missouri, Columbia, MO 65211, USA;
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO 65211, USA;
- Christopher S. Bond Life Sciences Center, University of Missouri, Columbia, MO 65211, USA
- MU Data Science and Informatics Institute, University of Missouri, Columbia, MO 65211, USA
| | - Uri S. Alon
- Section of Nephrology, Children’s Mercy Hospital and University of Missouri at Kansas City, Kansas City, MO 64108, USA; (M.H.R.); (L.P.); (M.F.A.); (U.S.A.)
| | - Yuexu Jiang
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO 65211, USA;
- Christopher S. Bond Life Sciences Center, University of Missouri, Columbia, MO 65211, USA
| | - Ellen T. McCarthy
- Department of Internal Medicine, The Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Virginia J. Savin
- Kansas City VA Medical Center, Kansas City, MO 64128, USA; (V.J.S.); (R.S.)
| | - Ram Sharma
- Kansas City VA Medical Center, Kansas City, MO 64128, USA; (V.J.S.); (R.S.)
| | - Mark L. Johnson
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri at Kansas City, Kansas City, MO 64108, USA;
| | - Mukut Sharma
- Midwest Veterans’ Biomedical Research Foundation (MVBRF), Kansas City, MO 64128, USA; (J.Z.); (V.C.B.); (M.S.)
- Kansas City VA Medical Center, Kansas City, MO 64128, USA; (V.J.S.); (R.S.)
- Department of Internal Medicine, The Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| |
Collapse
|
46
|
AbdElnaser T, Elkhiat YI, El-Azizi HM, Fatah E, Abd M, Elshibany AM, GamalEl Din SF. A cross-sectional study of the genital duct and renal anomalies in Egyptian cases of congenital absence of the vas deferens. HUM FERTIL 2021; 25:738-744. [PMID: 33908325 DOI: 10.1080/14647273.2021.1918352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of the study was to detect the incidence and types of genital and renal duct anomalies associated with congenital absent vas deferens (CAVD). In 200 males with CAVD, the demographic characteristics, physical examination findings were evaluated. Scrotal ultrasonography and transrectal ultrasonography (TRUS) were used as the diagnostic methods for evaluating unilateral or bilateral CAVD with associated abnormalities or agenesis of the testes, epididymes, seminal vesicles and prostate. Abdominal ultrasound was performed to detect any associated renal anomalies. There were a total of 111 CBAVD and 89 CUAVD males. Eight cases (8.98%) of CUAVD were associated with contralateral cryptorchidism. In most cases there were agenesis in the epididymal body and tail and seminal vesicles. Different types of renal anomalies (32.50%) especially renal agenesis were observed mainly in cases of left CUAVD and were predominately on the left hand side. An important implication of our study is the importance of requesting ultrasound of males with CAVD to discover any associated anomalies especially renal agenesis that may be ignored by many physicians.
Collapse
Affiliation(s)
- Taha AbdElnaser
- Andrology & STDs department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yasser Ibrahem Elkhiat
- Andrology & STDs department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | - Mohamed Abd
- Andrology & STDs department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Mahmoud Elshibany
- Andrology, Sexology &STDs unit at Department of Dermatology, Venereology & Andrology, Assiut University, Asyut, Egypt
| | - Sameh Fayek GamalEl Din
- Andrology & STDs department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| |
Collapse
|
47
|
Groen In 't Woud S, Westland R, Feitz WFJ, Roeleveld N, van Wijk JAE, van der Zanden LFM, Schreuder MF. Clinical Management of Children with a Congenital Solitary Functioning Kidney: Overview and Recommendations. EUR UROL SUPPL 2021; 25:11-20. [PMID: 34337499 PMCID: PMC8317823 DOI: 10.1016/j.euros.2021.01.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 11/25/2022] Open
Abstract
CONTEXT A congenital solitary functioning kidney (cSFK) is a common developmental defect that predisposes to hypertension and chronic kidney disease (CKD) as a consequence of hyperfiltration. Every urologist takes care of patients with a cSFK, since some will need lifelong urological care or will come with clinical problems or questions to an adult urologist later in life. OBJECTIVE We aim to provide clear recommendations for the initial clinical management and follow-up of children with a cSFK. EVIDENCE ACQUISITION PubMed and EMBASE were searched to identify relevant publications, which were combined with guidelines on related topics and expert opinion. EVIDENCE SYNTHESIS Initially, cSFK diagnosis should be confirmed and risk factors for kidney injury should be identified using ultrasound. Although more research into early predictors of kidney injury is needed, additional congenital anomalies of the kidney or urinary tract and absence of compensatory kidney hypertrophy have repeatedly been associated with a worse prognosis. The role of voiding cystourethrography and antibiotic prophylaxis remains controversial, and is complicated by the exclusion of children with a cSFK from studies. A yearly follow-up for signs of kidney injury is recommended for children with a cSFK. As masked hypertension is prevalent, annual ambulatory blood pressure measurement should be considered. During puberty, an increasing incidence of kidney injury is seen, indicating that long-term follow-up is necessary. If signs of kidney injury are present, angiotensin converting enzyme inhibitors are the first-line drugs of choice. CONCLUSIONS This overview points to the urological and medical clinical aspects and long-term care guidance for children with a cSFK, who are at risk of hypertension and CKD. Monitoring for signs of kidney injury is therefore recommended throughout life. Large, prospective studies with long-term follow-up of clearly defined cohorts are still needed to facilitate more risk-based and individualized clinical management. PATIENT SUMMARY Many children are born with only one functioning kidney, which could lead to kidney injury later in life. Therefore, a kidney ultrasound is made soon after birth, and other investigations may be needed as well. Urologists taking care of patients with a solitary functioning kidney should realize the long-term clinical aspects, which might need medical management.
Collapse
Affiliation(s)
- Sander Groen In 't Woud
- Department for Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Department of Pediatric Nephrology, Radboudumc Amalia Children's Hospital, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Rik Westland
- Department of Pediatric Nephrology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Wout F J Feitz
- Division of Pediatric Urology, Department of Urology, Radboudumc Amalia Children's Hospital, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Nel Roeleveld
- Department for Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Joanna A E van Wijk
- Division of Pediatric Urology, Department of Urology, Radboudumc Amalia Children's Hospital, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Loes F M van der Zanden
- Department for Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Michiel F Schreuder
- Department of Pediatric Nephrology, Radboudumc Amalia Children's Hospital, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| |
Collapse
|
48
|
Houat AP, Guimarães CTS, Takahashi MS, Rodi GP, Gasparetto TPD, Blasbalg R, Velloni FG. Congenital Anomalies of the Upper Urinary Tract: A Comprehensive Review. Radiographics 2021; 41:462-486. [PMID: 33513074 DOI: 10.1148/rg.2021200078] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The upper urinary tract is the most common human system affected by congenital anomalies. Congenital anomalies of the kidneys and ureters comprise a wide spectrum of disorders ranging from simple variants with no clinical significance to complex anomalies that may lead to severe complications and end-stage renal disease. They may be classified as anomalies of renal form, which are subclassified as structural anomalies (eg, persistent fetal lobulation, hypertrophied column of Bertin, and dromedary hump) and fusion anomalies (eg, horseshoe kidney and pancake kidney); anomalies of renal position (eg, renal malrotation, simple renal ectopia, and crossed renal ectopia) and renal number (eg, renal agenesis and supernumerary kidney); and abnormalities in development of the urinary collecting system (eg, pyelocaliceal diverticulum, megacalycosis, ureteropelvic junction obstruction, duplex collecting system, megaureter, ectopic ureter, and ureterocele). US is usually the first imaging modality used because of its low cost, wide availability, and absence of ionizing radiation. Intravenous urography and voiding cystourethrography are also useful, mainly for characterization of the collecting system and vesicoureteral reflux. However, intravenous urography has been replaced by CT urography and MR urography. These imaging methods not only allow direct visualization of the collecting system but also demonstrate the function of the kidneys, the vascular anatomy, adjacent structures, and complications. Comprehension of congenital anomalies of the upper urinary tract is crucial for an accurate diagnosis and correct management. The authors discuss the spectrum of these anomalies, with emphasis on embryologic development, imaging findings, clinical manifestations, and complications. Online supplemental material is available for this article. ©RSNA, 2021.
Collapse
Affiliation(s)
- Abdallah P Houat
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil
| | - Cassia T S Guimarães
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil
| | - Marcelo S Takahashi
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil
| | - Gustavo P Rodi
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil
| | - Taísa P D Gasparetto
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil
| | - Roberto Blasbalg
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil
| | - Fernanda G Velloni
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil
| |
Collapse
|
49
|
Westland R, Renkema KY, Knoers NV. Clinical Integration of Genome Diagnostics for Congenital Anomalies of the Kidney and Urinary Tract. Clin J Am Soc Nephrol 2021; 16:128-137. [PMID: 32312792 PMCID: PMC7792653 DOI: 10.2215/cjn.14661119] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Revolutions in genetics, epigenetics, and bioinformatics are currently changing the outline of diagnostics and clinical medicine. From a nephrologist's perspective, individuals with congenital anomalies of the kidney and urinary tract (CAKUT) are an important patient category: not only is CAKUT the predominant cause of kidney failure in children and young adults, but the strong phenotypic and genotypic heterogeneity of kidney and urinary tract malformations has hampered standardization of clinical decision making until now. However, patients with CAKUT may benefit from precision medicine, including an integrated diagnostics trajectory, genetic counseling, and personalized management to improve clinical outcomes of developmental kidney and urinary tract defects. In this review, we discuss the present understanding of the molecular etiology of CAKUT and the currently available genome diagnostic modalities in the clinical care of patients with CAKUT. Finally, we discuss how clinical integration of findings from large-scale genetic, epigenetic, and gene-environment interaction studies may improve the prognosis of all individuals with CAKUT.
Collapse
Affiliation(s)
- Rik Westland
- Department of Pediatric Nephrology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Kirsten Y. Renkema
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nine V.A.M. Knoers
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands,Department of Genetics, University Medical Centre Groningen, Groningen, The Netherlands
| |
Collapse
|
50
|
van Dam MJCM, Zegers BSHJ, Schreuder MF. Case Report: Uterine Anomalies in Girls With a Congenital Solitary Functioning Kidney. Front Pediatr 2021; 9:791499. [PMID: 34970519 PMCID: PMC8713333 DOI: 10.3389/fped.2021.791499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022] Open
Abstract
Unilateral renal agenesis and multicystic dysplastic kidney, resulting in a contralateral solitary functioning kidney (SFK), are part of the broad spectrum of congenital anomalies of the kidney and urinary tract (CAKUT). In girls with SFK, screening for asymptomatic Müllerian anomalies of uterus and vagina is not yet routinely performed, and therefore often overlooked until clinical complications in the menstrual cycle or fertility process occur. In this case series, we report on four teenagers with congenital SFK presenting with menstrual problems due to a Müllerian anomaly. Routine peri-menarchal screening for Müllerian anomalies in girls with SFK may provide timely counseling, surgical treatment and prevention of associated complications such as endometriosis, infertility and miscarriages.
Collapse
Affiliation(s)
- Mark J C M van Dam
- Department of Pediatrics, Máxima Medical Center, Veldhoven, Netherlands.,Department of Pediatrics, Maastricht University Medical Center, Maastricht, Netherlands
| | - Bas S H J Zegers
- Department of Pediatrics, Máxima Medical Center, Veldhoven, Netherlands
| | - Michiel F Schreuder
- Department of Pediatric Nephrology, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Amalia Children's Hospital, Nijmegen, Netherlands
| |
Collapse
|