Malformative uropathies in children: epidemiological, clinical, therapeutic and evolutive aspects in an ivoirian hospital setting

Abstract

Congenital anomalies of the kidney and the urinary tract are a major cause of chronic kidney failure in children. Prevalence in paediatrics varies according to studies. The data being rare in the ivorian context, this study aims to describe these defects' epidemiological, clinical, therapeutic and evolutionary aspects in children in a reference hospital setting. We performed a retrospective and descriptive study held in the Yopougon's Teaching Hospital Pediatric Nephrology Unit from December 1st 2008 to December 31st 2020. It involved 152 children aged 0 to 15 years, admitted to the unit, with a congenital anomaly of the kidney and the urinary tract diagnosed with radiology. Socio-demographic characteristics: congenital anomalies of the kidney and urinary tract's prevalence was 11%. The median age at admission was 36 months. The median age at diagnosis of malformative uropathy was 17.5 months. The sex ratio (M/F) was 2.3. Clinical characteristics: posterior urethra valves were the most common malformative uropathy (38%). Malformative uropathy was associated with other defects in 4% of cases. The antenatal diagnosis involved 24% of patients. The average gestational age of discovery was 32 weeks of amenorrhea. In the postnatal period, abdominal pain was the main circumstance for discovery (39%). Therapeutic characteristics: surgery was indicated in 58% of patients and performed in 64% of cases. Evolutionary characteristics: evolution was better in patients who had received surgical treatment (asymptomatic in 83% of cases, occurrence of urinary tract infection in 35% of cases and chronic renal failure in 23% of cases). 72% of the study population was lost. In Côte d'Ivoire, malformatives uropathies are late-discovered and are dominated by posterior urethra valves. Knowledge and management of these renal and urinary tract defects deserve to be improved through the development of antenatal diagnosis and training of practitioners in early recognition of clinical signs. The high rate of lost patients must be reduced by the implementation of an active patients' follow-up system.