Urinary Tract Anomalies Increased in Congenital Hypothyroidism

Abstract

Urology| April 01 2009 Urinary Tract Anomalies Increased in Congenital Hypothyroidism AAP Grand Rounds (2009) 21 (4): 37. https://doi.org/10.1542/gr.21-4-37 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Urinary Tract Anomalies Increased in Congenital Hypothyroidism. AAP Grand Rounds April 2009; 21 (4): 37. https://doi.org/10.1542/gr.21-4-37 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: congenital hypothyroidism, congenital malformation of the urinary system Source: Kumar J, Gordillo R, Kaskel FJ, et al. Increased prevalence of renal and urinary tract anomalies in children with congenital hypothyroidism. J Pediatr. 2009;154(2):263–266; doi:10.1016/j.jpeds.2008.08.023 Authors from Einstein College of Medicine and the New York State Department of Health sought to determine the prevalence of congenital renal and urologic anomalies in children with congenital hypothyroidism born in New York State between 1992 and 2005. The authors examined the NY Department of Health Congenital Malformations Registry. The registry includes data on children born in or residing in New York State before the age of two years with any anomaly (including structural, functional, and biochemical but excluding those associated with birthing events). Additionally, congenital hypothyroidism data from the New York State newborn screening database was matched to the Congenital Malformation Registry data. During the study period there were 1,538 newborns with congenital hypothyroidism and 3,654,033 without. Except for pyloric stenosis, children with congenital hypothyroidism had a significantly increased risk of any of the congenital anomalies listed in the database. Using the Congenital Malformation Registry data, children with congenital hypothyroidism were much more likely to have congenital renal and urologic anomalies (OR=13.2; CI, 10.6–16.5). Using newborn screening data, the OR was 4.8 (CI, 3.7–6.3). In both analyses, the risks for hydronephrosis, renal dysgenesis, and renal agenesis were especially significant. The authors speculate that the PAX 2 and 8 gene systems, which have recently been described as essential for normal development of the thyroid and urinary tract, are involved. They conclude that there is a strong association between congenital hypothyroidism and urinary tract anomalies, and recommend routine postnatal screening with renal and bladder sonography in children with congenital hypothyroidism. Dr. Mesrobian has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Pax 2 and Pax 8 genes are important regulators of kidney development. A recent article provides a detailed description of their mechanism of action.1 Pax 8 is also involved in encoding for a nuclear transcription factor involved in thyroid follicular cell development.2 Mutations in this gene have been associated with congenital hypothyroidism secondary to dysgenesis. This report’s clear demonstration of a strong association between congenital hypothyroidism and urinary tract and renal anomalies makes it imperative to evaluate infants with congenital hypothyroidism for such anomalies. Ultrasound is non-invasive and can detect many of the abnormalities associated with congenital hypothyroidism. It remains to be seen, however, whether early detection of urinary tract anomalies in this patient population will result in the prevention of long-term sequelae or delay end-stage renal disease. This article by Kumar, et al, is an example of a well done epidemiologic study utilizing a secondary database. These databases consist of existing data that were collected for a variety of purposes rather than to answer a specific research question. They are collected from surveys, medical records, vital records, or the census. They can be found at the National Center for Health... You do not currently have access to this content.