Congenital Hydronephrosis Research Articles

Biomarkers of renal parenchymal damage in young children with congenital hydronephrosis: literature review

Enlargement of the renal cavity system in a fetus is revealed at prenatal ultrasound in 1–5% of cases and can be caused by congenital hydronephrosis due to pelvic-ureteral junction obstruction, which is one of the most common nosologies in the structure of obstructive uropathies in childhood. A high risk of renal function decrease at the preclinical stage of disease development dictates a need to create highly informative diagnostic programs and treatment algorithms aimed at preventing complications. In this review, we discuss results of studies on diagnostic and prognostic value of cytokine biomarkers which are of a great interest in congenital hydronephrosis in young children. They include: kidney injury molecule-1, vascular endothelial growth factor-A, monocyte chemoattractant protein-1, neutrophil gelatinase-associated lipocalin, interleukin-1. Literature search for this review was made in Web of Science, PubMed, Russian Science Citation Index, CyberLeninka, Scopus databases.

A case of hydronephrosis due to intrarenal ureteral obstruction in a Japanese Black calf.

A 23-day-old Japanese Black female calf presented with distension of the lower abdomen. Abdominal ultrasonography revealed a cystic structure with fluid accumulation and moderate echoluminance in the right abdominal cavity. Ultrasonography and contrast-enhanced computed tomography revealed congenital hydronephrosis due to narrowing of the intrarenal ureter, and right kidney resection was performed. Blood urea nitrogen and serum creatinine levels, which were within reference values preoperatively, peaked on the third postoperative day and gradually decreased afterward until reaching preoperative values on the tenth day. In bovine hydronephrosis, nephrectomy may provide a favorable prognosis if one kidney is intact. Moreover, this case suggests that blood tests immediately after surgery are not suitable for evaluating residual kidneys.

Narrative Review of Bilateral Congenital Hydronephrosis in a Newborn: A Multidisciplinary Approach

Narrative Review of Bilateral Congenital Hydronephrosis in a Newborn: A Multidisciplinary Approach

Hydronephrosis in children. Clinical and therapeutic considerations

The present study analyses the experience of the Pediatric Urology Clinic of the National Scientific-Practical Center of Pediatric Surgery "Acad. Natalia Gheorghiu" during the years 2013-2022. During this period, 35 children aged 0-18 years with congenital hydronephrosis were evaluated. Indications for surgery were acuity, changes recorded on urinary system ultrasonography, intravenous urography, renal scintigraphy, computed tomography with vasography, nuclear magnetic resonance with angiography. The used surgical intervention was resection of the pyelo-ureteral junction and plasty of the pyelo-ureteral junction Andersen-Hynes procedure. No immediate postoperative local (nephrosclerosis) or general complications were recorded. Chronic kidney disease developed in 4 patients. No deaths were recorded.

P-265 Should we divide two types of direct cleavage at the first division in human embryos observed by time-lapse imaging?

Abstract Study question Are there any differences on clinical outcomes between two types of direct cleavage at the first division (DC1) in human embryos observed by time-lapse imaging? Summary answer Blastocyst development of DC1 without any two-cell stage was lower than DC1 with momentary two-cell stage. Once they became blastocysts, they didn’t affect pregnancy outcomes. What is known already In recent years, time-lapse imaging (TLI) has been used to analyze dynamics on embryo development. It clarified that some embryo showed direct cleavage, where one cell divided into three or more cells directly (DC1). It has been reported that DC1 embryos showed chromosomal abnormalities and negative effect on the embryonic development compared to normal cleavage without DC1. Some reports revealed that once embryos with DC1 became blastocysts, they didn’t affect pregnancy outcomes compared to normal cleavage without DC1. No study has been published to date that categorizes DC1 into two types: DC1 embryos with or without momentary two-cell stage. Study design, size, duration This study included patients whose oocytes had been retrieved between January 2020 to December 2022. A retrospective study was conducted on 11,366 cleavage embryos derived from 2PN2PB in 2,735 cycles using time-lapse imaging (Geri®, Genea BIOMEDX, Australia, 5-minute intervals, 9 slices) after intracytoplasmic sperm injection (ICSI) with ejaculated spermatozoa. We focused on DC1 only and analyzed pregnancy outcomes on 248 cycles with single blastocyst transfer obtained from this study. Participants/materials, setting, methods Among 1,817 cycles where DC1 was observed by TLI, DC1 were classified into two types: DC1 embryos without any two-cell stage (DC1A) and with momentary two-cell stage (DC1B). We comparatively analyzed for blastocyst developmental rates, good-quality blastocyst (Grade 3BB or more by the Gardner’s classification) rates and pregnancy outcomes with single blastocyst transfer (clinical pregnancy rate, CPR; live birth rate, LBR). Statistical analysis was performed using student t-test and chi-square test. Main results and the role of chance Among 2,735 cycles where ICSI was performed, female age was 39.3 ± 4.8 years (mean ± SD), previous ART cycles were 4.6 ± 5.5 times, and number of retrieved oocytes was 10.0 ± 8.7. DC1 embryos were found in 32.2% (3,663/11,366). Blastocyst development and good-quality blastocyst rates were 28.3% (826/2,921) and 14.6% (427/2,921) in DC1 embryos, whereas 67.5% (3,512/5,204) and 41.4% (2,157/5,204) in embryos without direct cleavage (non-DC), respectively. The former was significantly lower than the latter (P < 0.001). Among DC1 embryos, we confirmed DC1A was relatively fewer (21.2%) than DC1B (78.8%). Blastocyst development and good blastocyst rates were 11.7% and 2.1% in DC1A embryos, whereas 32.7% and 11.0% in DC1B embryos, respectively. The former was significantly lower than the latter (P < 0.001). CPRs, miscarriage rates and LBRs per single blastocyst transfer of DC1A were 44.4% (4/9), 11.1% (1/9), and 33.3% (3/9), while those of DC1B were 33.8% (47/139), 12.2% (17/139), and 21.6% (30/139), respectively. On the other hand, those of non-DC were 44.7% (232/519), 13.1% (68/519), and 30.6% (159/519). Both embryos with DC1A and DC1B produced healthy babies, except for one case with congenital hydronephrosis from DC1B. Limitations, reasons for caution We excluded embryos with direct cleavage in the second division (DC2) in this study, because we focused on DC1 only. DC2 embryos may have complex effects besides DC1. The number of blastocysts from DC1A embryos may not be sufficient for comparison of pregnancy outcomes. Wider implications of the findings Since blastocyst development and good-quality blastocyst rates were of DC1A was significantly lower than those of DC1B, it may be necessary to categorizes DC1 into two types: DC1 embryos with or without momentary two-cell stage. However, once they became blastocysts, they didn’t affect pregnancy outcomes. Trial registration number not applicable

Use of Sotrovimab in Pregnancy: Experiences from the COVID-19 International Drug Pregnancy Registry.

Available data regarding the safety and efficacy of sotrovimab in pregnant patients remain limited due to their exclusion from clinical trials. The COVID-19 International Drug Pregnancy Registry (COVID-PR) was established to gather comprehensive safety data from pregnant women who have received monoclonal antibody (mAb) or antiviral treatments for mild, moderate, or severe coronavirus disease 2019 (COVID-19) during pregnancy. Participants actively contributed self-reported data concerning their COVID-19 symptoms, in addition to sociodemographic and health-related characteristics. Obstetric, neonatal, and infant outcomes were also documented, with follow-up extending up to 12 months after childbirth. As of 30 November 2023, sotrovimab was administered to 39 participants enrolled in the COVID-PR. At the time of this report, 26 participants had given birth, with nine deliveries performed via cesarean section. The infants' birthweight ranged from 2381g to 4762g, with a mean of 3439.91g. Twenty-five infants were born at ≥37weeks. A total of 31 adverse events (AEs) were reported by 12 participants. The most frequently reported AE was gestational hypertension, observed in three participants. COVID-19 re-infection, fatigue, gestational diabetes, headache, and morning sickness were each reported by two participants. Of the reported AEs, eight (in five participants) were classified as serious, including four AEs (prolonged labor, pre-eclampsia, polyhydramnios, premature labor) that affected pregnancy. Seven of these eight serious AEs (SAEs) were found to be unrelated to sotrovimab, with one event (urinary retention) not assessable. A total of 44 AEs were reported in 19 delivered infants or in utero fetuses. The most common were COVID-19 (n=6 events), ear infection (n=5 events), neonatal dyspnea (n=3 events), and respiratory syncytial virus infection (n=3 events). Sixteen AEs (in 11 infants/fetuses) were classified as serious, including one report each of fetal cardiac disorder, congenital ankyloglossia, persistent right umbilical vein, and congenital hydronephrosis; the latter was considered a major congenital malformation. For all assessable SAEs, causality of sotrovimab treatment was ruled out based on lack of a temporal relationship alone or in combination with absence of a plausible mechanism. A sizable proportion of sotrovimab-treated participants in the COVID-PR had underlying medical conditions associated with an increased risk of severe COVID-19. None of the assessable SAEs were considered to be related to sotrovimab treatment.

Association between NDUFS1 from urinary extracellular vesicles and decreased differential renal function in children with ureteropelvic junction obstruction

BackgroundUreteropelvic junction obstruction (UPJO) is the most common cause of pediatric congenital hydronephrosis, and continuous kidney function monitoring plays a role in guiding the treatment of UPJO. In this study, we aimed to explore the differentially expressed proteins (DEPs) in the urinary extracellular vesicles(uEVs) of children with UPJO and determine potential biomarkers of uEVs proteins that reflect kidney function changes.MethodsPreoperative urine samples from 6 unilateral UPJO patients were collected and divided into two groups: differential renal function (DRF) ≥ 40% and DRF < 40%.We subsequently used data-independent acquisition (DIA) to identify and quantify uEVs proteins in urine, screened for DEPs between the two groups, and analyzed biofunctional enrichment information. The proteomic data were evaluated by Western blotting and enzyme-linked immunosorbent assay (ELISA) in a new UPJO testing cohort.ResultsAfter one-way ANOVA, a P adj value < 0.05 (P-value corrected by Benjamin–Hochberg) was taken, and the absolute value of the difference multiple was more than 1.5 as the screening basis for obtaining 334 DEPs. After analyzing the enrichment of the DEPs according to Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment combined with the protein–protein interaction (PPI) network results, we selected nicotinamide adenine dinucleotide-ubiquinone oxidoreductase core subunit S1 (NDUFS1) for further detection. The expression of NDUFS1 in uEVs was significantly lower in patients with DRF < 40% (1.182 ± 0.437 vs. 1.818 ± 0.489, P < 0.05), and the expression level of NDUFS1 was correlated with the DRF in the affected kidney (r = 0.78, P < 0.05). However, the NDUFS1 concentration in intravesical urine was not necessarily related to the change in DRF (r = 0.28, P = 0.24).ConclusionsReduced expression of NDUFS1 in uEVs might indicate the decline of DRF in children with UPJO.

Interstitial Cells of Cajal and P2X3 Receptors at Ureteropelvic Junction Obstruction and Their Relationship with Pain Response.

Introduction: Etiopathogenesis and the symptomatology of ureteropelvic junction obstruction (UPJO) in the pediatric population has not yet been definitely clarified, suggesting a multifactorial nature of the condition. The aim was to analyze the association between the number of Interstitial Cells of Cajal (ICCs), as well as P2X3 receptors in ureteropelvic junction (UPJ) and the pain response in pediatric patients with hydronephrosis. Methods: 50 patients with congenital hydronephrosis underwent open or laparoscopic pyeloplasty at one of two departments of pediatric surgery and urology in Poland. Patients were divided into two groups according to the pain symptoms before surgery. A total of 50 samples of UPJ were obtained intraoperatively and underwent histopathological and immunohistochemical (IHC) analysis. Quantitative assessment of ICCs was based on the number of CD117(+) cells of adequate morphology in the subepithelial layer and the muscularis propria. Expression of P2X3 receptors was evaluated as the intensity of IHC staining. Results: Patients with hydronephrosis and accompanying pain were on average 60 months older (77 vs. 17 months) than children with asymptomatic hydronephrosis (p = 0.017). Symptomatic children revealed higher numbers of ICCs in both the subepithelial layer and in the lamina muscularis propria. In particular, symptomatic patients aged 2 years or more exhibited significantly higher numbers of ICCs in the subepithelial layer. Significant differences in the distribution of ICCs between the subepithelial layer and the lamina muscularis propria were observed in both groups. Expression of P2X3 receptors was limited to the urothelium and the muscle layer and correlated between these structures. There was no relationship between pain response and the expression of P2X3 receptors. Conclusions: ICCs and P2X3 receptors may participate in the pathogenesis of UPJO and in the modulation of pain response to a dilatation of the pyelocaliceal system. Explanation of the role of ICCs and P2X3 receptors in propagation of ureteral peristaltic wave and the modulation of pain stimuli requires further studies.

Associations between PM2.5, ambient heat exposure and congenital hydronephrosis in southeastern China.

This research aims to analyze how exposure to fine particulate matter (PM2.5) and ambient heat during pregnancy increases the risk of congenital hydronephrosis (CH) in newborns. A case-control study was conducted to investigate the relationship between exposure to PM2.5 and ambient heat during pregnancy and the occurrence of CH in newborns. The study, which was conducted from 2015 to 2020, included 409 infants with CH as the case group and 409 infants without any abnormalities as the control group. Using spatial remote sensing technology, the exposure of each pregnant mother to PM2.5 concentration was meticulously mapped. Additionally, data on the ambient temperature of exposure for each participant were also collected. A logistics regression model was used to calculate the influence of exposure to PM2.5 and ambient heat on the occurrence of CH. Stratified analysis and interaction analysis were used to study the interaction between ambient heat exposure and PM2.5 on the occurrence of CH. At the 6th week of gestation, exposure to PM2.5 may increase the risk of CH. For every 10 μg/m3 increase in PM2.5 exposure, the risk of CH increased by 2% (95%CI = 0.98, 1.05) at a p-value of >0.05, indicating that there was no significant relationship between the results. Exposure to intense heat at 6th and 7th weeks of gestation increased the risk of CH. Specifically, for every 1°C increase in heat exposure, the risk of CH in offspring increased by 21% (95%CI = 1.04, 1.41) during the 6th week and 13% during the 7th week (95%CI = 1.02, 1.24). At 5th and 6th weeks of gestation, the relative excess risk due to interaction (RERI) was greater than 0 at the 50th percentile (22.58°C), 75th percentile (27.25°C), and 90th percentile (29.13°C) of daily maximum temperature (Tmax) distribution, indicating that the risk of CH was higher when exposed to both ambient heat and PM2.5 at the same time compared to exposure to a single risk factor. Exposure to higher levels of PM2.5 and ambient heat during pregnancy increases the risk of CH in infants. There was a positive interaction between exposure to intense heat and high concentration of PM2.5 on the occurrence of CH.

Expression of Aquaporin-1 and Endothelin-1 in Children with Congenital Hydronephrosis

Expression of Aquaporin-1 and Endothelin-1 in Children with Congenital Hydronephrosis

Successful Laparoscopic Hepaticojejunostomy for Infant Congenital Biliary Dilatation with both Aberrant Right Hepatic Artery and Bile Duct from the Caudate Region.

A boy with congenital hydronephrosis underwent ultrasonography every month for follow-up. At 4 months of age, ultrasonography incidentally revealed congenital biliary dilatation (5-cm type Ia). We performed laparoscopic extrahepatic bile duct resection and hepaticojejunostomy. After dissecting the dilated common bile duct (CBD), we found that the arcading-like shaped right hepatic artery (RHA) coursed in front of the CBD. Additionally, a tiny duct was identified below the main hepatic duct. At first, we thought it was a lymphatic vessel and dissected it from the main hepatic duct. However, bile flow out was recognized after dissecting the tiny duct. Finally, we confirmed it as an aberrant bile duct from the caudate region. We anastomosed the bile duct from the caudate region and main hepatic duct in a double-barrel fashion and performed hepaticojejunostomy below the RHA. The postoperative course was uneventful. Ultrasonography showed no intrahepatic ductal dilatation including the caudate lobe.

Clearance While Upright on Initial Diuretic Renography Predicts the Need for Surgery in Children With Congenital Hydronephrosis

ObjectivesTo improve the predictive ability of diuretic renography (DR) for surgical intervention in children with congenital hydronephrosis (CH) and concern for Ureteropelvic Junction Obstruction. MethodsChildren with CH born between 2007 and 2021 who underwent initial DR prior to 6 months of life, had both clearance while upright (CUP) and T ½ reported, and did not have immediate surgical intervention after the first DR were retrospectively evaluated for surgical intervention during the period of clinical observation. Once the optimal cut-points were identified for CUP and T ½, they were used to calculate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). ResultsIn total 65 patients were included in the final analysis with 33 (50.8%) undergoing surgical intervention (pyeloplasty) and 32 (49.2%) still on observation at last follow-up. The optimal cut-points for predicting surgical intervention were 28.1 minutes for T ½ and 22.4% for CUP. Applying the CUP cut-point of 22.4% we achieved a sensitivity of 60.6% (95% CI: 43.9-77.3), specificity of 96.9% (95% CI: 90.1-100.0), PPV of 95.2% (95% CI: 86.1-100.0), and NPV of 70.5% (95% CI: 57.0-83.9). ConclusionsA low CUP accurately predicts surgical intervention in children with CH who are initially observed. Although there is no singular measure on DR that can with absolute certainty predict future clinical course, our data do suggest there is utility in incorporating CUP (if <22.4%) into the decision process. Further research is necessary to help guide the management of children with intermediate CUP values.

The correlation between GFR and unit renal volume in infants with hydronephrosis measured by two imaging methods

The purpose of this study was to investigate the correlation between GFR and unit renal volume in infants with congenital hydronephrosis measured by 99mTc-DMSA static renal imaging and ultrasonography. According to the classification of hydronephrosis, 38 infants aged 0–12 months with congenital hydronephrosis were divided into six groups: healthy kidney groups, mild hydronephrosis groups, and severe hydronephrosis groups. Within one week, all patients underwent ultrasound, diuretic dynamic renal imaging, static renal imaging and lateral imagings of both kidneys after static renal imaging respectively. Pediatric renal volume was calculated using the improved formula length × width × thickness × 0.674, and then the renal function in per unit volume (GFR/unit volume, ml/cm3) was obtained. All statistical analysis was done with SPSS Statistics version 24.0. The renal function in per unit volume was a minimum of 1.62 ml/cm3 in left healthy kidney in static renal imaging, but the renal function in per unit volume was a maximum value of 2.20 ml/cm3 in right healthy kidney in ultrasonography. There was a strong positive correlation observed between GFR and renal volume in left healthy kidney group and left and right kidneys with mild hydronephrosis groups (r = 0.865, r = 0.872, r = 0.822). A moderate positive correlation was found between GFR and renal volume in right healthy kidney group and left and right kidneys wih severe hydronephrosis groups (r = 0.783, r = 0.542, r = 0.798). GFR in per unit volume ranged from 1.62 to 2.20 ml/cm3 in healthy kidney, and was significantly higher in right kidney as compared to in left kidney, and also decreased with the progression of hydronephrosis.

Validation of ICD-9-CM codes for major genitourinary birth defects in Military Health System administrative data, 2006-2014.

The Department of Defense Birth and Infant Health Research program is dedicated to birth defects research and surveillance among military families. Here, we assess and refine the validity of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for selected genitourinary birth defects in the Military Health System (MHS). We additionally outline methods for the calculation of positive predictive value (PPV) and negative predictive value (NPV), sensitivity, and specificity using a stratified sampling design. Among military infants born from 2006 through 2014, a random sample of ICD-9-CM screen-positive cases (for six genitourinary birth defects) and screen-negative cases were selected for chart review. PPV, NPV, sensitivity, and specificity were calculated for individual defects and any included defect (i.e., overall); measures were weighted by the inverse probability of being sampled. Of 461,557 infants, 686 were sampled for chart review. Bladder exstrophy was accurately reported (PPV: >90%), while the accuracy of renal dysplasia, renal agenesis/hypoplasia, and hypospadias was moderate (PPVs: 66%-68%) and congenital hydronephrosis was low (PPV: 20%). Specificity and NPVs always exceeded 98%. The overall PPV was 50%; however, excluding congenital hydronephrosis screen-positive cases and requiring at least two inpatient or outpatient diagnostic codes resulted in a PPV of 85%. The validity of major genitourinary birth defect codes varied in MHS administrative data. The accuracy of an overall defect measure improved by omitting congenital hydronephrosis and requiring at least two diagnostic codes. Although PPV is generally useful for research, additional calculation of NPV, sensitivity, and specificity better informs the identification of appropriate selection criteria across surveillance and research settings.

Cost-effectiveness analysis of robot-assisted laparoscopic surgery for complex pediatric surgical conditions.

Robotics has been used safely and successfully in a variety of adult surgeries and is gradually gaining ground in pediatrics. While the benefits of robotic-assisted surgery in disease treatment are well recognized, its high cost has led to questions. To investigate whether robotic-assisted laparoscopic surgery (RALS) is cost-effective compared to conventional laparoscopic surgery (LS) in pediatric surgery, we attempted to construct a model to perform an analysis of these two surgical approaches using Python statistical analysis software. We selected four common complex pediatric surgical conditions (choledochal cyst, Hirschsprung's disease, vesicoureteral reflux, and congenital hydronephrosis) from three systems (pediatric hepatobiliary, gastroenterology, and urology). Models were constructed using Python statistical software to compare hospital costs and surgical outcomes for RALS and LS. In addition, we performed a preferred strategy analysis for both surgical modalities while assessing model uncertainty using one-way sensitivity analysis. For the four diseases, the operative time decreased sequentially. The total inpatient costs of RALS were 10,816.72, 9145.44, 8414.29, 7973.58 dollars, respectively, yielding 1.789, 1.712, 1.749, 1.792 quality adjustment life years (QALYs) over two years post-operatively. The incremental cost of RALS relative to LS for each disease was 3523.44, 3200.20, 3049.79, 3043.66 dollars, respectively, with an incremental utility of 0.060, 0.054, 0.051, 0.050 QALYs. The incremental cost-effectiveness ratios (ICERs) for RALS for each of the four diseases were 58,724.01, 59,262.95, 59,799.79, 60,873.20 dollars/QALY, all less than 100,000 dollars/QALY. The cost of robot consumables was the main incremental cost of RALS and had the most significant impact on the model. For the four pediatric surgical conditions described above, RALS has higher inpatient costs than LS, but it has better postoperative outcomes, and all four RALS treatments are cost-effective. Children with complex diseases and long operative times appear to benefit more from RALS.

Laser ureteroscopic endopyelotomy efficacy in pyeloureteral junction stenosis

Introduction. Pyeloureteral junction stenosis (PUJS) is a condition that affects urinary drainage at level of the renal pelvis and upper ureter. It is found in approximately 1 in 500 newborns, with a higher prevalence in males (2:1 ratio). PUJS is the main cause of congenital hydronephrosis and can also be caused by other specific pathologies. Endoscopic management is the primary treatment for PUJS, particularly in cases of aperistaltic and &lt;2cm intrinsic ureteral stenosis without aberrant vessels. Aim of the study. Efficacy assessment of endoscopic retrograde incision of PUJS for urinary drainage recovery and duration of postoperatory effect. Material and methods. 5 patients were operated, from November 2022 to February 2023. Each patient has been operated by using retrograde LASER endopyelotomy method. There were excluded patients with extrinsic ureteral obstruction, defected segment more than 2 cm, massive hydronephrosis, split renal function &lt;20%, tumor in the obstruction area, high ureteral insertion, patients &lt;18 years of age. Mean follow-up time of patients is 8 weeks. Results. One month after intervention patients were recalled for investigations. There were observed way more better results in the patients with grade 1 hydronephrosis than those with grade 2 (p = 0.002). All patients at 3-month postoperative follow-up reported resolution of symptoms. Conclusions. Efficacy of LASER endopyelotomy is 99.9% in first months of the follow-up, after double J stent extraction. More follow-up time and patients are required to present more statistically significant results.

Decreased percent change in renal pelvis diameter on diuretic functional magnetic resonance urography following administration of furosemide may help characterize unilateral uretero-pelvic junction obstruction

A well-established definition of obstruction in the setting of congenital hydronephrosis is lacking. Multiple imaging modalities and radiographic characteristics or parameters have been described to help confirm the diagnosis of ureteropelvic junction obstruction (UPJO). We sought to evaluate the change in anterior-posterior renal pelvic diameter (APRPD) following furosemide administration in patients with unilateral hydronephrosis and confirmed UPJO on functional magnetic resonance urography (fMRU) who underwent pyeloplasty. There were 49 patients who met inclusion criteria (11 females, 38 males; average age 2.2 years, SD 3.4 years) from February 2006 to September 2020, diagnosed with unilateral hydronephrosis (SFU Grade 3-4) who underwent fMRU prior to pyeloplasty for confirmed UPJO. 29 of the included patients also underwent a post-pyeloplasty fMRU. A weight-adjusted dose of 1mg/kg of furosemide (max 20mg/kg) was administered intravenously. Two board-certified pediatric radiologists measured the APRPD of the obstructed and non-dilated kidneys prior to pyeloplasty and APRPD of the hydronephrotic kidneys on the post-pyeloplasty follow up fMRUs. Measurements were performed on images prior to and approximately 30min following furosemide injection. The average APRPD before furosemide injection in the obstructed kidney prior to pyeloplasty was 26.3mm (SD 9.0mm) compared to the non-dilated (not obstructed) kidney measurement of 5.1mm (SD 3.6mm) (p<0.001). Following administration of furosemide, the average APRPD was 31.4mm (SD 8.8mm) in the obstructed kidney, and 7.8mm (SD 4.1mm) in the non-dilated kidney (p<0.001). After pyeloplasty, the pre-furosemide APRPD measurement was 17.8mm (SD 11mm), which was significantly less compared to the pre-pyeloplasty APRPD (p<0.001). The post-pyeloplasty, post-furosemide APRPD measurement was 25.8mm (SD 12mm), also significantly less compared to the pre-pyeloplasty measurement (p=0.02). The changes in APRPD in the obstructed kidney prior to pyeloplasty was 5.1mm (SD 3.5mm) and after pyeloplasty was 8mm (SD 4.6mm) (p=0.002). Change in APRPD in the non-dilated kidney was 2.7mm (SD 2.3mm). Percent APRPD change in the obstructed kidney was 22.9% (SD 18.5%), which was significantly less than 33.3% (SD 22.1%) in the post-pyeloplasty kidney (p=0.028) and 82.8% (SD 87.9%) in the non-dilated kidney (p<0.001). A relatively smaller change in APRPD on fMRU following administration of furosemide in the setting of UPJO may serve as another predictive characteristic of obstructed kidneys.

Role and significance of SIRT1 in regulating the LPS-activated pyroptosis pathway in children with congenital hydronephrosis

ObjectiveTo explore the characteristics and mechanism of sirtuin 1 (SIRT1) in lipopolysaccharide (LPS)-activated pyroptosis in the renal tissue of children with congenital hydronephrosis (CHn).MethodsWe detected the expression characteristics and clinical...

Congenital Bilateral Hydronephrosis Resulting in Afunctional Kidney

Cilj: Prikazati pacijenta s kongenitalnom bilateralnom hidronefrozom i posljedičnim unilateralnim afunkcionalnim bubregom kao jednom od rijetkih razvojnih anomalija urotrakta te ukazati na važnost primjene ultrazvuka sa svrhom ranog otkrivanja i prevencije daljnjih ireverzibilnih oštećenja bubrežnog parenhima. Prikaz slučaja: Muško novorođenče zaprimljeno je na Zavod za intenzivno liječenje i neonatologiju zbog prenatalno dijagnosticirane obostrane hidronefroze u 26. tjednu gestacije. Tijekom boravka u bolnici učinjen je ultrazvuk bubrega koji je pokazao hidronefrozu IV. stupnja desno, s dilatiranim kaliksima i baloniranim pijelonom te blago reduciranim parenhimom. Na očekivanom mjestu lijevog bubrega prikazala se nepravilna, vrećasta formacija u očekivanom području kanalnog sustava, dok se parenhim bubrega nije razaznao. U dobi od jednog mjeseca rađena je dinamička scintigrafija bubrega koja je pokazala usporenu drenažu iz desnog bubrega na području PU ušća. Lijevi se bubreg tijekom pretrage nije prikazao. S obzirom na opisani nalaz, zauzet je konzervativan stav u liječenju ovog pacijenta. Dječak je bio urednog rasta i razvoja. U dobi od dvije godine učinjena je kontrolna scintigrafija koja je ponovno pokazala značajno usporenu spontanu drenažu u području PU ušća, bez poboljšanja nakon aplikacije diuretika. S obzirom na pogoršanje nalaza, pacijent je podvrgnut kirurškom načinu liječenja. Metoda izbora bila je unutrašnja drenaža protezom „double J“. Uslijedilo je ambulantno praćenje parametara bubrežne funkcije. Zaključak: Hidronefroza se može liječiti kirurški, postavljanjem proteze „double J“ i time potencijalno izbjeći invazivnije metode kirurškog liječenja. Međutim, svakom je pacijentu potrebno pristupiti individualno, uzimajući u obzir indikacije i moguće komplikacije.

Influence of Atmospheric Air Pollution on Frequency of Congenital Anomalies (on an example of a region)

INTRODUCTION: Atmospheric air pollution is the underlying factor of a great number of human diseases in both industrialized and developing countries. Studies show that exposure to atmospheric pollutions in pregnancy can be associated with an increased risk of congenital anomalies (CAs).&#x0D; AIM: To analyze the impact of atmospheric air pollutants in Ryazan city on the incidence of CAs in newborns.&#x0D; MATERIALS AND METHODS: The data of monitoring of CAs by Ryazan Regional Perinatal Center; information on atmospheric air pollution of the Federal Service for Hydrometeorology and Environmental Monitoring, of Ryazan Center for Hydrometeorology and Environmental Monitoring, of Rospotrebnadzor of the Ryazan region are presented. The statistical analysis was conducted using free R computing environment (ver. 4.1.2).&#x0D; RESULTS: In 2019, the prevalence of CAs in Ryazan was 24.09 per 1,000 newborns; in the period 20102021, the absolute number of recorded CAs grew by 244.57%. The most common congenital anomalies were Q21.0 Ventricular septal defects (28.5%, 95% CI: 20.836.2%) and Q62.0 Congenital hydronephrosis (7.3%, 95% CI: 2.911.7%). Correlation was recorded with such air pollutant as sulfur dioxide (SO2) in the second month of pregnancy (AOR 1.39; 95%; CI 1.051.83, p 0.05) and the third month of pregnancy (AOR 1.59; 95% CI 1.172.16, p 0.05). No statistically significant relationship was established between CAs and carbon monoxide (CO), nitrogen dioxide (NO2) and ozone (O3, p 0.05).&#x0D; CONCLUSION: The study confirms the association between atmospheric air pollution and frequency of CAs. In particular, SO2 has a negative effect in the second and third months of pregnancy. In this context, it is important that the authority bodies of the region and governmental regulatory agencies direct their efforts to reduction of the pollution of the environment which should help reduce the frequency of CAs in children.