Childhood Hydronephrosis Research Articles

Ultrasound in Neonatal and Childhood Hydronephrosis: Is It Reliable Pediatric Tool to Guide the Management?

Ultrasound in Neonatal and Childhood Hydronephrosis: Is It Reliable Pediatric Tool to Guide the Management?

The outcomes of mini-laparoscopic pyeloplasty in children - brazilian experience.

ABSTRACTObjetive Pelvicureteric junction (PUJ) obstruction is the main cause of hydronephrosis in childhood. Open pyeloplasty has been the gold standard treatment of this condition with success rate above 90%. The role of laparoscopic pyeloplasty (LP) in children is less well defined and has slowly emerged as an alternative procedure. We report outcomes of our initial experience with LP in 38 children from 2 months of age.Materials and Methods From June 2015 to December 2017 38 children aged 2-60 months (mean age 1.7 years) underwent LP for correction of PUJ obstruction. The mean pre operative anteroposterior diameter of the renal pelvis (APD) was 43,5mm and all patients had hydronephrosis (APD 21.4-76 mm) and obstructed curve on diuretic renogram. Anderson-Hynes pyeloplasty was the performed technique. Results are reported.Results Mean operative time was 107 minutes (70-180) with no conversion to open procedure. Pain control was needed mainly in the first 12hs. Mean hospitalization was 2 days (1-5). There were complications in 5 children not affecting the final outcome. Two patients had a re-obstruction requiring a second procedure with good result. The mean follow up was 18 months (13-36). The mean reduction on the postoperative APD was 41% - p<0,001 (end APD 5 to 41mm). Overall success rate was 94,7%. All children had good cosmetic results.Conclusions This is a small series limited by short follow up, however its data suggest that LP has good functional and cosmetic results, not compromising the success of the open procedure, regardless patient age.

English

English

Ранняя диагностика и лечение гидронефроза в детском возрасте

Ранняя диагностика и лечение гидронефроза в детском возрасте

Intermittent hydronephrosis in childhood

Intermittent pelviureteric junction obstruction, and its consequence,intermittent hydronephrosis is a difficult condition to identify. The renal collecting system is not dilated between the episodes of abdominal pain attacks and a prompt investigation is hard to carry out during the time of painful crisis. Therefore, most of the patients are initially misdiagnosed. The aim of the study was to assess the occurrence and the clinical characteristics of this phenomenon in children operated in the Department of Urological Surgery, Heim Pál Children Hospital, Budapest, Hungary. Medical records of children operated for hydronephrosis between 2008 and 2012 were reviewed. The occurrence rate and clinical features of intermittent hydronephrosis were analyzed. 76 children were operated for pelviureteric junction obstruction, of which 10 met the criteria of intermittent hydronephrosis. The average interval between the onset of symptoms and the final diagnosis was 2 years and 4 months. In 7 patients pyeloplasty, and in 3 patients nephrectomy were performed. Intermittent hydronephrosis represents a well-defined proportion among cases operated for hydronephrosis. The delay in diagnosis led to the loss of the kidney in one third of the patients, and this finding urges for the awareness of health professionals for this phenomenon. In case of recurrent abdominal pain of unknown etiology one must suspect a urological origin, even if a previous abdominal ultrasound showed normal kidneys.

Ultrasound in neonatal and childhood hydronephrosis

Ultrasound in neonatal and childhood hydronephrosis

Urinary NGAL, cystatin C, β2-microglobulin, and osteopontin significance in hydronephrotic children

Ureteropelvic junction obstruction (UPJO) accounts for 35 % of all congenital hydronephrosis cases. The challenge in managing childhood hydronephrosis is to distinguish obstructive from nonobstructive cases and, thereby, identify patients requiring surgical intervention. This study aimed to examine four urinary proteins as potential biomarkers of obstruction in hydronephrosis. Urine samples from 24 children with UPJO were collected pre-, peri-, and postoperatively, together with urine samples from healthy children. Neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (CyC), β2-microglobulin (β2-M), and osteopontin (OPN) in the samples were measured simultaneously using multiplex sandwich immunoassay technology. Compared with controls, NGAL and β2-M were significantly increased in urine from patients with obstructed kidneys at the time of surgery. This increase was followed by a decrease and stabilization to the same level as that of the controls. Furthermore, age was negatively correlated with preoperative urinary concentrations of CyC, β2-M, and OPN. This study confirms increased concentrations of NGAL and β2-M in urine from obstructed kidneys and should be tested in larger studies to ascertain their ability to identify obstruction and to determine the importance of age-adjusted reference values.

Clinical Significance of Hydronephrosis in Febrile Urinary Tract Infection

Purpose : Hydronephrosis is found about 30% of children with urinary tract infection (UTI). It can be caused by various conditions, although most childhood hydronephrosis is congenital. This study was performed to investigate the relationship between febrile UTI and hydronephrosis. Methods :We retrospectively reviewed the medical charts of 183 patients diagnosed as UTI between January 2007 and May 2009 at Korea University Guro Hospital. Inclusion criteria were as followings; 1) fever more than 37.5 measured in the axilla , 2) positive °C urine culture, 3) no history of urinary tract anomaly on antenatal sonography and urinary tract infection. We classified the enrolled children into two groups of patients with hydronephrosis (HN) and those without hydronephrosis (NHN). Results : The 80 patients were HN and 103 patients NHN. Hydronephrosis was found in 58 patients with left kidney, 8 right and 14 both kidneys. Most of hydronephrosis were of low grade. Compared with NHN group, initial renal cortical defects on DMSA scan significantly increased in HN group (HN 37.5%, NHN 16.5%, P <0.05). The incidence of VUR was not different between the two groups (HN 22%, NHN 12.1%). White blood cell counts and C-reactive protein were not different between the two groups. Follow-up DMSA scan (about 6 months later after UTI) showed no difference of renal scarring in both two groups. Conclusion : Our data suggests that hydronephrosis in febrile UTI patients is clinically useful for detecting renal cortical defects, but is not associated with follow-up renal scar. (J Korean Soc Pediatr Nephrol 2010;14:71-78)

Impact of magnetic resonance urography on preoperative diagnostic workup in children affected by hydronephrosis: Should IVU be replaced?

Purpose: The aim of this study was to determine the role of magnetic resonance urography (MRU) in preoperative diagnostic workup of children with hydronephrosis in a prospective clinical study with comparison of MRU, standard diagnostic investigations, and intraoperative findings. Methods: Thirty-one children with hydronephrosis secondary to different causes underwent ultrasound scan (US), intravenous urography (IVU), micturation cysto-urethrography (MCU), isotope nephrography (ING) and MRU. For MRU the authors performed sagittal and coronal halve-Fourier SSFSE scans in a 1.5 Tesla MR system. T1- and T2-weighted sequences were used in axial orientation to improve morphologic information. In 24 patients, preoperative data were compared with intraoperative findings. Results: Comparison of the different imaging modalities proved MRU to be able to provide more detailed information about the correct localization of stenoses along the urinary tract and the morphology of renal parenchyma. MRU showed the highest concordance of all imaging modalities with intraoperative findings. Conclusion: As a reliable investigation, MRU has the potentials to replace IVU in preoperative diagnostic workup of hydronephrosis in childhood. J Pediatr Surg 37:1441-1445. Copyright 2002, Elsevier Science (USA). All rights reserved.

Renal diuretic duplex Doppler sonography in childhood hydronephrosis.

The purpose of this study was to determine the diagnostic value of diuretic duplex Doppler sonography in distinguishing between obstructive and nonobstructive hydronephrosis in children by calculating the resistive indices (RI) before and after administration of furosemide. We prospectively evaluated 28 kidneys (2 solitary) in 15 patients with unilateral or bilateral neonatal hydronephrosis. All patients underwent diuretic renography and duplex Doppler sonography before and after administration of furosemide. According to the half-time drainage patterns at diuretic renography, 13 kidneys were classified as nonobstructed and 15 as obstructed. At baseline, the mean RI values of nonobstructed and obstructed kidneys were not significantly different (0.66 and 0.64, respectively). Ten minutes after the injection of furosemide, the mean RI values of the nonobstructed and obstructed kidneys were 0.68 and 0.70, respectively. The increase in RI over the baseline 10 min after the diuretic injection was statistically significant (p<0.00001) in the obstructed kidneys. The baseline RI value of 0.70 is not a definite value for distinguishing obstructed from nonobstructed systems. An increase in RI of at least 10% over the baseline seems to be a more reliable criterion, especially when it is used in conjunction with diuretic renography.

The uretero-vesical jet as a functional diagnostic tool in childhood hydronephrosis

Childhood hydronephrosis (HN) is accurately detected by ultrasound (US), but its functional work-up remains a domain of scintigraphy, the Whitaker-test, and clinical follow-up. We utilized color doppler US (CD-Jet) of uretero-vesical jets (UVJ) to visualize the post-obstructive ureteral flow in childhood HN. A total of 177 standardized CD-Jet were performed in 132 children aged 1 day to 14.9 years. Sixty-nine investigations in 43 patients with unilateral HN were compared with a standardized technetium 99m-mercaptotriacetylglycine nephrogram; in 10 infants both procedures were performed consecutively on the same day. UVJ were visible in 96% of all investigations. Ureteral obstruction resulted in absence of UVJ in 85% of examinations; in the remaining 15% the jet frequency was less than 10% observed in the contralateral control. Results are highly significant in both uretero-pelvic (P < 0.00007) and uretero-vesical lesions (P < 0.00005, Wilcoxon test) and are reproducible in sequential investigations. In nonobstructive distal HN the jet frequency averaged 70% of the unaffected side (P < 0.05). In proximal lesions it is equal. Jet evaluation in reflux nephropathy did not differ from controls. Compared with scintigraphy, CD-US identifies obstruction with a specificity of 94.2% and sensitivity of 94.8%. CD-US of UVJ therefore may serve as a reliable screening parameter in unilateral childhood HN.

Ureteric polyp as a cause of hydronephrosis in childhood

Obstruction of the ureteropelvic junction from a polypoid lesion is considered to be an exceedingly rare cause of hydronephrosis in childhood.

Visualization of individual papillary ducts (ducts of Bellini) by excretory urography in childhood hydronephrosis.

Individual papillary ducts (ducts of Bellini) were visualized during excretory urography in three cases of childhood hydronephrosis. Dilatation and reorientation because of hydronephrosis, persistence of good glomerular filtrating function, and stasis with increased reabsorption of water from the filtrate in the tubules seem to be the major factors in the demonstration of these structures.