Renal Growth In Children Research Articles

Effects of Intrarenal Reflux on Renal Growth in Children With Grades III-V Primary Vesicoureteral Reflux.

The phenomenon of intrarenal reflux (IRR) has been considered a crucial link between vesicoureteral reflux (VUR) and segmental scarring. We conducted a study on renal length in 104 children diagnosed with Grades III-V VUR, with or without IRR, using contrast-enhanced voiding urosonography (ceVUS). The patients were divided into two treatment groups: the conservative antibiotic prophylaxis (CAP) group and the operation group, which were further categorized into two subgroups: the IRR group and the non-IRR group. Our findings revealed an incidence rate of 35.96% (41/114) for IRR occurrence, with 43.42% (33/76) occurring in upper renal segments, 32.89% (25/76) in lower segments, and 23.68% (18/76) in middle segments. In the CAP group where the effects of IRR persisted, the renal growth observed was as follows: IRR group-0.19 ± 0.13 cm; non-IRR group-0.39 ± 0.23 cm; contralateral negative group-0.66 ± 0.35 cm; control group-0.46 ± 0 .25 cm respectively (P < .05). In the operation group, where the effects of IRR were eliminated, the renal growth for the IRR group, non-IRR group, contralateral negative group, and control group was 0.46 ± 0.22 cm, 0.54 ± 0.31 cm, 0.67 ± 0 .42 cm, and 0.36 ± 0.17 cm respectively (P < .005). In conclusion, the presence of IRR can impact renal growth in children diagnosed with Grades III-V primary VUR. Following surgical intervention, the IRR kidney does not exhibit catch-up growth; however, it demonstrates parallel growth alongside the unaffected kidney. Conversely, the non-IRR kidney experiences catch-up growth. Therefore, for children presenting with Grades III-V primary VUR combined with IRR, a more aggressive treatment approach such as surgery is recommended.

P1088 - Renal growth in children with vesicoureteral reflux, is it a significant clinical indicator?

P1088 - Renal growth in children with vesicoureteral reflux, is it a significant clinical indicator?

Effect of Extracorporeal Shock Wave Lithotripsy on Kidney Growth in Children

We investigated whether shock wave lithotripsy affects kidney growth in children. This prospective controlled study included 150 children with renal stones who presented for shock wave lithotripsy between March 2005 and February 2010 (group A). The control arm included 100 children without any urological problems who were enrolled in the study after obtaining written maternal consent (group B). All children in both groups underwent abdominal ultrasound to assess renal size (bipolar renal length), which was repeated after 6 months for group A and after 1 year for both groups. Bipolar renal size in group A increased significantly at 6 months and 1 year after shock wave lithotripsy. Renal growth did not differ based on patient age at shock wave lithotripsy (p = 0.472), number of shock wave lithotripsy sessions (p = 0.65) or number of stones (p = 0.405). There was no significant difference between the rate of kidney growth in children who underwent shock wave lithotripsy during the year of the study and normal controls. Shock wave lithotripsy has no deleterious effect on the normal rate of renal growth in children. This outcome is not affected by either the number of stones or the age of the child at shock wave lithotripsy.

Compensatory Renal Growth in Children with Unilateral Renal Tumor Treated by Nephron-Sparing Surgery or Nephrectomy

In children with an unilateral renal tumor, nephron-sparing surgery (NSS) results in a more adequate renal function adaptation compared to nephrectomy. In the present study, we investigated whether nephron-sparing surgery is followed by a different renal structure adaptation compared to nephrectomy. Sixteen patients with unilateral renal tumor treated by nephrectomy (Group 1) and 10 treated by nephron-sparing surgery (Group 2) were enrolled in the study. Kidney volume was estimated by ultrasonography, using the formula for a prolate ellipsoid. Kidney volume was adjusted to the patient's weight and kidney laterality and expressed as a percentage of the expected volume of two kidneys in a healthy child. Total kidney volume (TKV) corresponded to the volume of the contralateral kidney in Group 1 patients, and to the volume of contralateral kidney + kidney remnant in Group 2 patients. Renal function was evaluated by serum creatinine values adjusted for sex and age and expressed as standard deviation scores (SDS). Group 2 patients presented with a greater indexed TKV compared to Group 1 patients, (97.4 +/- 18.8 % vs. 77.0 +/- 17.7 %; p = 0.005). Indexed TKV below the reference range for healthy controls with two kidneys was found in 4 of 10 Group 2 patients vs. 14 of 16 Group 1 patients (p = 0.017). In both patient groups, correlation analysis of indexed TKV and creatinine SDS showed a negative correlation (r = - 0.47; p = 0.01). In children with unilateral renal tumor, NSS is followed by a more adequate compensatory restoration of TKV compared with nephrectomy.

554: Long Term Follow-Up of Renal Growth in Children Treated with Extracorporeal Shock Wave Lithotripsy, Percutaneous Nephrolithotomy or Ureteroscopy

554: Long Term Follow-Up of Renal Growth in Children Treated with Extracorporeal Shock Wave Lithotripsy, Percutaneous Nephrolithotomy or Ureteroscopy

Renal growth in children with vesicoureteral reflux

Renal growth in children with vesicoureteral reflux

The Use of Renal Parenchymal Area in Children With High Grade Vesicoureteral Reflux

Purpose We sought to apply 2-dimensional sonographic measurements of renal parenchymal area in children with high grade vesicoureteral reflux to assess reliability and accuracy in estimating differential renal function, and in predicting clinical outcome compared to traditional 1-dimensional sonographic measurements. Materials and Methods We retrospectively evaluated 121 sonograms from 30 patients with a grade 4 or 5 primary vesicoureteral reflux, including 14 who underwent ureteral reimplantation during followup and 16 who were followed on prophylactic antibiotic therapy. One-dimensional sonographic measurements of longitudinal length and bipolar thickness were determined in refluxing and contralateral kidneys, as were 2-dimensional measurements of longitudinal parenchymal area using computer planimetry. Renal length, bipolar thickness and parenchymal area were compared to renal function data determined by nuclear renography. Renal length and area was also represented as a percent of age adjusted normal values using previously published nomograms. Results Differential renal function correlated well with differential parenchymal area for all patients (r = 0.924). This correlation persisted in patients with (r = 0.917) and without scarring (r = 0.890), as determined by dimercapto-succinic acid scan. Differential length did not correlate as well (r = 0.661) and bipolar parenchymal thickness did not correlate at all (r = 0.021). Sonographic age adjusted area of the refluxing kidneys was approximately two-third normal. No statistically significant difference was observed among age adjusted renal area of the observation, preoperative and postoperative groups. Contralateral kidney area was not significantly different than normal. Conclusions Our data indicate that serial sonographic measurements of longitudinal renal parenchymal area provide a simple and accurate method of monitoring renal growth and function in patients with high grade vesicoureteral reflux. In contrast to 1-dimensional measurements of renal length and bipolar parenchymal thickness, renal parenchymal area correlates well with renal function. Area also appears to be a more sensitive method of monitoring renal growth in children with vesicoureteral reflux.

The use of renal parenchymal area in children with high grade vesicoureteral reflux.

We sought to apply 2-dimensional sonographic measurements of renal parenchymal area in children with high grade vesicoureteral reflux to assess reliability and accuracy in estimating differential renal function, and in predicting clinical outcome compared to traditional 1-dimensional sonographic measurements. We retrospectively evaluated 121 sonograms from 30 patients with a grade 4 or 5 primary vesicoureteral reflux, including 14 who underwent ureteral reimplantation during followup and 16 who were followed on prophylactic antibiotic therapy. One-dimensional sonographic measurements of longitudinal length and bipolar thickness were determined in refluxing and contralateral kidneys, as were 2-dimensional measurements of longitudinal parenchymal area using computer planimetry. Renal length, bipolar thickness and parenchymal area were compared to renal function data determined by nuclear renography. Renal length and area was also represented as a percent of age adjusted normal values using previously published nomograms. Differential renal function correlated well with differential parenchymal area for all patients (r = 0.924). This correlation persisted in patients with (r = 0.917) and without scarring (r = 0.890), as determined by dimercapto-succinic acid scan. Differential length did not correlate as well (r = 0.661) and bipolar parenchymal thickness did not correlate at all (r = 0.021). Sonographic age adjusted area of the refluxing kidneys was approximately two-third normal. No statistically significant difference was observed among age adjusted renal area of the observation, preoperative and postoperative groups. Contralateral kidney area was not significantly different than normal. Our data indicate that serial sonographic measurements of longitudinal renal parenchymal area provide a simple and accurate method of monitoring renal growth and function in patients with high grade vesicoureteral reflux. In contrast to 1-dimensional measurements of renal length and bipolar parenchymal thickness, renal parenchymal area correlates well with renal function. Area also appears to be a more sensitive method of monitoring renal growth in children with vesicoureteral reflux.

Compensatory renal growth in children and adults studied by Doppler sonography.

To identify modifications of kidney morphology and of the time-velocity spectral waveform associated with long-term compensatory hypertrophy, spectral Doppler sonography was performed in 30 children and adults with solitary kidneys 7 years to 28 years following nephrectomy. Doppler signals were obtained from three arterial sites in each kidney. The average renal volume was 207 mL and the mean hypertrophy of the kidneys was 186%. The mean value of pulsatility (PI) and Pourcelot (RI) indexes of solitary hypertrophied kidneys was significantly lower than that of normal paired kidneys or allografts with normal function described in the literature. The PI and RI were found to correlate inversely with the kidney volume and the body surface area (BSA). In spite of a long follow-up time, no patient suffered from renal failure. This study suggests that in the case of solitary kidney, specific ranges of PI and RI should be employed rather than those used with paired kidneys.

Interobserver and intraobserver variations in sonographic renal length measurements in children.

Sonographic measurement of renal length is used commonly to evaluate growth of the kidneys in children. However, no previous studies have been performed to determine the degree of interobserver and intraobserver variability in such determinations. We measured the interobserver and intraobserver error in sonographic measurements of renal length obtained independently by three experienced imagers in 21 children (41 kidneys). The mean interobserver variation between any two imagers ranged from 3.87 to 5.49 mm. The mean intraobserver variation was 0.87 to 3.61 mm. The observed variability in sonographic measurement of renal length is comparable to the expected annual increase in length of the kidneys during childhood (2.2-5.7 mm per year). Therefore, caution is suggested when using sonography to evaluate renal growth in children during a year's time.

Influence of Vesicoureteral Reflux and Urinary Tract Infection on Renal Growth in Children with Upper Urinary Tract Duplication

The growth of the renal parenchyma was examined in children with duplicated outflow systems, vesicoureteral reflux (VUR), urinary tract infection (UTI) and no sign of obstruction. Ten patients with reflux occurring only in the caudal system (group A) and 4 patients with reflux both to the caudal and the apical system (group B) were studied shortly after their first UTI (study 1) and then 1.5 to 9 years later (study 2). The frequency of UTI was relatively high during the follow-up period. At urography, renal length and renal area were normal in group A in studies 1 and 2. Parenchymal thickness of the apical pole (APT/L) did not differ from normal values in any of the studies. Parenchymal thickness of the caudal pole (CPT/L) was significantly smaller than normal in both studies. There was also a significant decrease in CPT/L between study 1 and 2. UTI during the first year of life was associated with a greater reduction in CPT/L. The determination of renal length and renal area in children with a duplicated ureter, VUR and UTI, does not identify subjects at risk of developing renal growth retardation while serial determinations of parenchymal thickness appear to be an appropriate method.

Influence of Vesicoureteral Reflux and Urinary Tract Infection on Renal Growth in Children with Upper Urinary Tract Duplication

Influence of Vesicoureteral Reflux and Urinary Tract Infection on Renal Growth in Children with Upper Urinary Tract Duplication

Sonographic Assessment of Normal Renal Size in Children with Myelodysplasia

Periodic assessment of upper urinary tract anatomy and renal size is an important component in the urological management of children with myelodysplasia (spina bifida). As a correlation to a previous study of renal growth in children with spina bifida determined by excretory urography, we evaluated 297 renal ultrasonographic examinations in 145 patients with spina bifida and compared the renal size and growth pattern to those of normal children. Patients with known vesicoureteral reflux (grade 2 or greater), congenital renal anomalies, hydronephrosis, renal scarring or urinary tract surgery were excluded. Mean values and standard deviations for sonographically determined renal length were calculated. In general, mean renal length for each age group was below mean values for normal children. A normal renal growth curve for children with spina bifida, based on sonographic renal measurements, is developed for clinical use. (J. Urol, 140: 784-786, 1988)

The Impact of the Artificial Urinary Sphincter in the Neurogenic Bladder on the Upper Urinary Tracts

The charts and x-rays of 120 neurogenic bladder patients who underwent artificial sphincter implantation for treatment of urinary incontinence between 1973 and 1984 were reviewed retrospectively. Patients were followed for 3 to 130 months (average 36.8 months). The upper urinary tracts remained unchanged in 108 patients (90 per cent). Renal growth in children was undisturbed. Transient hydroureteronephrosis occurred in 8 patients (6.7 per cent) and progressive hydroureteronephrosis occurred in 4 (3.3 per cent). A total of 26 patients with vesicoureteral reflux (39 ureters) underwent ureteral reimplantation. Our results indicate that 1) implantation of the artificial urinary sphincter in neurogenic bladder patients has minimal adverse impact on the upper urinary tracts, 2) followup should be long-term and should include an IVP, 3) outflow obstruction should be eliminated preoperatively by means of external sphincterotomy in male patients and bladder flap urethroplasty in female patients, 4) similarly, adequate emptying of the bladder always must be assured during followup, 5) if hydroureteronephrosis is detected early appropriate treatment can restore normal upper tracts, 6) the presence of previously damaged upper tracts without evidence of obstruction is not a contraindication for artificial sphincter implantation and 7) an antireflux operation in combination with artificial sphincter implantation is feasible.

Normal renal growth in children with myelodysplasia.

Optimum urologic management of children with myelodysplasia includes periodic assessment of upper tract anatomy and renal growth. To investigate the perception that many children with spina bifida but without a history of intrinsic renal disease have small kidneys when compared with age-matched standard renal growth charts, 212 children with spina bifida were studied retrospectively, measuring renal length on excretory urograms. Patients with known vesicoureteric reflux of grade 2 or greater, congenital renal anomalies, hydronephrosis, renal scarring, or urinary diversion were excluded. For 95 patients aged 2 days to 19 days, 249 urograms were available for evaluation. Renal lengths were measured on the supine 5-min urogram. Mean values and standard deviations were calculated for each age group. Mean renal length for each age group fell below the mean of the standard curves devised by Hodson and Currarino, with increasing deviation from the mean with age.

Effect of vesicoureteric reflux on renal growth in children with urinary tract infection.

Renal growth was studied for periods ranging from 2 to 22 years (average 9·4) in 70 children who presented between 2 weeks and 12 years of age with urinary tract infection and who were found to have vesicoureteric reflux. They were managed on a conservative regimen of continuous prophylaxis and regular, complete voiding. Renal growth over the entire period of observation was normal in relation to the child9s growth in height in 100 of the 111 kidneys originally drained by refluxing ureters. During the time that reflux was known to be still present, renal growth was within normal limits in 101 kidneys. Renal growth was impaired in 11 kidneys. Ten of them were exposed to a recurrence of urinary tract infection. The eleventh child had an unproved symptomatic infection. Seven of these kidneys were also already scarred and 4 had gross reflux. In 2 of these children a fresh scar developed, one in a previously normal kidney. Because of the tendency for reflux to disappear, the renal growth during the first 2 years of observation was also analysed. A significant association was found between impaired growth and, independently, infection and renal scarring. No independent association was found between impaired growth and the severity of reflux. Small kidneys tended to grow at the expected rate. If growth was compared in pairs of kidneys with unilateral reflux, no difference in rate could be found if the kidneys were unscarred, but a significant difference was found if the refluxing ureter drained a scarred kidney; this tended to grow slowly, and the unscarred non-refluxing kidney tended to accelerate in growth. The small group of kidneys which grew least well had established severe scarring associated with severe persisting vesicoureteric reflux and each had a further infection during the period of observation, although no rise in plasma creatinine concentration was observed in any of these children. It is in such children that the results of a controlled comparison of medical and surgical management will be of greatest value.

Monitoring the magnetostriction of thin magnetic films during vacuum deposition: C. H. Thomas et al., Rev. Sci. Instrum., 35 (6), June 1964, 738–741

Periodic assessment of upper urinary tract anatomy and renal size is an important component in the urological management of children with myelodysplasia (spina bifida). As a correlation to a previous study of renal growth in children with spina bifida determined by excretory urography, we evaluated 297 renal ultrasonographic examinations in 145 patients with spina bifida and compared the renal size and growth pattern to those of normal children. Patients with known vesicoureteral reflux (grade 2 or greater), congenital renal anomalies, hydronephrosis, renal scarring or urinary tract surgery were excluded. Mean values and standard deviations for sonographically determined renal length were calculated. In general, mean renal length for each age group was below mean values for normal children. A normal renal growth curve for children with spina bifida, based on sonographic renal measurements, is developed for clinical use. (J. Urol, 140: 784-786, 1988)

The high vacuum system using epoxy resin and glass cloth for the Princeton-Pennsylavania Proton-Synchroton: N. Oser and R. Westwig, Trans. 10 Nat. Vac Symp., New York, 1963, 72–76.

Periodic assessment of upper urinary tract anatomy and renal size is an important component in the urological management of children with myelodysplasia (spina bifida). As a correlation to a previous study of renal growth in children with spina bifida determined by excretory urography, we evaluated 297 renal ultrasonographic examinations in 145 patients with spina bifida and compared the renal size and growth pattern to those of normal children. Patients with known vesicoureteral reflux (grade 2 or greater), congenital renal anomalies, hydronephrosis, renal scarring or urinary tract surgery were excluded. Mean values and standard deviations for sonographically determined renal length were calculated. In general, mean renal length for each age group was below mean values for normal children. A normal renal growth curve for children with spina bifida, based on sonographic renal measurements, is developed for clinical use. (J. Urol, 140: 784-786, 1988)

Dependence of the aperture error of an electromagnetic single lens on magnification: E. Jahn, Exper. Tech. Phys., 12 (1), 1864, 15–23

Periodic assessment of upper urinary tract anatomy and renal size is an important component in the urological management of children with myelodysplasia (spina bifida). As a correlation to a previous study of renal growth in children with spina bifida determined by excretory urography, we evaluated 297 renal ultrasonographic examinations in 145 patients with spina bifida and compared the renal size and growth pattern to those of normal children. Patients with known vesicoureteral reflux (grade 2 or greater), congenital renal anomalies, hydronephrosis, renal scarring or urinary tract surgery were excluded. Mean values and standard deviations for sonographically determined renal length were calculated. In general, mean renal length for each age group was below mean values for normal children. A normal renal growth curve for children with spina bifida, based on sonographic renal measurements, is developed for clinical use. (J. Urol, 140: 784-786, 1988)