Renal Ultrasound Scan Research Articles

Human Immunodeficiency Virus Associated Neuropathy Perinatally Infected HIV Children In Calabar, Nigeria. Clinical Features, Treatment and Outcome

Background Renal disease is increasing being recognized as a significant cause of morbidity and mortality in HIV positive patients. Human Immunodeficiency virus associated nephropathy (HIVAN) is the most common type of HIV related renal disease and rapidly progress to end stage renal disease(ESRD). There is paucity of report on true prevalence of HIVAN in African. This study was aimed at determining the prevalence of HIVAN, clinical features, treatment and outcome, in Calabar Nigeria. Methods/Subject This was a retrospective review of all renal patients managed by Pediatric nephrology unit of University of Calabar Teaching Hospital from January 2016 to December 2022 enrolled in the Renal register. During the period of study 215 patients had renal diseases out of which 15 had HIVAN. The following information were extracted from the HIVAN patients; Demographics and clinical data as well as mode of transmission, laboratory investigations, renal Ultrasound scan, treatment and Outcome were obtained and analyzed using SPSS version 20. Results There were 215 cases of renal diseases seen during the study period of which 15 had HIVAN giving a prevalence of 6.9% There were 5 males and 10 females giving a ratio of 1:2, age range 69-192months. with a mean age of 127±43.7months All received HAART and had acquired HIV infection through vertical transmission. 8 (53%) of patient were asymptomatic with 6 (40%) presenting with both legs and facial swelling. Nephrotic range proteinuria was a common presentation seen in 40% of the patients and 5(33.3%) had hypertension. Only 4 (33%) had eGFR<60 ml/min/1.73m2 and 2(16%) had ESRD. Two were lost to follow-up and 4 (26%) died with two requiring dialysis. Conclusion HIVAN is common in patients with renal diseases and there is need to monitor patient at initiation of HAART and at risk patients with low CD4+ count and exposure to nephrotoxic HAART.

Electrochemical Detection of Neutrophil Gelatinase-Associated Lipocalin (NGAL) in Simulated Urine Using Au@Si/Ni-Porphyrin Nanocomposite for the Prediction of Kidney Injury

Kidney Injury is multifactorial out of which ureteropelvic junction obstruction is one of the major causes of concern. There are a multitude of methods for monitoring the deterioration of renal function like serum creatinine levels, ultrasound scans, renograms, and nuclear scans like radiolabelled MAG3 and DMSA which require repeat evaluation or sedation during the process. Many of the biomarkers utilized for the assessment of kidney injury are expressed at the later stages. Urine NGAL is a promising biomarker for risk stratification which is reported to be expressed at the onset of ureteropelvic junction obstruction (UPJO) and is a gold standard for the estimation of tubular injury. Urinary NGAL is also reported to be a specific marker for the prediction of hydronephrosis in children who require surgical intervention. The kidney injury cut-off for NGAL in urine is 185ng/mL and 48 ng/mL in the adult and pediatric population groups respectively. Electrochemical detection of NGAL in patient urine is a fast, reliable, non-invasive, accurate, and cost-effective method for monitoring kidney health to segregate patient groups that require surgical intervention.In this study, an electrochemical sensor was designed with Au(150nm) electrodes fabricated using thermal evaporation on a flexible substrate (PET; 250μm) by using Cr(20nm) as the seed layer. The electrode was immobilized with Au@Si core-shell decorated on Ni-porphyrin nanosheets functionalized with anti-NGAL using covalent chemistry. The nanocomposite was synthesized through a bottom-up approach where the Ni-tetrakis(4-carboxyphenyl) porphyrin nanosheets were synthesized using the solvothermal method in an organic phase (DMF) followed by purification and suspension in ethanol medium. The Si nanocrystals were synthesized in a citrate medium with APTMS as the precursor followed by purification via dialysis. The purified Si nanocrystals (60ppm) and Ni-porphyrin nanosheets (880ppm) were treated in chloroauric acid (0.25mM) and the reducing agent trisodium citrate (34mM) to form Au shell. The physicochemical and electronic properties of the synthesized nanocomposite were evaluated through XRD, XPS, microscopic analysis(TEM, SEM), AFM, UV-Vis, FTIR, and Raman spectroscopy. The resultant nanocomposite was purified and linked to anti-NGAL (100μg/mL) through EDC (0.4M)/NHS (0.1M) chemistry. The antibody-nanocomposite was immobilized on the fabricated Au electrodes (working electrode surface area: 0.35mm2) through BSA(1.2mM)/glutaraldehyde (2.5% v/v) crosslinking. The quantitative electrochemical estimation of NGAL antigen spiked in 0.1M PBS (pH=7.2±0.2) and simulated urine was performed using cyclic voltammetry (CV) and differential pulse voltammetry (DPV). The shelf life of the fabricated sensors was evaluated for 30 days (stored at 4˚ C until use) over the concentration range of 0-5000 ng/mL. The amount of test solution required per measurement for the miniaturized electrodes was 6μL.The sensing mechanism of the electrochemical platform was established through CV by varying the scan rate (0.05 V/s - 2.5 V/s) for 500ng/mL in 0.1M PBS and urine. With increasing scan rate a linear relationship between log ip and log ν was observed. For 0.1M PBS, the process was largely capacitive at various detected potentials (b=0.94 @ 0.5V; b=0.86 @ 0.3V; b=0.85 @ 0.07V). However, in the case of simulated urine, the electrochemical process was diffusion-limited at 0.6V (b=0.49). Therefore, to obtain higher current sensitivity in the diffusion-limited regime, DPV was adopted. With increasing concentration of antigen NGAL, a monotonic decrease in the redox current at 0.6V and 0.45V potential was observed. This signifies that the presence of NGAL antigen leads to the formation of antigen-antibody complex immobilized on the surface of the nanocomposite translating into an increase in the resistance at the electrode surface leading to a decrease in the redox current. The decrease in the current was proportional to the increase in the amount of the test antigen. The sensitivity of the sensor at 0.45V and 0.6V was 2.22 nA/ng mL-1/mm2 and 0.51 nA/ng mL-1/mm2 respectively with the lowest limit of NGAL detection as 12.5ng/mL in simulated urine by using DPV. Similarly, for CV the sensitivity of the sensor at 0.56V was 3.48 nA/ng mL-1/mm2 with 22ng/mL as the limit of detection. The sensor performance was evaluated without the use of nanocomposite (only antibody) as a control for comparison.Therefore, this study is a proof of concept for an effective electrochemical sensor platform design for urinary NGAL detection using a novel nanocomposite. It was established that the use of nanocomposite provides a better surface area to volume ratio through the core-shell nanostructures decorated on the nanosheets translating into higher electrochemical activity. The sensing platform was found to be specific, sensitive, and stable making it a perfect candidate for a point-of-care-testing(POCT) platform. Figure 1

New Insights into the Diagnosis, Monitoring, and Management of Antenatal Hydronephrosis, Aiming to Refine Treatment Protocols: A Clinical Study.

Antenatal hydronephrosis (ANH) is a common prenatal finding that requires careful evaluation to determine appropriate management strategies. The variability in outcomes underscores the need for refined diagnostic and monitoring protocols to differentiate between cases necessitating intervention and those likely to resolve spontaneously. A prospective clinical study was conducted involving 150 pregnant women diagnosed with ANH between gestational weeks 18 to 24. Prenatal ultrasounds were performed at regular intervals to monitor renal pelvic dilatation. Postnatal evaluations included renal ultrasound, voiding cystourethrography, and nuclear renal scans to assess renal function and identify associated anomalies. Management decisions were based on standardized criteria including degree of hydronephrosis, presence of associated anomalies, and renal function. Of the 150 cases, 80 (53.3%) resolved spontaneously during the prenatal period, while 70 (46.7%) required postnatal intervention. Among the intervention group, 45 cases (64.3%) required surgical correction for persistent hydronephrosis or associated anomalies, while the remaining 25 cases (35.7%) were managed conservatively with close monitoring. Arbitrarily, the mean anteroposterior renal pelvic diameter (APRPD) in the resolved group was 5.2 mm, compared to 10.6 mm in the intervention group. The median postnatal follow-up duration was 24 months. This study highlights the importance of systematic evaluation and monitoring in managing ANH. While a significant proportion of cases resolve spontaneously, a careful assessment of associated anomalies and renal function is crucial in identifying cases requiring intervention. The arbitrary APRPD values presented underscore the potential for establishing diagnostic thresholds to guide clinical decision-making. Refinement of treatment protocols based on such parameters can improve outcomes and reduce unnecessary interventions in infants with ANH.

Review of Urinary Tract Infections and Pyelonephritis

Urinary tract infections (UTIs) are serious bacterial infections affecting children of all ages. An understanding of the methods of urine collection is important to prevent the contamination of urine specimens and to interpret results. The diagnosis of a UTI requires appropriate interpretation of both urinalysis and urine culture results because testing must indicate evidence of inflammation and the presence of bacteria. Rapid treatment of UTIs is imperative to prevent acute decompensation and systemic illness. Empiric antibiotics should be narrowed as soon as possible to tailor antibiotic treatment and limit antibiotic overuse. Imaging with a renal ultrasound scan is recommended for all infants with first febrile UTIs rather than a voiding cystourethrogram. An additional goal of UTI treatment is to prevent renal scarring, which can lead to lifelong health consequences. Children with anatomic abnormalities of the urinary tract and those who have recurrent UTIs are at increased risk of renal scarring. [ Pediatr Ann . 2024;53(6):e217–e222.]

Deep-learning-based sampling position selection on color Doppler sonography images during renal artery ultrasound scanning

Accurate selection of sampling positions is critical in renal artery ultrasound examinations, and the potential of utilizing deep learning (DL) for assisting in this selection has not been previously evaluated. This study aimed to evaluate the effectiveness of DL object detection technology applied to color Doppler sonography (CDS) images in assisting sampling position selection. A total of 2004 patients who underwent renal artery ultrasound examinations were included in the study. CDS images from these patients were categorized into four groups based on the scanning position: abdominal aorta (AO), normal renal artery (NRA), renal artery stenosis (RAS), and intrarenal interlobular artery (IRA). Seven object detection models, including three two-stage models (Faster R-CNN, Cascade R-CNN, and Double Head R-CNN) and four one-stage models (RetinaNet, YOLOv3, FoveaBox, and Deformable DETR), were trained to predict the sampling position, and their predictive accuracies were compared. The Double Head R-CNN model exhibited significantly higher average accuracies on both parameter optimization and validation datasets (89.3 ± 0.6% and 88.5 ± 0.3%, respectively) compared to other methods. On clinical validation data, the predictive accuracies of the Double Head R-CNN model for all four types of images were significantly higher than those of the other methods. The DL object detection model shows promise in assisting inexperienced physicians in improving the accuracy of sampling position selection during renal artery ultrasound examinations.

Evaluating Sonographers' Awareness of Artifacts in Renal Ultrasound Scans.

A routine ultrasound scan is used to assess a variety of renal pathological cases. Sonographers face a variety of challenges that may affect their interpretation. Understanding normal organ shapes, human anatomy, physical concepts, and artifacts is required for accurate diagnosis. Sonographers must understand how artifacts appear in ultrasound images in order to reduce errors and improve diagnosis. The purpose of this study is to assess sonographers' awareness and knowledge of artifacts in renal ultrasound scans. Participants in this cross-sectional study were asked to complete a survey containing different types of common artifacts in renal system ultrasound scans. An online questionnaire survey was used to collect the data. The questionnaire targeted radiologists, radiologic technologists, and intern students in Madinah hospitals in the ultrasound department. The total number of participants was 99, with 9.1% being radiologists, 31.3% being radiology technologists, 6.1% being senior specialists, and 53.5% being intern students. There was a significant difference in the participants' knowledge of ultrasound artifacts in the renal system with the total selection of the right artifact in senior specialists at 73% and intern students 45%. There was a direct relationship between age and years of experience in distinguishing artifacts in the renal system scan. A category of participants with the highest age and experience got 92% of the correct selection of artifacts. The study concluded that intern students and radiology technologists have limited knowledge of ultrasound scan artifacts, whereas senior specialists and radiologists have a high level of awareness of the artifacts.

Low yield from imaging after non-E. coli urine tract infections in children treated in primary care and emergency department

BackgroundImaging is recommended for selected children following urinary tract infections (UTIs) to look for actionable structural abnormalities. Non-E. coli is considered high risk in many national guidelines, but evidence is...

Comparing the role of renal ultrasound vs MAG3 renal scans for evaluation of neurogenic bladder after spinal cord injury.

Compare ability of renal ultrasound and Tc-99m mercaptoacetyltriglycine (MAG3) renal scan to identify upper urinary tract stasis. Retrospective chart review. Outpatient Neuro-urology clinic serving a large SCI population. One hundred and sixty-five individuals with spinal cord injury, presenting for annual evaluation. Renal ultrasound, MAG3 renal scan. Radiologic evidence of upper urinary tract stasis as reviewed by independent radiologist. For renal ultrasounds, this included: mild hydronephrosis, dilation of collecting systems, pelviectasis, or caliectasis. For MAG3 renal scans, this included evidence of slow drainage of radioisotope, dilation of collecting systems, or reverse peristalsis. Forty-five individuals with spinal cord injury demonstrated upper tract stasis, with 12 identified by renal ultrasound and 43 identified by MAG3 renal scan. There was a strong relative correlation between test results (Yule's Q = 0.90), though MAG3 renal scan identified a significantly higher rate of upper tract stasis within the same patients (P < 0.0001). The odds ratio of improved identification using MAG3 renal scan was 16.5 (95% CI 3.96-68.76). While renal ultrasound is more effective at evaluating renal anatomy, MAG3 renal scan identifies significantly more upper urinary tract stasis than renal ultrasound and should be considered for SCI individuals with risk factors of upper tract injury.

Transperitoneal Versus Retroperitoneal Robotic-assisted Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction in Children. A Multicentre, Prospective Study

BackgroundRobotic-assisted laparoscopic pyeloplasty (RALP) has been gaining acceptance among paediatric urologists. ObjectiveTo compare surgical variables and clinical outcomes, including complications and success rate, with RALP using the transperitoneal (T-RALP) and retroperitoneal (R-RALP) approaches. Design, setting, and participantsWe performed a multicentre, prospective, cohort study (NCT03274050) between November 2016 and October 2021 in three paediatric urology teaching centres (transperitoneal approach, n = 2; retroperitoneal approach, n = 1). The diagnosis of ureteropelvic junction obstruction (UPJO) was confirmed by renal ultrasound and mercaptoacetyltriglycine-3 renal scan or uro–magnetic resonance imaging with functional evaluation. The exclusion criteria were children <2 yr old, persistent UPJO after failed pyeloplasty, and horseshoe and ectopic kidney. InterventionWe performed dismembered pyeloplasty using running monofilament 6-0 absorbable suture. Outcome measurements and statistical analysisWe assessed intra- and postoperative morbidity (primary outcome) and success (secondary outcome). Data were expressed as medians and interquartile range (25th and 75th percentiles) for quantitative variables, and analysed comparatively. Results and limitationsWe operated on 106 children (T-RALP, n = 53; R-RALP, n = 53). Preoperative data were comparable between groups (median age 9.1 [6.2–11.2] yr; median weight 26.8 [21–40] kg). Set-up time (10 vs 31 min), anastomotic time (49 vs 73 min), and console time (97 vs 153 min) were significantly shorter with T-RALP than with R-RALP (p < 0.001). No intraoperative complications occurred. No conversion to open surgery was necessary. The median hospital stay was longer after T-RALP (2 d) than after R-RALP (1 d; p < 0.001). Overall, postoperative complication rates were similar. No failure had occurred at the mean follow-up of 25.4 (15.1–34.7) mo. ConclusionsIn selected children, RALP is safe and effective using either the transperitoneal or the retroperitoneal approach, with a shorter hospital stay after R-RALP. Patient summaryIn our multicentre, prospective study, we compared the results and complications of robotic-assisted laparoscopic pyeloplasty (RALP) using the transperitoneal and retroperitoneal approaches. We found that RALP is safe and effective using either approach, with a shorter hospital stay after R-RALP.

The prevalence of familial vesicoureteric reflux in infants with normal antenatal scans.

To determine the prevalence of familial vesicoureteric reflux (VUR) by studying the outcomes of screening in a contemporary cohort of newborns with normal antenatal kidney scans. A review of screening outcomes in newborns with a first degree relative with VUR, normal antenatal scans and no prior urine infections between 2014-2019 at three maternity units in the North East of England was conducted. Imaging consisted of micturating cystourethrogram (MCUG) in all and renal tract ultrasound scan (RUS) routinely in two units and by clinician preference in one unit. At a median age of 59 days, 265 infants underwent MCUG. High-grade VUR (Grades 3-5) was detected in 13 (4.9%) and low-grade VUR (Grades 1-2) in 24 (9.1%). In the 152 infants who had a RUS, abnormalities were detected in 21 (13.8%). An abnormal postnatal RUS has a low positive predictive value (14.3%) for high-grade VUR, but a normal RUS has a high negative predictive value (95.4%). Compared to historical cohorts from two decades ago, the yield from familial VUR screening is low and unjustifiable in the setting of normal antenatal anomaly scans.

Reference values of somatometric and sonographic renal parameters of apparently healthy Hausa children in Kano metropolis, Nigeria

Accurate measurement of organ size is important in children to estimate adequate growth. Among various growth parameters, kidney size is an important parameter used for the clinical evaluation of renal growth and renal abnormalities. The study is aimed at evaluating the renal volume using ultrasound scan in normal Hausa primary school children in Kano aged 2 to 13 years. The study design was prospective cross sectional conducted among healthy Hausa children, aged 2 to 13 in Kano metropolis from October 2017 to October 2019. Approval to carry out the study was obtained from the State Universal Basic Education, Kano, Ministry of Health, Kano. Informed oral and written consent were obtained from the child’s parents or caregiver. A simple random sampling was employed in the study and a total of 457 subjects were recruited. The instrument used was MindrayDigiprince DP4900 ultrasound machines with 3.5 – 5.0MHz curvilinear transducer. Renal ultrasound scan was performed on all the selected subjects. SPSS version 22.0 was used for the data analysis. The mean heights, weights and BMI of the subjects were 1.21±0.11m, 20.46±4.92kg and 13.93kg/m2. The mean renal length, thickness, width and renal volume were 7.69±0.71cm, 3.31 ± 0.42cm, 4.80 ± 0.49cm and 64.79±16.13cm3 respectively. This study provides data for normal sonographic renal volume and length in Kano metropolis, a Hausa dominated Nigerian population.

Posterior nutcracker syndrome combined with right renal artery aneurysm: a case report

Background: Posterior Nutcracker syndrome (PNS) is a rare condition caused by the left renal vein was compressed between the abdominal aorta and the vertebral column. Diagnosis and therapeutic options of posterior nutcracker syndrome are still controversial, as symptoms are variable and not specific. Renal artery aneurysm (RAA) is also a rare disease and is generally discovered during diagnostic procedures performed with other conditions. Therefore, a patient co-ordinating both of these rare conditions cause enormous challenges in diagnosis and treatment.&#x0D; Method: A rare case report. &#x0D; Clinical case: A 25 years old female had been hospitalized for macroscopic hematuria and pain in the hypogastrium. Renal duplex ultrasound and CT scan revealed retro aortic LRV and right renal artery aneurysm. She was operated successfully with anterior transposition of the LRV into the IVC, aneurysmectomy associated with revascularization of RAA.&#x0D; Conclusion: PNS combination with RAA is a rare condition unreported in medical literature, with treatment criteria still uncertain. However, surgery with anterior transposition of LRV and aneurysm repair may be a safe and effective technique.

Posterior nutcracker syndrome combined with right renal artery aneurysm: a case report

Background: Posterior Nutcracker syndrome (PNS) is a rare condition caused by the left renal vein was compressed between the abdominal aorta and the vertebral column. Diagnosis and therapeutic options of posterior nutcracker syndrome are still controversial, as symptoms are variable and not specific. Renal artery aneurysm (RAA) is also a rare disease and is generally discovered during diagnostic procedures performed with other conditions. Therefore, a patient co-ordinating both of these rare conditions cause enormous challenges in diagnosis and treatment.&#x0D; Method: A rare case report. &#x0D; Clinical case: A 25 years old female had been hospitalized for macroscopic hematuria and pain in the hypogastrium. Renal duplex ultrasound and CT scan revealed retro aortic LRV and right renal artery aneurysm. She was operated successfully with anterior transposition of the LRV into the IVC, aneurysmectomy associated with revascularization of RAA.&#x0D; Conclusion: PNS combination with RAA is a rare condition unreported in medical literature, with treatment criteria still uncertain. However, surgery with anterior transposition of LRV and aneurysm repair may be a safe and effective technique.

Chronic Kidney Disease and Its Clinical Correlates in a Rural Community in Southwestern Nigeria.

Chronic kidney disease (CKD) is a burgeoning problem globally, and more than a billion adults were affected as of 2016, with 1.2 million people dying from renal failure in 2017. To arrest the seemingly relentless progression of CKD to renal failure, there is a need to detect CKD early in the community. A community-based study was carried out to look at the prevalence and risk factors of CKD. Anthropometric and other clinical variables were measured. Blood samples were taken for determining creatinine, uric acid, urea, and lipids. CKD was defined as an estimated glomerular filtration rate of ≤60 mL/min/1.73 m2. Electrocardiograms and renal ultrasound scans were performed. In total, 201 people were recruited. Those with CKD had a male:female ratio of 1:3.9 and were older. The prevalence of autosomal-dominant polycystic kidney disease and CKD was 531.9 persons/100,000 population and 46.3%, respectively. Systolic blood pressure, pulse pressure, total cholesterol, triglycerides, high-density lipoprotein (HDL), uric acid, QTc interval, and electrocardiographic left ventricular hypertrophy were higher in those with CKD. Age, female sex, and HDL were independently associated with CKD. There was a steep rise in CKD at the community level. Increased awareness of CKD and prompt interventions are therefore imperative.

Clinical Utility of Kidney Cortical Thickness in assessing severity of CKD in Low Income Setting

Background: Renal Ultrasound Scan (RUS) is known to have an important role in assessing kidney function in healthy people and people with Chronic Kidney Disease (CKD) with the kidney length (KL) being the most commonly used measure. The Glomerular Filtration Rate (GFR) is the gold standard in kidney function assessment and its strength of correlation with a RUS measure is used in ascertaining the reliability of that RUS measure.&#x0D; Objectives: To compare the strength of correlations between the GFR and RUS measures like KL and cortical thickness (CT) in healthy people and people with CKD.&#x0D; Methods: One hundred and forty study participants who had kidney ultrasound scan were studied. Creatinine based GFR was determined and linear correlation coefficients (r) were used to determine the relationship between the GFR and RUS measures.&#x0D; Results: Seventy CKD cohorts with stage 2-4 disease and 70 healthy volunteers (each with 35 males and 35 females) took part. The total mean eGFR, KL and CT for the study participants were 70.5 ± 12.5ml/min, 10.0 ± 3.1cm, and 8.6 ± 2.7mm respectively. There was a progressive decline in eGFR and renal CT as CKD worsened down the stages. The mean eGFR, KL and CT of the CKD cohorts were 44.7 + 3.6 ml/min, 9.1 + 3.3 cm and 7.4 + 2.4 mm respectively. Among the CKD cohorts, the eGFR was highest in CGN and, the KL and CT were highest in obstructive uropathy. The GFR, was positively correlated with KL and CT, the strength of association being more with the CT. The mean age and GFR independently predicted the kidney cortical thickness.&#x0D; Conclusion: Kidney sizes were smaller in females, with aging and with declining kidney function. The CT being more positively correlated with GFR than the KL, is a more reliable RUS measure in assessing kidney function.&#x0D; Keywords: Glomerular filtration rate; cortical thickness; kidney length.

Evaluation of quality of renal tract ultrasound scans and reports performed in children with first urinary tract infection

PurposeTo determine the quality of renal tract ultrasound (US) imaging records performed in children for evaluation of urinary tract infection (UTI) by multiple professionals with different levels of experience in a dedicated academic children's hospital. MethodsRetrospective analysis of US images and reports for children ≤ 13-years with first presentation of a UTI. 9 Operators (6 consultant radiologists and 3 sonographers) were anonymised and the adequacy of their US images and reports were evaluated for the following categories; Image acquisition, Image labelling, Metric labelling, and Final reporting. The frequency of the reporting quality of the elements assessed was compared between radiologists and sonographers using Chi-square or fisher exact test. ResultsRenal tract US studies for 100 children (20 males, 80 females) with first UTI episode were assessed. Mean age was 4.5 ± 3.4 years. 54% of the studies were performed by sonographers and 46% by radiologists.Kidneys and pre-micturition bladder scans were acquired in more than 96% of exams by both sonographers and radiologists. Kidney image and metric labelling was adequate in almost all exams (98-100%) with the exception of plane labelling which was not routinely done by US operators (less than 3%).Sonographers performed consistently better than radiologists in post-micturition bladder scanning, pre- and post-micturition bladder labelling and renal length reporting (p<0.05).Least to be recorded by US operators (both radiologists and sonographers) were doppler scan acquisitions (less than 3%), bladder wall thickness labelling (less than 3%), and renal calculi reporting (less than 1%). ConclusionThe inconsistency of the reporting quality between the different elements assessed highlights the difference in US training and experience received by sonographers and radiologists. A pro-forma structured reporting template may ensure US operators provide consistent, thorough and good quality ultrasound images and reports.

Prenatal Diagnosis of Severe Fetal Hydronephrosis Due to Pyeloureteral Junction Syndrome with False Neonatal Resolution

A case of severe fetal hydronephrosis due to isolated bilateral stenosis of the pyelo-ureteral junction was diagnosed at our centre. Surprisingly, a negative renal ultrasound scan was performed on the 3rd postnatal day. An ultrasound follow-up showed severe bilateral pyelectasis a few weeks later. The infant underwent bilateral pyeloplasty at six months of age with an excellent outcome. Such a neonatal picture may be due to the reduction of urinary output secondary to excessive postnatal weight loss and dehydration. In this case, prenatal ultrasound result was more reliable than postnatal ultrasound, emphasizing the importance of postnatal urologic follow-up after prenatal indication.

Relationship between renal ultrasonographic, CD4 cell count and proteinuria findings in HIV infected adult patients in Jos, Nigeria

This study intends to describe renal sonographic outcomes in matured patients with HIV/AIDS in Plateau State capital Jos and relate the outcome with proteinuria and the subjects’ CD4 cell count. The 504 subjects were evaluated for renal ultrasound scan, CD4 cell counts and dipstick proteinuria (using Combi 10 Urinalysis strips) were obtained, and their findings recorded. Twenty-four (4.8%) of the patients had abnormal renal sonographic findings while 480 (95.2%) had normal findings. Sixteen (3.2%) out of the 24 patients with abnormal renal ultrasound had enlarged kidneys, 24 (4.8%) patients had increased renal echogenicity while 19 (3.8%) had loss of corticomedullary differentiation. One (0.2%) patient was observed to have a globular kidney. Significant proteinuria was observed in all the 24 (4.8%) patients with abnormal renal sonographic findings to suggest HIV-associated nephropathy (HIVAN) while the remaining 480 (95.2%) patients had no significant proteinuria. Hence, the prevalence of HIVAN in this study was 4.8%. Kidney size, renal echogenicity and corticomedullary differentiation correlated significantly with proteinuria count with P-values of 0.05, r = 0.084) and between corticomedullary differentiation and CD4 cell amount (p >0.05, r = 0.049). Sonographically based determination of renal size and echogenicity/echopattern combined with proteinuria are good determinants of renal parenchymal disease and may have diagnostic usefulness as a non-invasive procedure in the identification of HIVAN in HIV-positive subjects with renal disease. Key words: HIV, AIDS, HIV-associated nephropathy, kidneys, ultrasonography, proteinuria.

P023 Secondary membranous nephropathy in a patient with a background of rheumatoid arthritis treated with biosimilar etanercept

Abstract Background/Aims There is a growing number of reports of the development of autoimmune processes related to TNF-targeted therapies. This relationship is much more established with the originator biologics as they have been in clinical use for longer, but data for biosimilar safety is still emerging. Here we describe a case of an 80-year-old gentleman with a background of rheumatoid arthritis who developed membranous nephropathy secondary to Benepali®. Methods An 80-year-old Caucasian gentleman with a background of seropositive rheumatoid arthritis, diagnosed at the age of 35 years, was maintained in a clinical remission on oral methotrexate 15 mg weekly, until 2017, when his disease started to flare. At that time, his treatment was switched to sulfasalazine, but due to ongoing high disease activity, this was changed again in December 2018 to methotrexate with Benepali®. His rheumatoid arthritis was controlled with these disease-modifying anti-rheumatic drugs (DMARDs) and his blood test monitoring including full blood count, liver and renal profile (eGFR 80 ml/min/1.73m2) remained normal during the first seven months of treatment. In June 2019, his eGFR deteriorated to 46 and methotrexate was held. Despite this, his eGFR continued to worsen to 28 in July. At that point his Benepali® was discontinued and he was referred to the renal physicians. Results He was normotensive (blood pressure 120/68) and had no dependent oedema. A renal tract ultrasound scan showed normal appearing (with a couple of simple cysts) 10.7/9.4 cm kidneys. Urine dipstick showed 2+ blood and 2+ protein, urine protein:creatinine ratio was 138 mg/mmol (normal ≤ 23) and serum albumin 31 g/L (normal ≥ 34). Serum electrophoresis, HIV and Hepatitis PCRs and serum anti-phospholipase A2 receptor antibody were negative. Renal biopsy confirmed stage I to II membranous nephropathy with mild focal segmental glomerulosclerosis. Reassuringly his renal function and proteinuria continued to improve off Benepali® and both returned to normal a few months after stopping this agent. Conclusion This is the case of an 80-year-old gentleman who developed membranous nephropathy eight months after commencing etanercept biosimilar - Benepali® - for rheumatoid arthritis. Although attribution to a single agent is challenging, we believe that it is likely Benepali® was the main attributing factor for the development of membranous nephropathy. The temporal relationship between the initiation of Benepali® and the subsequent development of biopsy proven membranous nephropathy along with the resolution following withdrawal of Benepali® supports drug-related renal injury. Although TNF inhibitor-induced renal injury is uncommon, this case highlights the need for physicians to maintain a high level of suspicion if a patient on a TNF inhibitor, including biosimilars, develops proteinuria and renal injury. Disclosure L. Sammut: None. T. Leach: None. L. Yalakki: None.

Evaluation of transverse dorsal lumbotomy in management of PUJ obstruction in patients younger than 6 months

The transverse dorsal lumbotomy approach provides excellent exposure to the PUJ and causes minimal tissue damage. In this study, we assess the efficacy of dorsal lumbotomy in PUJ obstruction in children younger than 6 months. All children less than 6 months who were managed with the dorsal lumbotomy approach between 2009 and 2017 were reviewed prospectively. Data included: demographic data, pre/post-operative renal ultrasound scan with SFU grading and RDS, operative time, post-operative complications, and follow up results. A total of 42 children with a mean age of 4.4 ± 1 months were included. On pre-operative RDS, all patients had an obstructive pattern and a SRF of 30.3 ± 9.3. The mean operative duration was 49 min and analgesia was minimal. Post-operative ultrasound at 6 months showed an improvement in hydronephrosis (p < 0.05) and a mean SRF of 39.3 ± 6.1 (p < 0.001). Transverse dorsal lumbotomy approach is a safe and efficient alternative in patients less than 6 month.