Tract Abnormalities In Children Research Articles

Urine Neutrophil Gelatinase Associated Lipocalin as a Predictor of Vesicoureteral Reflux and Renal Parenchymal Damage: A Systematic Review

Background: Vesicoureteral reflux (VUR) is the most common congenital urinary tract abnormality in children. Renal parenchymal damage is the most devastating complication of severe undiagnosed VUR. Different diagnostic biomarkers have been introduced as alternatives for radiologic evaluation in these patients. This review article aimed to increase the knowledge about the role of urine neutrophil gelatinase-associated lipocalin (uNGAL) in children affected by primary VUR and renal parenchymal damage. Methods: A systematic review of PubMed, Scopus, Web of Science, ProQuest, and Ovid was conducted in September 2022 to retrieve studies that investigated the correlation between uNGAL or uNGAL/Cr excretion and primary VUR in male/female patients younger than 18 years of age. Patients with secondary VUR, age older than 18 years, infectious or inflammatory disorders, obstructive uropathies, and acute or chronic kidney diseases were excluded. Two reviewers independently screened the titles and abstracts of the search results and then assessed the full texts selected from the pertinent studies. Results: Eighteen research articles with a total sample of 699 patients were found to measure uNGAL in VUR or renal scarring. UNGAL or uNGAL/Cr had increased excretion in the majority of children with primary VUR or RPD, with a positive or no correlation to the severity of VUR. Conclusions: Several studies addressed uNGAL and uNGAL/Cr as putative biomarkers for the prediction of VUR or reflux-associated RPD.

Neurovisualization features of brain anatomy in children with spastic cerebral palsy revealed by magnetic resonance tractography

Aim. To perform quantitative evaluation of the degree of white matter tract abnormalities in children with spastic cerebral palsy by magnetic resonance tractography to determine severity of the disease, as well as to carry out a dynamic assessment of treatment effectiveness.Materials and methods. The study included 46 children (32 males, 14 females; average age 5.4 ± 1.1 years). The participants were divided into two groups. The experimental group consisted of 23 children with spastic cerebral palsy. The control group included 23 children without any neurological disorder. Examination of the brain was performed on the Siemens Essenza 1,5 Т system (Siemens, Germany) and included magnetic resonance tractography to reconstruct the major white matter tracts. The number of fibers, average fractional anisotropy value, apparent diffusion coefficient, and coefficient of myelination of major white matter tracts in the brain were calculated and analyzed.Results. We found a significant difference in the above-stated parameters between the groups. The experimental group showed a decrease in the absolute number of fibers at the central and posterior segments of the corpus callosum, corticospinal tracts, and left inferior longitudinal fasciculus. Besides, we detected a decrease in fractional anisotropy at 2–5 segments of the corpus callosum and right lateral corticospinal tract, an increase in the apparent diffusion coefficient at 2, 4, and 5 segments of the corpus callosum and left lateral corticospinal tract, and a decrease in the myelination coefficient in all the examined tracts, except for superior longitudinal fasciculus. We revealed a positive correlation between the intensity of the motor disturbance and the coefficient of myelination at the anterior corpus callosum and inferior longitudinal fasciculus.Conclusion. Magnetic resonance tractography is an informative technique for unbiased evaluation of white matter tract anatomy, as well the level and degree of motor tract damage. The most useful characteristics of white matter tract anatomy are the absolute number of fibers in the tract, fractional anisotropy, and coefficient of myelination. Some of them correlated with the intensity of motor disturbance, so they can be regarded as potential predictors of rehabilitation potential.

Urinary tract abnormalities in children with first urinary tract infection

Background: Pediatric urinary tract infections (UTIs) are a major health-care issue. UTI may be a harbinger of variety of underlying urinary tract abnormalities. The long-term complications of recurrent UTI are kidney scarring, hypertension, and chronic kidney disease. Aim: The present study aims to determine the prevalence of urinary tract abnormalities in children with first episode of UTI. Materials and Methods: This study was a hospital-based prospective observational study carried out in the department of pediatrics over a period of 15 months from January 2015 to March 2016. A total of 100 children with culture-positive first UTI who fulfilled the inclusion criteria were enrolled in the study. Ultrasonography (USG) abdomen, micturating cystourethrography (MCU), and dimercaptosuccinic acid (DMSA) kidney scan were done. Results: Among 100 children with culture-proven UTI, USG was abnormal in 16% with the majority (31.7%) having hydroureteronephrosis. MCU was abnormal in 14% and DMSA in 13%. About 9% had kidney scarring. Overall prevalence of urinary tract abnormalities was 14%. About 42.8% of urinary tract abnormalities were detected in children between 1 and 5 years and 35.7% below 1 year. Vesicoureteral reflux was the most common abnormality (8.0%). Conclusion: UTI in young children serves as marker for abnormalities of the urinary tract. Early diagnosis is of considerable significance to preserve kidney function and prevent complications.

Validity of urine neutrophile gelatinase-associated lipocalin in children with primary vesicoureteral reflux.

Vesicoureteral reflux (VUR) is the most common congenital urinary tract abnormality in children. The objective of this study was to evaluate the diagnostic value of urine neutrophil gelatinase-associated lipocalin (NGAL) in children with primary vesicoureteral reflux (VUR). A total of 69 patients were evaluated in 2 groups with (32) and without (37) VUR. Patients with secondary VUR, infectious or inflammatory disorders, obstructive uropathies, and acute or chronic kidney disease were excluded. Urine NGAL level was measured by ELISA kit. Mean age of children with VUR was 36.84 ± 28.16, compared to those without VUR 32.32 ± 29.08, with no significant difference (p = 0.51). Mean urine NGAL (p = 0.012) and urine NGAL/Cr (p = 0.003) were higher in patients with VUR. In addition, urine NGAL/Cr increased significantly in patients with decreased parenchymal function, compared to those with normal DMSA scan. Using the cutoff value of 0.888, urine NGAL had 84% sensitivity and 81% specificity for diagnosis of VUR. Based on AUC (0.86), urine NGAL had acceptable diagnostic accuracy in children with VUR. The results of this study support the evidence that urine NGAL/Cr is a sensitive, specific and accurate biomarker for diagnosis of children with primary VUR.

Detection of Vesicoureteral Reflux Using Electrical Impedance Tomography.

The purpose of this study is to detect vesicoureteral reflux (VUR) noninvasively using an electrical impedance tomography (EIT). VUR is characterized by the backflow of urine from the bladder to the kidneys. Using porcine models, small quantities of a solution mimicking the electrical properties of urine were infused into each ureter. EIT measurements were taken before, during and after the infusion using electrodes positioned around the abdomen. The collected data from 116 experiments were then processed and time-difference images reconstructed. Objective VUR detection was determined through statistical analysis of the mean change in the voltage signals and EIT image pixel intensities. Unilateral VUR was successfully detected in 94.83% of all mean voltage signals and in over 98.28% of the reconstructed images. The images showed strong visual contrast between the region of interest and the background. In animal models, EIT has the capability to detect reflux in the kidneys with high accuracy. The results show promise for EIT to be used for screening of VUR in children. VUR is the most common congenital urinary tract abnormality in children. The condition predisposes children to urinary tract infections and kidney damage. The current gold standard diagnostic test, a voiding cystourethrogram, is invasive and uses ionizing radiation; therefore, there is a need for new tools for identifying VUR in children. This study presents a noninvasive method to detect VUR in animal models, illustrating the potential for EIT as a screening tool in clinical scenarios.

Clinico-microbiological determinants of urinary tract abnormality following first culture proven urinary tract infection in children

Introduction: Clinico-microbiological factors would help clinicians in developing countries to optimize the use of radioimaging childhood urinary tract infection (UTI), especially in resource limited settings with financial constraints Objective : To study the clinico-microbiological profile and determine the association of renal tract abnormalities in children with their first documented UTI and to find out the clinico-microbiological determinants of the anomalies. Method: This prospective study was carried out over a period of two years in a tertiary care teaching hospital at Ahmedabad, Gujarat after obtaining permission from institutional review board. A total of 65 children up to 12 years of age with first culture proven UTI, were recruited from the paediatric outpatient department (OPD), paediatric ward and neonatal intensive care unit (NICU) after obtaining parental consent. Results : Most (49.2%) patients belonged to the 1-5 year age group. There were 36 (55.4%) males. Fever (69.2%) was the commonest symptom followed by excessive crying (29.2%) and dysuria (27.7%). Of the 65 patients, 15.3% had complicated UTI, 29.2% required hospitalization and 4.6% had hypertension. Of male patients 91.7% were uncircumcised. Malnutrition was found in 57.9% of patients in the under 5 year age group. We found altered renal function tests (RFTs) in 6.1%, leucocytosis in 29.2% and pyuria in 35.2% patients. Escherichia coli caused 40% of the infections, followed by Klebsiella (29.2%). Renal abnormalities were found in 27 (41.5%) with statistically significant (p correlation with young age, complicated UTI, haematuria, oliguria, hypertension, altered RFTs, malnutrition and non- Escherichia coli organisms. Ultrasonography (USG) detected abnormalities in 24/65 (36.9%), micturating cystourethrogram (MCUG) in 7/32 (21.8%) and DMSA revealed scar in 4/32 (12.5%) patients. USG had sensitivity of 88.8%. Conclusions: Escherichia coli caused 40% of the UTI, followed by Klebsiella (29%). Renal anomalies were found in 41.5% with statistically significant correlation with young age, complicated UTI, haematuria, oliguria, hypertension, altered RFTs, malnutrition and non- Escherichia coli. Sri Lanka Journal of Child Health , 2018; 47 (2): 104-111

One-phase Split-bolus CT Urography – a Novel Approach To Reduce Radiation Dose in Diagnostics of Congenital Anomalies of Kidneys and Urinary Tract in Children

BackgroundLow-dose CT Urography (LD-CTU) has become a standard procedure in urinary tract abnormalities in children, especially when MR Urography is not available. Standard one-phase CTU is performed in excretory phase. There is also a split-bolus technique, which combines two or even three phases during one scan and provides more clinical information without higher radiation exposure. It can be implemented for congenital anomalies of kidneys and urinary tract (CAKUT) in children, however, this application is not deeply discussed in scientific literature. Aim of this publication is to present the protocol and determine the role of LD-CTU in diagnostic imaging of CAKUT in children.Material and methodsClose to 300 CTUs in children were performed as a standard of care during the last 6 years in our Department. Diagnostic accuracy in suspected CAKUT was analyzed, depending on applied protocol − standard excretory CTU, multiphase CTU and two different one-phase split-bolus CTU protocols.ResultsVisualization of the urinary tract was adequate in all study protocols. However, more clinically significant information was received in vascular-excretory protocol, including vascular and renal anatomy. Radiation exposure was similar or even lower than in other study protocols.ConclusionsOne-phase split-bolus CTU protocol is a novel approach in low-dose diagnostic imaging of CAKUT in children. Combination of vascular and excretory phases has been shown as very effective technique, especially in comprehensive anatomical assessment of the abnormality and qualification to surgical intervention.

Computed tomography urography with iterative reconstruction algorithm in congenital urinary tract abnormalities in children - association of radiation dose with image quality.

PurposeTo assess the extent to which a radiation dose can be lowered without compromising image quality and diagnostic confidence in congenital urinary tract abnormalities in children by using a CT scanner with an iterative reconstruction algorithm.Material and methods120 CT urography image series were analysed retrospectively. Image series were divided into four study groups depending on effective radiation dose (group 1: 0.8-2 mSv; group 2: 2-4 mSv; group 3: 4-6 mSv; group 4: 6-11 mSv). Objective and subjective image quality were investigated. In objective analysis, measurements of attenuation and standard deviation (SD) in five regions of interest (ROIs) were performed in 109 excretory image series, and image noise was evaluated. In subjective analysis, two independent radiologists evaluated 138 kidney units for subjective image quality and diagnostic confidence.ResultsThere were no significant differences in image noise in objective evaluation between the following study groups: 2 vs. 3 and 3 vs. 4 in all ROIs (with the only exception in spleen SD measurement between study groups 2 vs. 3), while there was significantly more image noise in group 2 in comparison to group 4. For all other ROIs in all study groups, there was more image noise on lower dose images. There were no significant differences in pairwise comparisons between study groups in subjective image quality. Diagnostic confidence was not significantly different between all study groups.ConclusionsLow-dose CT urography can be a valuable method in congenital urinary tract abnormalities in children. Despite poorer image quality, diagnostic confidence is not significantly compromised in examinations performed with lower radiation doses.

Vascular endothelial growth factor-A gene polymorphism is associated with congenital renal lesions in children with urinary tract infections.

This study investigated the relationship between vascular endothelial growth factor-A (VEGF-A)-460C/T functional gene polymorphism and renal parenchymal lesions, vesicoureteral reflux and other urinary tract abnormalities in children with a urinary tract infection (UTI). VEGF-A-460C/T gene polymorphism was investigated with restriction length polymorphism analysis in 76 children with their first UTI and in 63 controls without infections. Genotype and allele frequencies were compared between children with UTIs and controls and between different groups with UTIs. The VEGF-A-460C/T genotype frequencies differed significantly between those with and without renal parenchymal lesions in the UTI cohort. Allele C homozygosity was significantly more common in those with renal parenchymal lesions (36.6% versus 8.7%, p = 0.007). A separate analysis showed that allele C was associated with lesions compatible with hypodysplasia, rather than with focal ones associated with infections, with an odds ratio of 11.55 and 95% confidence interval of 3.03-43.9 (p = 0.0001). No significant differences in genotypes or allele frequencies were found between children with and without reflux or other urinary tract anomalies. In children with UTIs, C allele polymorphism of the VEGF-A gene was associated with hypodysplastic renal parenchymal lesions, which were possibly congenital and existed before the infection.

Color Doppler Ultrasound Evaluation of Ureteral Jet Angle to Detect Vesicoureteral Reflux in Children

Vesicoureteral reflux is the most common urinary tract abnormality in children. Although voiding cystourethrography is the gold standard for diagnosing reflux, this approach is invasive. We evaluated color Doppler ultrasound measurement of ureteral jet angle as a noninvasive screening tool for detecting reflux. We retrospectively evaluated 125 children (250 renal units) who presented with urinary tract infections or hydronephrosis. All patients underwent color Doppler ultrasonography and voiding cystourethrography. Ureteral jet angle was measured as angle between the direction of the ureteral jet and interureteral ridge. Reflux was diagnosed in 80 patients (117 renal units). Mean ± SD ureteral jet angle was significantly greater in refluxing units (67.9 ± 18.7 degrees) than in nonrefluxing units (47.8 ± 17.3 degrees, p <0.0001). Angle value in each reflux grade became significantly greater according to grade (p <0.0001). Overall ability of ureteral jet angle to detect grade III to V and grade IV/V reflux, as given by the area under the receiver operating characteristic curve, was 0.81 and 0.88, respectively. A cutoff angle of 55 degrees or greater detected grade III to V and grade IV/V reflux with a sensitivity of 85.5% and 94.7%, respectively. A cutoff angle of 70 degrees or greater diagnosed grade IV/V reflux with a sensitivity of 81.6% and a specificity of 82.7%. Color Doppler ultrasound measurement of ureteral jet angle represents a simple and noninvasive method that is applicable as a screening tool to detect high grade vesicoureteral reflux in children.

Modern look on congenital kidney and urinary tract abnormalities early diagnostics in children

The article outlines the main provisions of modern data on early diagnostics of the with congenital kidney and urinary tract abnormalities in children. The aim of the study was to evaluate the efficacy of modern techniques in the diagnosis of congenital abnormalities of the fetal urinary system. Methods and results. The article summarizes survey data of 160 children with kidney and upper urinary tract abnormalities of varying severity. 70 children with prenatally diagnosed with ultrasound abnormality were included into group study. The second group consisted of 70 children who were diagnosed with congenital malformations after birth. A separate group consisted of 20 fetuses whose mothers were receiving unequal MRI results after ultrasound. Evaluation of the results comparing ultrasound and MRI data in the same patients found that most urinary tract defects were diagnosed during prenatal ultrasound. The spectrum of abnormalities can range from mild to fatal. However, the presence of oligohydramnios or obese mothers can reduce the diagnostic accuracy of ultrasound, which requires additional and more informative friendly methods to visualize various pathologies of the fetus. Conclusions. It has been proved that most part of the urinary tract defects can be diagnosed prenatally by ultrasound, but MRI allows us to establish a more accurate diagnosis and resolve the issue of prolongation of pregnancy and postnatal tactics of keeping such children development.

Recent advances in the diagnosis of vesicoureteral reflux in children

Primary vesicoureteral reflux is a common congenital urinary tract abnormality in children. There is considerable controversy regarding its management. Preservation of kidney function is the main goal treatment, which necessitates identification of patients requiring early intervention. The aim of this review is to evidence the recent advances in the diagnosis of this congenital abnormality and to indicate the guidelines for its diagnostic management.

Cowden disease and multicystic dysplastic kidney: increased risk of renal cancer?

Unilateral multicystic dysplastic kidney is one of the most frequently identified urinary tract abnormalities in children. Although it can be an isolated finding, it is often associated with other anomalies of the kidney and urinary tract. It has also been described in association with other multisystemic disorders of known genetic aetiologies. Cowden disease (CD) is a rare autosomal-dominant disorder with age-related penetrance characterized by benign and malignant hamartomatous lesions affecting derivatives of all three germ cell layers. Hamartomas can emerge in virtually every organ, but are mostly found in the skin and gastrointestinal tract. We report a 7-year-old patient presenting with unilateral multicystic dysplastic kidney and CD, a hitherto unknown association in paediatrics, which raises the question of an increased risk of renal cancer.

Low Risk for Urinary Tract Infection After Endoscopic Treatment of Vesicoureteral Reflux

Vesicoureteral reflux (VUR) is the most common urinary tract abnormality in children and is associated with recurrent urinary tract infection (UTI).

Usefulness of DTI-based three dimensional corticospinal tractography in children with hemiplegic cerebral palsy

Purpose : Magnetic resonance diffusion tensor imaging-based three-dimensional fiber tractography (DTI-FT) is a new method which demonstrates the orientation and integrity of white matter fibers in vivo. However, clinical application on children with cerebral palsy is still under investigation. We present various abnormal patterns of DTI-FT findings and accordance rate with clinical findings in children with hemiplegic cerebral palsy, to recognize the usefulness of DTI-FT. Methods : The thirteen children with hemiplegic cerebral palsy evaluated at Yeungnam University hospital from March, 2003 to August, 2007 were enrolled in this study and underwent magnetic resonance DTI-FT of the corticospinal tracts. Two regions of interest (ROI) were applied and the termination criteria were fractional anisotropy . Results : The patterns and distribution of abnormal DTI-based corticospinal tractographic findings were interruption(10 cases, 76.9%), reduction of fiber volume (8 cases, 61.5%), agenesis of corticospinal tract (3 cases, 23.1%), transcallosal fiber (2 cases, 15.4%) and, aberrant corticospinal tracts (4 cases, 30.8%). Abnormal DTI-based corticospinal tractographic findings were in accordance with the clinical findings of cerebral palsy in 84.6% of the enrolled patients. Conclusion : Our results suggest that DTI-FT would be a useful modality in the assessment of the corticospinal tract abnormalities in children with hemiplegic cerebral palsy.

RET Gly691Ser mutation is associated with primary vesicoureteral reflux in the French-Canadian population from Quebec

Primary vesicoureteral reflux (pVUR) is a common, genetically heterogeneous congenital urinary tract abnormality in children. It causes urine to flow backward from the bladder to the ureter due to a developmental defect at the vesicoureteral junction, whose formation requires rearrangement during transformation (Ret)-mediated signaling pathways. To study the genetic causes of pVUR in Quebec patients, we used a sequencing-based candidate gene approach to screen the RET gene and found that 83 out of 118 pVUR patients are carriers of the rare A allele of single nucleotide polymorphism (SNP) rs1799939:G>A that results in a Gly691Ser mutation, a statistically significant increase in allelic frequency, that is absent at six flanking RET SNPs tested. Ser691 is a predicted phosphorylation site and our analysis of transfected cells showed that the Gly691Ser Ret mutant can efficiently interact and associate with a 75-80-kD tyrosine phosphorylated cellular protein, an event not seen with wild-type Ret. This interaction and/or the steric or electric hindrance created by phospho-Ser691 may interfere with the known regulatory functions of the normally phosphorylated phospho-Tyr687 and phospho-Ser696 on the cytoskeleton actin reorganization that are responsible for cell motility and morphology, which consequently may lead to the deficiency in ureteral development observed in pVUR. Our study demonstrates that the Ret Gly691Ser mutation is associated with pVUR and may be one of the genetic causes of this condition in the French-Canadian population in Quebec.

Magnetic Resonance Urographic Parameters for Predicting the Need for Pyeloplasty in Infants With Prenatally Diagnosed Severe Hydronephrosis

Treatment in infants with prenatally diagnosed, severe hydronephrosis remains controversial. We measured anatomical parameters using magnetic resonance urography to create a pelvic index ratio, which we correlated with outcome to assess its value. We reviewed 35 cases of prenatally diagnosed severe hydronephrosis, including grade III in 19 and grade IV in 16. By 6 weeks after birth all patients had undergone repeat ultrasonography, diuretic renography and magnetic resonance urography. Magnetic resonance urography was used to measure the distance (D) from the bottom of the lowest renal calyx to the ureteropelvic junction and the total longitudinal length (L) of the caliceal system. The pelvic index ratio, defined as D/L, assesses the level at which the ureter inserts into the renal pelvis. All cases were initially managed conservatively. Pyeloplasty was required in 16 kidneys (mean patient age +/- SD 7.5 +/- 3.9 months) because of deterioration in renal function. All patients were well at a mean followup of 3.8 years. The remaining 19 cases continued to be managed conservatively. By a mean of 5.4 years spontaneous resolution of prenatally diagnosed severe hydronephrosis had occurred in 7 of 19 cases, while 12 were downgraded to grades I-II. The mean pelvic index ratio in surgical cases was 0.26 +/- 0.13 and in nonsurgical cases it was 0.12 +/- 0.11, indicating that ureters inserted significantly higher in surgical cases (p = 0.0012). Of 9 kidneys with a pelvic index ratio of greater than 0.3 pyeloplasty was required in 8, while 10 of 12 with a pelvic index ratio of less than 0.1 were managed conservatively. Pyeloplasty is likely to be required if the pelvic index ratio is greater than 0.3 and conservative management is likely to succeed if the ratio is less than 0.1. The pelvic index ratio can be calculated easily even in the neonatal period. It appears to be prognostic for pyeloplasty in cases of prenatally diagnosed, severe hydronephrosis.

Diameter of the External Urethral Sphincter as a Predictor of Detrusor-Sphincter Incoordination in Children: Comparative Study of Voiding Cystourethrography

Voiding cystourethrography is a diagnostic procedure widely used to evaluate lower urinary tract abnormalities in children. In children with and without suspected voiding dysfunction we measured the internal diameter of the external urethral sphincter on voiding cystourethrography to evaluate its diagnostic accuracy as a predictor of detrusor-sphincter incoordination.In part 1 of the study 59 boys and 37 girls with normal voiding function underwent voiding cystourethrography. In each child 1 to 6 voiding cystourethrograms (mean 2.1) were performed as a part of urological evaluation. Thus, a total of 200 voiding cystourethrograms were obtained. Underlying urological disease was primary vesicoureteral reflux in 57 cases, congenital hydronephrosis in 9, urinary tract infection in 6, ureteral anomalies in 11 and other in 13. To determine external urethral sphincter inner diameter on a given voiding cystourethrogram the sphincter was measured on consecutive images and the widest diameter was chosen. In part 2 of the study 43 children with suspected voiding dysfunction underwent voiding cystourethrography and external urethral sphincter electromyography. Electromyography results were comparatively analyzed with external urethral sphincter data.In part 1 an age dependent increase in external urethral sphincter inner diameter was noted in children with normal voiding function. External urethral sphincter inner diameter in mm. was determined by the formula, 0.166 x age in years + 4.31 in boys (p = 0.0001, r = 0.374) and 0.222 x age in years + 2.73 in girls (p <0.0001, r = 0.595). Overall the incidence of an external urethral sphincter inner diameter of less than 3 mm. was only 4% (8 of 200 patients). In part 2 external urethral sphincter electromyography documented detrusor-sphincter incoordination in 15 children (35%). When we defined an external urethral sphincter inner diameter of less than 3 mm. as a cutoff value for predicting detrusor-sphincter incoordination, the sensitivity, specificity, positive and negative predictive values were 93%, 89%, 82% and 96%, respectively.External urethral sphincter inner diameter has satisfactory sensitivity and specificity as a predictor of detrusor-sphincter incoordination in children. Thus, simple measurement of the inner diameter of the external urethral sphincter on voiding cystourethrography should be recommended in children with suspected voiding dysfunction before performing rather invasive urodynamic studies.

Urinary tract abnormalities in children with acute focal bacterial nephritis: D. T. Uehling, L.E. Hahnfeld, and K.A. Scanlan. Br J Urol Int 85:885–888, (May), 2000.

Urinary tract abnormalities in children with acute focal bacterial nephritis: D. T. Uehling, L.E. Hahnfeld, and K.A. Scanlan. Br J Urol Int 85:885–888, (May), 2000.

Urinary tract abnormalities in children with acute focal bacterial nephritis.

To review the presentation, methods of diagnosis, and incidence of concomitant urological abnormalities in children with acute focal bacterial nephritis (AFBN, also known as lobar nephronia, a severe nonliquefactive infection involving one or more renal lobules). Sixteen children (age range 6 months to 9 years) diagnosed with AFBN over a 5-year period were retrospectively reviewed. Their age, gender, presenting symptoms, presence of urinary tract abnormalities, radiological imaging and treatment were assessed. All 16 children received intensive intravenous and oral antibiotics. Ten required intervention for predisposing conditions including vesico-ureteric reflux (four), bladder diverticulum (one), renal and peri-rectal abscess (two), ureteric or bladder calculi (two), and renal mass (one). In addition, three children had reflux not requiring surgery; one had multiple renal calyceal diverticula, one had Hinman syndrome and one had leukaemia. Acute focal bacterial nephritis is being diagnosed with increasing frequency through increasing awareness and advances in imaging modalities. Active urological evaluation is warranted because of the high incidence of urinary tract abnormalities. In addition to antibiotics, intervention was needed in most children in this series.