Surgical management of renal tract problems (original) (raw)
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Congenital Anomalies of the Renal Pelvis and Ureter
2018
Congenital anomalies may involve any level of the collecting system; the most usual presentation is urinary tract dilatation that may already be detected during fetal life. The role of imaging is to determine the origin of the dilatation, i.e., obstructive versus nonobstructive (Table 1 lists the causes of urinary tract dilatation). Other useful information includes the level of the impairment to drainage (so-called obstruction) and its impact on renal function. All these data are important in order to determine the best therapeutic approach.
Renal dysplasia in children with posterior urethral valves: a primary or secondary malformation?
Pediatric Surgery International, 2002
Routine prenatal ultrasound examination of the urogenital tract is of importance in patients with posterior urethral valves (PUV), because the renal function and long-term prognosis of these patients depend on early diagnosis and subsequent therapy. Opinion is divided as to whether the often-observed association of PUV with renal dysplasia represents a primary malformation or a secondary pathology caused by recurrent infections. These aspects should have an influence on therapeutic consequences and optimal timing of therapy in order to preserve long-term renal function. The histology of kidney specimens from 13 children with PUV who underwent nephrectomy was reviewed to attempt to differentiate between primary dysplastic malformations and secondary pathologies. Clinical data were analyzed and compared with the histologic findings. The average age at nephrectomy was 29 months (range 3-158 months). Approximately 80% of the specimens showed primary dysplastic malformations (mesenchymal or fetal cartilage tissue or dysplastic glomeruli and tubuli) in the presence of well-developed renal parenchyma. All specimens showed secondary pathologies such as renal-cortical atrophy, interstitial fibrosis, and interstitial-nephritis atrophy. The histologic evidence of well-differentiated renal parenchyma in concurrence with dysplastic parenchyma makes infravesical obstruction as the only cause of renal alterations in patients with PUV questionable. This coincides with the fact that organogenesis of the kidney is terminated at the 12th gestational week and secondary renal damage is irreversible at the 20th gestational week, but prenatal urinary diversion of the upper urinary tract is feasible in the 20th gestational week at the earliest. These facts must be taken into account when considering intrauterine urinary diversion.
Epidemiology and Clinical Evolution of Congenital Anomalies of the Kidney and Urinary Tract
Congenital anomalies of the kidney and urinary tract (CAKUT) are characterized by structural and functional abnormalities of kidney, collecting system, bladder, and urethra. These anomalies are the most commonly diagnosed malformations in the prenatal and postnatal period and constitute the leading cause of Chronic Kidney Disease (CKD) in children, worldwide. CAKUT can be identified as single malformation or it can be part of a complex malformation. Classification of CAKUT on embryological basis consists of: abnormalities in the renal parenchymal development, aberrant embryonic migration and abnormalities of the collecting system. We analyzed 20,326 children admitted in Children Emergency Hospital Timisoara between January 2015 and March 2016 for different pathologies in a cross-sectional study. The prevalence of children with CAKUT was high in our study 5.3‰, with an incidence of 1.5‰ per year. CAKUT is difficult to detect since there is no significant clinical manifestations in early ages. Clinically, CAKUT are silent most of the time, UTI is the most frequent initial distress clue as it was present in 54.12% of cases by the time of diagnosis. Abdominal ultrasound is the preferred method of screening for CAKUT and it should be recommended as a routine of children`s physical examination.
Spectrum of Congenital Renal Anomalies
Journal of Medical Science And clinical Research, 2018
Introduction: Congenital anomalies of the kidney are a common renal pathology diagnosed in childhood or middle age. The varieties of these anomalies and their ensuing complications often pose a challenge to accurate diagnosis and timely management. Methods: The spectrum of congenital anomalies and their complications were evaluated in this observational cross-sectional study. Ultrasonography and Color Doppler was used along with CT Scan and IVP wherever necessary. The complications produced by these anomalies were also evaluated. Results: A total of thirty cases were observed over a period of one year. Ectopic kidney was the most commonly observed anomaly followed by duplex collecting system, horseshoe kidney and autosomally dominant polycystic kidney disease. Calculus, hydronephrosis, calculostasis and pyelonephritis were the most common complications observed. Conclusion: Radiographic imaging using Ultrasound with Doppler is a very good modality to identify the spectrum of congenital renal anomalies and its complications.
Congenital Renal and Urinary Tract Anomalies in Selected Neonates
Journal of Evidence Based Medicine and Healthcare, 2016
BACKGROUND Congenital anomaly of kidney and urinary tract (CAKUT) are among the most common anomalies diagnosed prenatally. Early diagnosis and timely intervention can preserve renal function and avoid morbidity. AIMS AND OBJECTIVES To screen, select at-risk newborns for congenital renal and urinary tract anomalies by postnatal ultrasound and to study the pattern of distribution, clinical presentation and its correlation with antenatal scan. MATERIALS AND METHODS It was a prospective study. Postnatal ultrasound of 40 subjects fulfilling the inclusion criteria was performed on 4 th day of life. Postnatal ultrasound findings were compared with antenatal records and immediate postnatal clinical course was assessed. RESULTS Out of 40 high-risk selected screen patients, 14 subjects were identified to have CAKUT on postnatal USG on 4 th day of life. Hydronephrosis was the most common congenital renal anomaly with statistically good correlation with antenatal and postnatal scan (P <0.0001). Mild hydronephrosis detected on antenatal scan (with anterior pelvic diameter 7-9 mm) showed resolution on postnatal ultrasound in 3 subjects. The congenital anomalies in 4 cases were missed on antenatal USG. The number of LBW babies in the screened population was 60% and 64% babies with CAKUT were LBW. Family predisposition was seen in 12.5% of CAKUT population. CONCLUSION Congenital renal and urinary tract anomalies can be easily identified on antenatal and post natal ultrasound. LBW babies with family history of CAKUT or high-risk factors warrant radiological screening and biochemical evaluation. Hydronephrosis is the most common finding consistent in both the scans and had a good resolution rate. Prenatal screening would help in early identification of CAKUT anomalies and possible early surgical or medical intervention to prevent or slow ESRD.
2020
Congenital anomalies of the kidney and urinary tract (CAKUT) occur in 5%-10% of the population. About 50%-60% of affected patients have malformations of other organ systems including the heart and cardiovascular system, gastrointestinal tract, central nervous system, skeletal system, lung, face, genito-reproductive system, abdominal wall, chromosomal abnormalities, multiple congenital anomalies (MCA) and others. CAKUT is a major cause of chronic kidney disease (CKD) especially in children accounting for about 50% of cases. CAKUT should be suspected in children with anomalies of other organ systems, MCA, chromosomal aberrations, and in newborns with major abnormalities of the ear lobe. Awareness of this association is essential in the early diagnosis and management of CAKUT to prevent renal damage and chronic kidney disease.
Congenital anomalies of kidney and urinary tract in siblings: An uncommon condition
Indian Journal of Nephrology, 2013
Case Reports Case 1: Bilateral pelviureteric junction obstruction in two brothers A 5-year-old boy presented to the outpatient department with recurrent abdominal pain and fever off and on for the last 6 months. General physical and systemic examination of the child was normal. Urine examination revealed pyuria and urine culture grew Escherichia coli. Blood urea and serum creatinine levels were 35 mg/dL and 0.6 mg/dL, respectively. The urinary tract infection was treated with appropriate antibiotics and further evaluation was carried out. Ultrasonography of the abdomen revealed right-sided hydronephrosis with suspicion of PUJO; the left kidney appeared normal. The micturating cystourethrogram (MCUG) did not reveal any abnormality. A radionuclide scan showed bilateral obstructive hydronephrosis with moderate impairment of the left kidney. The child underwent a pyeloplasty of the left kidney followed by pyeloplasty of the right kidney 3 months later. A Diethylene triamine penatacetic acid (DTPA) scan after 8 months of surgery showed mild hydronephrosis of both kidneys with preserved parenchymal function and slow but non-obstructed drainage pattern (differential function: Right kidney 49%, left kidney 51%). Subsequently, the child has been under regular follow-up of our pediatric nephrology clinic. At present, the child is 13 years old and has CKD stage 3 (estimated glomerular function rates (eGFR) 50 mL/min/1.73 m² by Schwartz formula).
2016
About one-third to half of patients with congenital anomalies of the kidney and urinary tract (CAKUT) have one or more associated anomalies of other organ systems including cardiovascular, gastrointestinal, central nervous, skeletal, and genito-reproductive systems as well as abnormalities of the lung and face, chromosomal aberrations and multiple congenital anomalies syndromes. Awareness of this association is essential in the management of affected patients, especially when the anomaly is not evident on routine physical examination and when early intervention can contribute to prevention of chronic kidney disease (CKD). CAKUT should be suspected in patients with multiple congenital anomalies particularly in those with chromosomal aberrations, congenital anomalies of other organ systems, and in newborns and children with single umbilical artery, febrile urinary tract infection, significant abnormalities of the ear lobes, and supernumerary nipples. Chromosomal studies should be cons...