Clinical Spectrum of Congenital Anomalies of Kidney and Urinary Tract in Children

Objective: To evaluate the clinical spectrum and patterns of clinical presentation incongenital anomalies of kidney and urinary tract. Methods: We enrolled 307 consecutivelypresenting children with congenital anomalies of kidney and urinary tract at the pediatricnephrology clinic. Patients were evaluated clinically, with serum biochemistry, appropriateimaging and radionuclide scans. Results: The most common anomaly was primaryvesicoureteric reflux (VUR) (87, 27.3%), followed by pelviureteral junction obstruction(PUJO) (62,20.1%), multicystic dysplastic kidney (51 16.6%), non-obstructivehydronephrosis (32, 10.4%) and posterior urethral valves (PUV) (23, 7.4%). 247 (80.4%)anomalies had been identified during the antenatal period. Another 33 (10.7%) werediagnosed during evaluation of urinary tract infection, and 21 (6.8%) during evaluation forhypertension at presentation. Obstructive anomalies presented earlier than non-obstructive(7 (3, 22.5) vs 10 (4, 24) mo: (P=0.01)). The median (IQR) ages of presentation for childrenwith PUV (n=23), VUR (n=87) and PUJO (n=62) were 4 (2, 14) mo, 10 (5, 27) mo, and 7 (3,22.5) mo, respectively. Nine (2.9%) children had extrarenal manifestations. Conclusions:The median age at clinical presentation for various subgroups of anomalies indicatesdelayed referral. We emphasize the need for prompt referral in order to initiate appropriatetherapeutic strategies in children with congenital anomalies of kidney and urinary tract

Need for a nomogram of renal sizes in the Indian population–findings from a single centre sonographic study.

Background & objectives: Renal size is an important parameter used in the diagnosis and follow up of renal diseases. However, while making decisions, clinicians must be aware of the dependence of these dimensions on the ethnicity of the individual, independent of anthropometric indices. There is no established nomogram for renal sizes in the Indian population. The aim of this study was to assess the applicability of oft-quoted ranges of normal renal sizes in our population. Methods: Renal dimensions including length, width and parenchymal thickness were sonographically measured in 140 individuals with no renal disease. Analysis was done for differences due to age, gender and laterality. The correlation of renal dimensions with anthropometric parameters like weight, height, body mass index (BMI) and body surface area (BSA) was analyzed. Results: The means of length, width and parenchymal thickness of all 280 kidneys of 140 patients were 9.65 ± 0.63, 4.5 ± 0.42 and 2.04 ± 0.2 cm, respectively. There was a significant difference in parenchymal thickness between the right and left kidneys, while there was no significant right-left difference in length or width. Gender-wise analysis showed significant differences between male and female renal breadths but not length and parenchymal thickness. Age group-wise analysis showed significant decrease in renal length and parenchymal thickness beyond the seventh decade. There was a moderate positive correlation of bilateral renal length with body weight and BSA, and a weak positive correlation with body height and BMI. Interpretation & conclusions: Renal sizes in our population are in contrast to commonly quoted normal values in literature. Conclusions about renal sizes need to be made with reference to nomograms and should not be based upon data from other populations. We also present formulae whereby to derive renal sizes from anthropometric indices in our population.