Diagnóstico prenatal y posnatal de anomalías del tracto urinario / Pre- natal and post-natal diagnosis of urinary tract anomalies

Introducción: El ultrasonido prenatal aporta una magnífica forma de introducirnos en la patofisiología renal humana, pero es incapaz de detectar todas las anomalías. Objetivos: Identificar las principales anomalías de riñón y tracto urinario en pacientes con diagnóstico prenatal o posnatal de estas anomalías. Métodos: Se incluyeron en el estudio todos los pacientes que llegaron remitidos al servicio de Nefrología del Hospital Pediátrico Docente William Soler entre el 1ero. de octubre de 2015 y el 30 de septiembre de 2017, por haberse detectado alteraciones en el ultrasonido prenatal durante el seguimiento de un embarazo normal y aquellos en los que después del nacimiento se comprobó alguna anormalidad en forma incidental o por síntomas relacionados. Se programó seguimiento clínico, imagenológico y terapéutico de acuerdo con la anomalía detectada. Resultados: El estudio incluyó 81 pacientes, 65 con diagnóstico prenatal y 16 con hallazgo posnatal. El sexo masculino estuvo representado por el 66,7 por ciento y la anomalía más frecuente estudiada resultó la displasia renal multiquística (23,4 por ciento). En segundo lugar, el diagnóstico morfológico correspondió a dilataciones del tracto urinario, que en su estudio posnatal se clasificaron como hidronefrosis (20,9 por ciento), pielectasias (17,4 por ciento) y reflujo vesicoureteral (7,4 por ciento). Conclusiones: El ultrasonido prenatal para la detección de anomalías de riñón y tracto urinario es un proceder diagnóstico de gran utilidad porque permite prepararnos para enfrentar estas anomalías antes que presente síntomas relacionados y además puede proporcionar una adecuada información a los padres. No todas las anomalías congénitas se detectan mediante ecografía prenatal(AU)

Introduction: The prenatal ultrasound provides a great way to introduce us to the human renal pathophysiology, but is unable to detect all of the anomalies. Objectives: To identify the main anomalies of the kidney and urinary tract in patients with prenatal or postnatal diagnosis of those. Methods: There were included in the study all the patients who were referred to the Nephrology Service of William Soler Pediatric Teaching Hospital from October 1, 2015 to September 30, 2017 being detected alterations in the prenatal ultrasound during the follow-up of a normal pregnancy and those in which after birth any abnormality was found incidentally or by related symptoms. Clinical, imaging and therapeutic follow-up were scheduled in accordance with the anomaly detected. Results: The study included 81 patients, 65 with prenatal diagnosis and 16 with post-natal finding. The male sex was represented by the 66.7 percent and the most common anomaly studied was the multicystic dysplastic kidney (23.4 percent). Secondly, the morphological diagnosis corresponded to dilations of the urinary tract, which in the post-natal study were classified as hydronephrosis (20.9 percent), pyelectasis (17.4 percent) and vesicoureteral reflux (7.4 percent). Conclusions: The prenatal ultrasound for the detection of kidney and urinary tract´s anomalies is a diagnosis of great utility because it allows us to prepare to face these anomalies before they present related symptoms and it can also provide adequate information to parents. Not all congenital anomalies are detected by prenatal ultrasound(AU)

Environmental factors associated with congenital anomalies of kidney and urinary tract / 国际儿科学杂志

Congenital anomalies of kidney and urinary tract(CAKUT) is a common birth defect in children,which is regulated by genetic and environmental factors.In this paper,we search CAKUT literatures and reviews about environmental factors and find that low protein diet,high salt and low salt intake,gestational diabetes,pregnancy obesity,drug intake during pregnancy and other factors are related to CAKUT.

Progress in genetics of vesicoureteral reflux / 国际儿科学杂志

Vesicoureteral reflux,a most common congenital anomaly of the kidney and urinary tract,is associated with the malformation of ureterovesical junction. It does not cause any specific symptoms or signs un-less it is part of a syndrome or complicated by urinary tract infection. The exact cause is not clear,and genes or environmental factors may result in vesicoureteral reflux. The prevalence of siblings and offspring of reflux pa-tients are higher than normal control groups,so the genetic screening is necessary. This article will review the ge-netics of vesicoureteral reflux and possible interactions.

Ultrasound screening of urinary system in 14256 asymptomatic children / 重庆医科大学学报

Objective:To investigate the clinical characteristics of urinary system abnormalities in Chongqing and its surrounding area, and to assess the role of the large-scale urinary system ultrasound screening in the asymptomatic children with kidney and urinary tract abnormalities. Methods:We performed urinary system ultrasound on Screening 14 256 children from September 2008 to October 2008 in Chongqing Children’s Hospital. The total samples were allocated into five groups as follows:less than 1 year group;1 to 3 years group;3 to 5 years group;5 to 10 years group ;more than 10 years group. Then according to each group’s age,sex,disease location,severity difference,we performed statistical analysis. Results:409(2.87%)of 14 256 children had abnormalities,284 of whom was diagnosed with significant anomalies,including hydronephrosis,renal maldevepment (aplastic,dysplastic,hypoplastic,ectopic kidneys)and renal agensis,nephrolithiasis,simple renal cyst,multicystic dysplastic kidneys (MCKD),ureter dilation,duplex kidneys and so on. Among these anomalies,the most prevalent abnormal finding was hydronephrosis accounting for 130 cases,almost a half of 284 (45.77%),92 cases in males,38 cases in femal. The prevalence of melamine related urinary calculus was as 5.17 times as that of others and its 95% confidence interval(CI)of population relative risk was [3.28,8.14]. Conclusion:① Ultrasonography in the diagnosis of diseases of the urinary system can play an important role,especially for congenial anomalies of kidney and urinary tract(CAKUT)and /or hydronephrosis and so on. Therefore,an early diagnosis of these defects allows to realize as fast as possible the best medical and/or surgical treatment, preventing or at least slowing down the progression to chronic renal failure. ② The prevalence rate of hydronephrosis in male is higher than female. ③Exposure to melamine- contaminated formula is associated with urinary stones.