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Background@#The most recent pediatric diuretic imaging guidelines recommend the use of normalized residual activity (NORA) as a semiquantitative index of renal tracer drainage. It is defined as the ratio of post-void renal counts to 1-2 minute post-injection renal counts, with values less than 1 indicative of good drainage. We present two instances where NORA calculation was adjunctive in the evaluation of obstructive uropathy. @*Case Presentation@#The first patient was a 3-month-old male with left-sided congenital hydronephrosis. On dynamic imaging, the diseased kidney showed adequate perfusion and parenchymal extraction; moderate to severe pelvicalyceal tracer retention exhibited good response to diuretic. The pre-diuretic NORA of 1.62 declined to 0.28 after furosemide challenge, concordant with imaging findings that were negative for obstruction. The second patient was a 7-week-old male, also with congenital hydronephrosis of the left kidney. Dynamic images showed the diseased kidney with diminished perfusion and function, as well as pelvicalyceal tracer retention which became more severe after the diuretic was given. The pre-diuretic NORA was 1.81, which became 1.18 post-diuretic. This inadequate decline supplemented imaging findings pointing to significant obstruction. Other semiquantitative parameters have preceded NORA; however, clearance half-time is not validated as a marker of obstructive uropathy in infants and children, and output efficiency requires specialized software to calculate. Standardization of NORA determination is largely provided for by the guidelines recommending a perirenal background region of interest, as well as minimizing the interval between starting camera acquisition and injecting the tracer. @*Conclusion@#Semiquantitative analysis through NORA calculation gives relevant supporting information in the reporting of renal tracer drainage among pediatric patients. Further studies are needed to ascertain its applicability among adults and its diagnostic value in a larger sample of affected Filipino children.
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Objective To investigate the expression of aquaporin 1(AQP1)and AQP2 in renal tissue of congenital hydronephrosis and its correlation with glomerular filtration rate(GFR).Methods Renal tissue specimens in 43 children cases of pathologically confirmed congenital hydronephrosis and normal kidney tissue specimens in 16 cases of operation were selected as the case group and healthy control group,the Western-blot and reverse transcription polymerase chain reaction were adopted to detect the expression levels of AQP 1, AQP2 protein and gene in the two groups,and its relationship with GFR was analyzed.Results The expres-sion levels of kidney tissue AQP1,AQP2 protein and gene in the case group were significantly lower than those in the healthy control group,the difference was statistically significant(P<0.05);the urine osmolality and GFR level in the case group were significantly lower than those in the healthy control group,while BUN and Scr levels in the case group were higher than those in the healthy control group,the difference was statis-tically significant(P< 0.05);the GFR level in the case group was positively correlated with AQP 1,AQP2 protein and gene expression levels(P<0.01).Conclusion The expression of AQP1 and AQP2 in renal tissue of congenital hydronephrosis is dow n-regulated,moreover is closely related to the disease severity degree.
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Congenital hydronephrosis is a common disease in children,causes and pathogenesis re-mains unclear.Hydronephrosis formation process is a slow and gradual development to the dynamic process of renal fibrosis.It involves a variety of cells,cytokines and ECM,more than aspects of interaction and mu-tual adjustment.The study found abroad that CTGF is closely related to the formation of congenital hydrone-phrosis.This article reviews the recent progress made CTGF relationship with congenital hydronephrosis formed on.
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Objective To explore the determination of urinary angiotensinogen (uAGT) in the urine of children with obstructive hydronephrosis and its relationship with impaired renal function, to provide a new and rapid reference index for the preoperative evaluation and postoperative follow-up of the children with hydronephrosis.Methods The data were collected from 48 children who were diagnosed as unilateral congenital renal pelvis and ureter obstruction in the outpatient or inpatient Department of Pediatric Surgery of the First Affiliated Hospital of Zhengzhou University,which were divided into operation group and non-operation group.There were 28 children in operation group(who were all severe hydronephrosis) ,who were all operated with dismembered pyeloplasty.There were 20 children in the non-operation group (who were all mild and moderate hydronephrosis).They temporarily had no surgery signs and hydronephrosis did not become increasingly serious for assuring the regular outpatient follow-up after being diagnosed as hydronephrosis;there were 20 children in the control group, 10 of which were male, and 10 female.The males were hospitalized children with hydrocele and the females were with inguinal hernia.Gender composition among the 3 groups, and the average age difference was not statistically significant.The clean urina of children in 3 groups was collected,3 times for operation group, once before operation and once in 6 weeks and once in 12 weeks after operation;3 times for non-operation group and control group with interval of 6 weeks in outpatient clinic.The children in operation group and non-operation group were all scanned for glomerular filtration rate (GFR) of diseased renal with radionuclide;enzyme-linked immunosorbent assay (ELISA) was adopted to determine the content of uAGT in the urine of the 3 groups of children, and automatic biochemical analyzer was used to measure the amount of urine creatinine (uCr).Results Before operation, in 6 weeks and 12 weeks after operation, uAGT / uCr average water of non-operation group and control group was significantly lower than the operation group, all the differences were statistically significant (F =34.360,14.683,5.035, all P ＜ 0.05).Preoperative and postoperative uAGT / uCr and GFR of diseased renal were of negative correlation(r =-0.647,-0.786, all P ＜ 0.05).In operation group, the preoperative and postoperative GFR average of diseased renal was 37.18 ± 7.31 and 45.27 ± 8.18.The difference of GFR changes was statistically significant before and after treatment (t =-3.971, P =0.000).Conclusions uAGT/uCr increased evidently in congenital renal pelvis and ureter obstruction patients who needed operation, so increase of uAGT might be the indicator of impaired renal function caused by obstructive hydronephrosis of children.
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Objective To explore the expression level and the clinical significance of Cys C,β2-MG,α1-MG in pediatric patients with congenital hydronephrosis.Methods 98 pediatric patients definitely diagnosed with congenital hydronephrosis in the depart-ment of pediatric surgery and urology of our hospital were enrolled and assigned to group B.The blood samples were collected.Ad-ditionally,selected another 98 normal children as a control:group A.Then the expression level of Cys C,β2-MG andα1-MG were de-tected via ELLSA for the groups.Results With aggravation of hydronephrosis,the expression of Cys C,β2-MG andα1-MG elevated correspondingly.Moreover,compared to the control group,the expression of Cys C,β2-MG andα1-MG in the pediatric patients with different degrees had significant differences(P 0.05).Conclusion Cys C,β2-MG and α1-MG can be used for evaluating the hydronephrosis and renal impair-ment.And it has more important significance by combining them.
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10.3969/j.issn.1000-3606.2013.06.002
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PURPOSE: The aim of this study was to evaluate the incidence of febrile urinary tract infection (UTI) according to clinical characteristics in patients with congenital hydronephrosis (CH) and hydronephrotic patients first diagnosed with hydronephrosis during treatment of febrile UTII. METHODS: In this study, 200 patients with congenital hydronephrosis were enrolled in group 1 and 252 patients first diagnosed with hydronephrosis during treatment of febrile UTI were enrolled in group 2. We counted the episodes of UTI in the two groups according to clinical characteristics, the presence of VUR, type of feeding, and clinical outcomes since 2000. And we compared those results between the two groups. and compared two groups as well. RESULTS: The incidence of recurrent UTI was 10%, 0.028 per person-year in group 1 and 16.7%, 0.051 per person-year in group 2, respectively (P <0.05). Group 2 had more VUR (3% vs. 27%, P <0.05) and higher incidence of UTI than group 1. The incidence of UTI in patients with CH of Society of Fetal Urology (SFU) grade 4 or grade 4-5 VUR was 80% and 44.4%, respectively. No significant differences were found in incidence of UTI between BMF (breast milk feeding) and artificial milk feeding group in both groups (P 1= 0.274, P 2=0.4). The time of resolution of CH had no correlation with either number of UTI episodes or the presence of VUR. CONCLUSION: The overall incidence of UTI is low in patients with CH as well as patients patients first diagnosed with hydronephrosis during treatment of febrile UTI except patients with SFU grade 4 or grade 4-5 VUR. BMF has no protective effect against UTI.
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Humans , Hydronephrosis , Incidence , Milk , Urinary Tract , Urinary Tract Infections , Urology , Vesico-Ureteral RefluxABSTRACT
Objective To investigate the relationship between aquaporin-1, -2, -3, -4 mRNA (AQP1-4) and renal parenchyma thickness in congenital hydronephrotic kidney in children. Methods The expressions of aquaporin 1, -2, -3, and -4 mRNA in hydronephrotic kidney of 37 children (aged 60.3±48.8 months) were evaluated with congenital hydronephrosis and control kidney of 6 children (aged 62.7±17.1 months) by using semi-quantitative reverse transcriptase polymerase chain reaction technique. Hydronephrotic kidney parenchyma thickness was measured by B-Ultrasound preoperative-ly and verified at operation. The relations of aquaporin 1, -2, -3, and -4 mRNA to the hydronephrotic kidney parenchyma thickness were analyzed by correlation analysis. Results The aquaporin 1 ,-2,-3, and -4/beta-actin ratio in the hydronephrotic kidney and normal kidney were 0.39±0.22 vs 0.90± 0.10, 0.42±0.20 vs 0.92±0.09, 0.525±0.22 vs 0.98±0.12, 0.30±0.18 vs 0.74±0.21 respec-tively, and the differences were significant (P<0.01). Hydronephrotic kidney parenchyma thickness measured by D-Ultrasound was 5.01±2.38 mm, which was identical with those measured at opera-tion. Significant correlation was found between the levels of aquaporin 1,-2,-3, and -4 mRNA and hydronephrotic kidney parenchyma thickness (r=0.773, 0.772, 0.557, 0.625, respectively; P< 0.01). Conclusions Significant correlation exists between decreased expressions of aquaporin 1 ,-2, -3, and -4 mRNA and atrophic change of renal parenchyma. This result may provide evidence to ex-plain the mechanism why the thinner renal parenchyma thickness, the weaker renal concentration and dilution function.
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PURPOSE: We checked voiding cystourethrography (VCUG) in patients with congenital hydronephrosis (CHN) and followed up the occurrence of urinary tract infection(UTI) in these patients. And we tried to figure out the relationship between CHN and VUR and UTI. METHODS: We performed a retrospective study in 122 CHN patients who received VCUG from 2002 to 2008 at Ajou University Hospital. We executed logistic regression, chi-square test and T-test using version 16.0 SPSS package for the statistical analysis. P<0.05 was regarded as significant. RESULTS: Most patients with CHN were male (73%) and there was a tendency of preferences for unilateral (77%) and left (84%) occurrence of hydronephrosis. The incidence of VUR was 18.9 % among 122 CHN patients and no laterality difference was found to the severity of VUR or hydronephrosis. The incidences of VUR and UTI was higher in group of higher grade (III-IV) CHN patients, when compared to the lower group, respectively. When VUR was present in CHN patients, the incidence of UTI during infancy was also higher. CONCLUSION: The incidence of VUR was higher in patients with higher grades of CHN. The incidence of UTI during infancy was higher when VUR was present in the CHN patients.
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Child , Humans , Male , Hydronephrosis , Incidence , Logistic Models , Retrospective Studies , Urinary Tract , Urinary Tract Infections , Vesico-Ureteral RefluxABSTRACT
PURPOSE: The increasing use of ultrasonography has allowed for an increase in the of the detection of congenital hydronephrosis, and the clinical outcomes of congenital hydronephrosis are widely varied. In this study, the necessity of voiding cystourethrography in neonate with hydronephrosis to rule out vesicoureteral reflux (VUR) was evaluated. METHODS: Between January 2004 and December 2007, we reviewed the medical record of 157 childrens with congenital hydronephrosis detected within 1 month of age. The severity of hydronephrosis was graded by SFU (Society of Fetal Urology) system, and anterior posterior pelvic diameter (APPD). We evaluated the relationship between severity of hydronephrosis and incidence of VUR by using SPSS windows version 16.0. A P-value0.05). In addition, there was no statistical significance between APPD, laterality of hydronephrosis and VUR incidence. However, renal units with VUR had lower spontaneous resolution rate (P<0.05), compared to renal units without VUR. CONCLUSION: In this study, there was no statistical significance between the severity of hydronephrosis and presence of VUR. Therefore, voiding cystourethrogram is recommended for all children with hydronephrosis to rule out VUR, regardless of the severity of hydronephrosis.
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Child , Humans , Infant, Newborn , Hydronephrosis , Incidence , Medical Records , Vesico-Ureteral RefluxABSTRACT
PURPOSE: Popular use of fetal ultrasonography has increased to detect congenital hydronephrosis(CH) which is the most common anomaly prenatally detected. We'd like to determine the frequency and clinical characteristics of prenatally diagnosed CH and outcome of ureteropelvic junction stenosis(UPJS). METHODS: The records of births between January 1994 and June 2003 in Chonnam National University Hospital(CNUH), and the records of children who were diagnosed with CH in the Department of Pediatrics of CNUH during the above period, were retrospectively analyzed. In the patients with UPJS, the initial anterior posterior diameters of renal pelvis(APD) were compared between the spontaneous regression (SR) and operation group(OP). In the SR group, sequential regression rates of APD were estimated. RESULTS: Among a total 9,076 births, 231(2.54 percent) patients with 293 renal units were diagnosed as CH and 19(6.78 percent) renal units spontaneously regressed 3 days after birth. In 228 children(56 bilateral; 172 unilateral; total 284 renal units) diagnosed with CH in the department of pediatrics of CNUH, male(71.9 percent) and left kidney(69.2 percent) predilection were found and 78.1 percent of CH were caused by UPJS. The initial APD of the SR group(121 units) in UPJS was 7.8+/-6.28 mm, which was significantly smaller than the APD(26.8+/-12.14 mm) of the OP group(25 unit)(P<0.05). In the SR group, 81 percent spontaneously regressed within one year. CONCLUSIONS: In CH, male and left kidney predilection were found. UPJS was the most common cause of CH and initial APD in UPJS at 3 days of age was a good prognostic indicator. Close monitoring should be done for at least one year because most SR in UPJS regressed spontaneously within one year.
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Child , Humans , Male , Constriction, Pathologic , Hydronephrosis , Kidney , Parturition , Pediatrics , Retrospective Studies , Ultrasonography, PrenatalABSTRACT
PURPOSE: The most important management of congenital hydronephrosis consists of the early diagnosis and evaluation of the pathologic abnormalities of congenital hydronephrosis. This study was conducted to investigate the different causes of hydronephrosis and its clinical outcome. METHODS: 54 live neonates who were hospitalized and diagnosed with congenital hydronephrosis at Chungnam National University Hospital from Aug. 1998 to Aug. 2003 were retrospectively analyzed. RESULTS: Hydronephrosis(renal pelvic AP diameter >5 mm) was postnatally detected in 54 cases(2.1%) among 2,539 neonates who were hospitalized from Aug. 1998 to Aug. 2003. There were three times more males than females. Additional imaging studies revealed that ureteropelvic junction obstruction was the most common postnatal diagnosis(48.7%), followed by multicystic dysplastic kidney, vesicoureteral reflux and duplication kidney with ureterocele. Spontaneous regression of hydronephrosis was revealed in 25 renal units(75.8%) of mild hydronephrosis, 14 renal units of moderate hydronephrosis and 1 renal unit of severe hydronephrosis. Operative correction were carried out in 14 renal units(70%) of severe hydronephrosis. CONCLUSION: The most common established cause of congenital hydronephrosis in this study was ureteropelvic junction obstruction. There are many cases of spontaneous regression in mild to moderate congenital hydronephrosis. Urinary tract infections occur in many neonates with hydronephrosis. Therefore, early detection and evaluation of congenital hydronephrosis and continuous follow-up at regular intervals are necessary for conservation of renal function.
Subject(s)
Female , Humans , Infant, Newborn , Male , Early Diagnosis , Follow-Up Studies , Hydronephrosis , Kidney , Multicystic Dysplastic Kidney , Retrospective Studies , Ureterocele , Urinary Tract Infections , Vesico-Ureteral RefluxABSTRACT
A clinical observation was made on 7 cases of congenital hydronephrosis due to ureteropelvic obstruction who were admitted to the department of Urology, Chonnam University Hospital, during the period from Sept. 1967 to Aug. l974 and the followings were obtained. I) The rates of congenital hydronephrosis accounted for 21.2% of total in-patients with hydronephrosis during the period of 7 years. 2) 3 cases were in male and 4 cases in female. The distribution of age was between 8 months and 29 years. The incidence of pathological side was 5 patients in left and 2 patients in bilateral. 3) The etiological factors were composed of congenital stricture in 4 cases, mucosal lip in I case. aberrant vessel in l case and unknown in l case. 4) The symptoms and signs at admission were palpable mass in 3 cases, hematuria after injury in 2 cases, flank pain in l case and abdominal discomfort in 2 cases. 5) On laboratory examination, microscopic pyuria in 4 cases. hematuria in 2 cases and BUN was increased in 2 cases of the bilateral hydronephrosis. 6) Ureteropelvioplasty was performed in 4 cases. Nephrectomy was done due to pyelonephritis in l case and ureteropelvic obstruction in 1 case. Nephrostomy was done due to ureteropelvic obstruction in 1 case.
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Female , Humans , Male , Constriction, Pathologic , Flank Pain , Hematuria , Hydronephrosis , Incidence , Lip , Nephrectomy , Pyelonephritis , Pyuria , UrologyABSTRACT
A clinical observation was made on the 20 cases of congenital hydronephrosis due to ureteral obstruction confirmed by pathological report or operation finding of the patients admitted to Severance Hospital during from 1965 to September 1971, and the followings were obtained: 1) The rate of congenital hydronephrosis accounted for 1.3 per cent of the total patient admitted to the Department of Urology, and 23.6 per cent of total patients with hydronephrosis during the period of seven years. 2) Fifteen cases were in male and only five cases in female. The distribution of age was between 2 and 1/2 years and 61 years, but the most common age was below 10 years as 6 cases of total cases. 3) The incidence of pathological side was more in the left side than the right and also two cases rare bilatera1. The pathological site of etiological factor was found near uretero-pelvic area chiefly, as 15 cases in upper one third, 6 cases lower one third, 1 case in body of ureter. 4) The symptoms on admission were flank pain in 50 per cent of total patients, palpable mass in 35 per cent, hematuria in 30 per cent, G-I trouble in 10 per cent, respiratory distress in one case, no symptom in one case. 5) The underlying causes were composed of intrinsic factor in 14 cases (63%), of which 3 cases were combined with aberrant vessel, and extrinsic factor in the remainder. Also one case of fibrous band combined with aberrant vessel was found. 6) The degree of hydronephrosis was determined by urography, pathological and operation finding, and according to these findings, grade 3 (advanced case) was prominent as rate of 54.3% of total cases and grade I (mild case) was only 18.0% of total cases. 7) The incidence of the associated disease in G-U tract of congenital hydronephrosis was 31. 5% of total cases, 6 cases in ipsilateral kidney and 1 case in opposite kidney. 8) On laboratory examination, abnormal finding in urinalysis was found in 60% of total cases and bacteriuria in urine culture was seen in 6 cases (30%) of total, of which 3 cases were infected with E. coli. Also, BUN was increased in 5 cases (25%), but highest level was 52mg% 9) In cases of impossibility to recover in view of renal function, the nephrectomy or uretero-nephroctomy was performed in 11 cases of total and plastic repair was performed in 4 cases as resection with oblique reanastomosis in 2 cases, Fenger's operation in one case, and Foley Y pyelo-ureteroplasty in one case. Besides above procedures, following: one was performed; ureterolysis in 4 cases, 5 cases in division of aberrant vessel, and 2 cases in ureteroneocystostomy. 19) As postoperative complication, continuous urinary leakage was seen in one case of 4 cases which plastic repair was performed and renal hypertension 3 months after operation developed in one cases of 5 cases which aberrant vessel was cut.