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)

Intravenous urogram as a first line investigation in comparison with ultrasound

The objective of was to evaluate the usefulness and efficacy of intravenous urogram in patients with urinary tract pathology detected on ultrasound and X-ray KUB. The duration of the study was from September 2007 to August 2009 and a total of 250 patients were included in this cross-sectional study by non probability purposive sampling technique. Ultrasound scans and intravenous urograms were conducted by/under direct supervision of consultant radiologist. Out of 254 patients, four were unable to complete the intravenous urogram due to reaction to the contrast medium; hence a total of 250 patients were included in the final study. There were 66 male and 184 female patients. Calculi [renal, ureteric and vesical] were seen in 139 patients, pefviureteric Junction obstruction in 9, double collecting system and/or ureter in 6, neurogenic bladder in 13, horseshoe/pancake kidney in 2, ectopic kidney in 1, ureterocele in 2, cystocele in 1 and bladder mass in 7 patients. In 14 patients, the tests conducted were inconclusive and further investigations were advised. 28 patients had no detectable urinary tract pathology on any of the diagnostic modality. Intravenous urogram should not be performed routinely as a first line investigation in every patient presenting with flank pain. However, in congenital anomalies, intravenous urograms are needed and should be performed after a preliminary ultrasound

Ultrasonographic imaging of the urinary tract pre and post experimental urethral obstruction in bucks

The purpose of this study is to throw a light on the validity of ultrasonographic examination of urinary tract pre and post urethral obstruction in Egyptian mixed breed non castrated bucks [male goats].Nine bucks were subjected to direct penile ligation at the distal bend of the sigmoid flexure after surgical exposure of the penis to induce urethral obstruction and subsequent urine retention. Clinical and ultrasonographic examinations were carried out immediately pre experimental urethral obstruction and continued periodically every 12 hrs, throughout 48 hrs. post experimental urethral obstruction. The Ultrasonographic appearance and measurements of urinary tract compartments were assessed and compared at different examination positions using linear array endorectal probe [7.5-2.6 MHZ] and convex array general purpose probe [6-2.6 MHZ]. Both kidneys were visualized ultrasonographically through transabdominal approach and the bladder was visualized through transabdominal and transrectal approaches in all bucks. Both of them revealed normal architexture, echogenicity and dimensions before ligation. The course of the urethra in the pelvis and in the penis was not imaged in any of the bucks before ligation. There were significant increase in kidneys and bladder dimensions after urethral obstruction. The proximal portion of the pelvic urethra was visualized clearly in all bucks 24 hrs. post urethral ligation. The course of the ureters was not visualized ultrasonographically by means of the transrectal or transbdominal approaches pre-and post experimental urethral obstruction. It could be concluded that using of ultrasonography is considered a good clinical diagnostic tool for examination of the urinary tract in bucks affected with urine retention

[ comparison of two different diuretic renal Scintigraphy protocols in patients with dilated upper urinary tract]

Diuretic renal scan is preferred noninvasive investigation in evaluating upper urinary tract function and assessing upper tract dilatation or obstruction. There are several protocols for diuretic renal scan which are named according to timing of diuretic administration before, after or at the same time of radiopharmaceutical injection. Timing of diuretic administration is not universally standardized in renography. In the present study we compared F-15, F+20 diuretic renography protocols in patient with upper urinary tract dilatation. From Feb 2004 to Nov 2005, 21 patients were referred with flank pain and pyelocalyceal system dilatation without ureteral dilatation in ultrasonography and after history taking, physical exams and radiological studies such as IVP, retrograde pyelogram, serum creatinin measurement and urine analysis, F-15 and F+20 diuretic renal scans were performed. The pharmaceutical drug in this study was TC-EC [Ethylene dicysteine]. Renal function data, curves and renograms were recorded and patients were undergone conservative or surgical therapy and followed up with physical exams and IVP or diuretic renal scan after 3-6 months and then we compared results with two diuretic renal scan protocols. We used marginal homogeneity test to compare renograms and paired t-student tests to compare renal function in two protocols. Among 21 cases, 15 were male and 6 were female. Mean age was 16.3 +/- 25 years. Left pyelocalyceal system dilatation was reported in 15 cases and right side dilation was seen in 6 cases. Chief complain of patients was flank pain. Ultrasound showed pyelocalyceal dilatation without uretral dilatation. IVP findings included delayed pyelogram and pyelocalyceal dilatation without seeing the ureter. Of all renal diuretic scans, 52.2 percent of patients had obstruction pattern in F-15 and F+20 protocols. Results were equivocal in 23.3% of F+20 scans whereas they had complete obstructive pattern in F-15 scans.14% had normal pattern in F+20 and F-15 scans. 9.5% had nonobstructive pattern in F+20 but equivocal or obstructive pattern in F-15 scans. Obstructions were diagnosed in 52.2% of patient by F+20 scan and in 75.5% by F-15 scan. Renal split function didn't change in F-15 and F+20 diuretic renogram protocols. According to the equivocal results of F+20 diuretic renal scans, F-15 can reduce equivocal results of F+20 diuretic renal scans. Of course we recommend future investigations to approve or disapprove this hypothesis

Ethylenedicysteine versus diethylenetriamine pentaacetic acid as the carrier of technetium Tc 99m in diuretic renography for patients with upper urinary tract obstruction

L,L-ethylenedicysteine [EC] is a new carrier of technetium Tc 99m [99mTc] with a lower affinity to plasma albumin in comparison with diethylenetriamine pentaacetic acid [DTPA]. We compared 99mTc-EC scan with 99mTc-DTPA scan in diuretic renography for patients with obstructive uropathy. Thirty-three patients with upper urinary tract obstruction were randomly selected and underwent diuretic renographies by 99mTc-EC and 99mTc-DTPA. The counts of radioisotope per pixel in the target [the kidney] and background tissues as well as the clearance half-life of these two radiopharmaceuticals were measured and compared. Mean counts of radioisotope per pixel in the target tissue was not different between 99mTc-EC and 99mTc-DTPA scans, but in the background tissue, it was less for 99mTc-EC [P =.003]. Target-background ratio was higher for 99mTc-EC scan [3.80 +/- 2.11 versus 2.48 +/- 1.39; P <.001]. Renal clearance half-life of radioisotope was shorter for 99mTc-EC scan than 99mTc-DTPA scan [58.15 +/- 15.17 minutes versus 78.65 +/- 19.99 minutes; P =.033]. The results were similar for uremic patients [with a serum creatinine level > 2mg/dL]. Target-background ratio of radiopharmaceutical uptake rates in diuretic renography was a good indicator of the higher resolution of 99mTc-EC than 99mTc-DTPA scan. We also demonstrated the faster clearance of 99mTc-EC than 99mTc-DTPA. This results in less radiation that is especially useful in children. To our opinion, 99mTc-EC can better depict the kidneys in comparison with 99mTc-DTPA

Group D salmonella as cause of urinary tract infection

A case of primary urinary tract infection caused by group-d salmonella is presented. Even though it is not the usual pathogen at this site, it proves that under certain circumstances this enteric pathogen can cause urinary tract infection. Other reported cases are also reviewed

Intravenous urography [IVU] Intravenous pyelography

Intravenous Urography is a common, extremely useful and freely available urinary investigation. In our part of the world it is poorly named, poorly understood, poorly performed and poorly interpreted. Its skill can be mastered easily. It can achieve excellent results and one can avoid more invasive urinary investigations such as retrograde pyelography

Experience with indwelling JJ Ureteral stents

J.J stents provide free drainage from the kidney to the bladder, reduce or eliminate urine leakage and provide stenting of the ureter. They were used in a total of 200 cases. In 158 to prevent ureteric obstruction before extracorporeal shock wave lithotripsy [ESWL], in 25 to bypass obstruction and in 12 as an adjunct to complicated upper urinary tract surgery. Majority [97%] of the stents were placed endoscopically under local anaesthesia [71.5%]. In all the cases stents were successful to provide free drainage. No mortality was attributable to the use of stents but certain complications were encountered. Encrustation of the stents occurred in 21 [10.5%] and migration in 11 [5.5%] cases. Stents were removed easily under local anaesthesia by cystoscope. "J" stents thus provide an effective means to reduce complications and enhance effectiveness specially of ESWL therapy

Diuretic ultrasound imaging for assessment of upper urinary tract obstruction

This study was done on 60 patients to evaluate the diagnostic reliability of renal ultrasound with a diuretic in the evaluation of upper tract obstruction. The test comprised an initial renal ultrasound examination followed by the intravenous injection of 250 ml physiological saline with 40 mg furosemide. Further ultrasound scans were carried out from 5 to 120 minutes later. The results were compared with those of diuretic intravenous urography and diuretic renography in some cases. It is concluded that dynamic ultrasound with a diuretic is a useful investigation, and it showed a sensitivity of about 94%