ABSTRACT
Pediatric patients suffering from valve bladder syndrome (VBS) are at risk of developing chronic kidney disease (CKD) and renal failure in later life. Therefore, it is of vital importance to determine the risk factors and the best possible strategies for diagnosis and treatment in patients with VBS that would minimize the risk of developing CKD. In this review we have presented the current knowledge of CKD risk factors in patients with posterior urethal value (PUV). We have also discussed possible recommendations for prenatal diagnostics procedures to be undertaken in patients with PUV, postnatal monitoring and therapeutic strategies that could reduce the risk of developing CKD in this population. Although in most cases there are no clear guidelines for appropriate clinical actions that can be undertaken in patients with PUV to minimize the risk of kidney failure, we have tried to present concise and accurate advice for physicians taking care of patients with PUV.
Subject(s)
Renal Insufficiency, Chronic/prevention & control , Urethra/abnormalities , Urinary Bladder/physiopathology , Humans , Prenatal Diagnosis , Renal Insufficiency, Chronic/etiology , Syndrome , UrodynamicsABSTRACT
Crossed renal ectopia (C-RE) is a rare congenital anomaly in which both kidneys are located unilaterally. The crossed kidney is situated on the side opposite to its ureteral orifice and usually lies below the normal kidney. The frequency of this malformation is estimated at 0.05% to 0.1%. Most of the patients remain asymptomatic. In other cases C-RE is diagnosed incidentally on routine ultrasonography, due to the presence of unspecific symptoms. The diagnosis of C-RE is possible due to a wide range of imaging techniques: US, IVU, CT, MRI, and TcDMSA scan. Among them IVU, CT, and MRI have the highest degree of confidence. The aim of this retrospective study was to present our own experience with 5 children affected with C-RE, emphasizing the differences in clinical picture and low sensitivity of ultrasound images. In all of them the final diagnosis was established by IVU or MRI.
Subject(s)
Kidney Diseases/congenital , Kidney Diseases/diagnosis , Kidney/abnormalities , Kidney/diagnostic imaging , Child , Child, Preschool , Female , Humans , Incidental Findings , Infant , Magnetic Resonance Imaging , Male , Retrospective Studies , Sensitivity and Specificity , Technetium Tc 99m Dimercaptosuccinic Acid , Ultrasonography , UrographyABSTRACT
UNLABELLED: Cardiovascular complications are associated with CKD and tend to aggravate in the course of dialysis. The disturbed calcium-phosphate metabolism plays the crucial role in the progression of atherosclerosis. Among the new, possible factors, taking part in this process, there are the calcification inhibitors: OPN and BMP-7, and the calcification process promoter:PDGF-BB. The aim of the study was to assess the concentrations of the above mentioned factors in the dialysis patients, comparing the two types of therapy: peritoneal dialysis (PD) and hemodialysis (HD). MATERIAL AND METHODS: OPN, PDGF-BB and BMP-7 plasma concentrations were assessed by ELISA, in 16 children on PD, in 13 on HD and in 12 controls with normal kidney function. RESULTS: OPN concentrations were higher in HD patients, whereas in PD patients comparable to those in the control group. There were no differences between PD and HD children. PDGF-BB median values were lower in both dialysis groups than in the controls, and the lowest of them were observed in HD patients. BMP-7 concentrations were increased in dialysis patients, comparing to the control group, and higher in HD patients than in the PD ones. CONCLUSIONS: Disturbed concentrations of OPN, PDGF-BB and BMP-7 in dialysis patients may indicate that the preventive mechanisms against the calcification disorders have been set. The fact that the changes in the concentrations of the above mentioned factors are less pronounced in the PD group, lets us assume that PD is the type of dialysis that interferes to the lesser extent with the balance between the promoters and inhibitors of calcification.
Subject(s)
Bone Morphogenetic Protein 7/blood , Kidney Failure, Chronic/blood , Kidney Failure, Chronic/therapy , Osteopontin/blood , Peritoneal Dialysis , Platelet-Derived Growth Factor/analysis , Renal Dialysis , Adolescent , Becaplermin , Child , Child, Preschool , Female , Humans , Infant , Male , Proto-Oncogene Proteins c-sis , Renal Replacement TherapyABSTRACT
UNLABELLED: Cardiovascular complications are the main cause of morbidity and mortality among patients with CKD. It is common knowledge that in atherogenesis the disorders of calcium--phosphate metabolism count. The molecules of paramount importance are OPN and BMP-7, inhibiting calcification, and PDGF-BB, facilitating this process. THE AIM OF THE STUDY: to assess the concentrations of the above mentioned factors and their correlation with other markers of atherogenesis in children with CKD. MATERIAL AND METHODS: OPN, PDGF-BB and BMP-7 plasma concentrations were assessed by ELISA in 18 patients with CKD (stage: I-IV) and in 12 patients from the control group. Ca-P parameters and the lipid profile were also estimated in both groups. RESULTS: OPN concentrations were comparable in both groups. PDGF-BB median values were lower (p < 0.05) and BMP-7 concentrations--higher in CKD patients than in the controls (p < 0.005). The PDGF-BB concentrations correlated negatively with OPN (R = -0.75, p < 0.001) and CRP (R = -0.71, p < 0.05) in CKD children. The negative correlation was also observed between OPN concentrations and hematocrit (R = -0.49, p < 0.04) and hemoglobin (R = -0.48, p < 0.04) values. In all patients the levels of Ca, P, alkaline phosphatase and PTH were within the normal range. CONCLUSIONS: The increase of BMP-7 concentrations and decrease of PDGF-BB values in children with CKD, coexisting with well controlled Ca-P metabolism parameters, may suggest early mobilization of mechanisms protecting against vascular calcification. These changes seem independent of dyslipidemia.
Subject(s)
Atherosclerosis/diagnosis , Atherosclerosis/metabolism , Bone Morphogenetic Proteins/metabolism , Kidney Diseases/complications , Osteopontin/metabolism , Platelet-Derived Growth Factor/metabolism , Transforming Growth Factor beta/metabolism , Adolescent , Atherosclerosis/complications , Becaplermin , Biomarkers/metabolism , Bone Morphogenetic Protein 7 , Child , Child, Preschool , Chronic Disease , Female , Humans , Infant , Male , Proto-Oncogene Proteins c-sisABSTRACT
Megacalycosis is an uncommon, congenital renal abnormality, characterized by nonobstructive dilatation of the renal calyces with normal renal pelvis, ureter and bladder. This condition is due to underdevelopement or hypoplasia of Malpighie's pyramids. It usually occurs unilateraly as the isolated anomaly with strong male predominance. Megacalycosis itself does not impair the renal function but it can be the cause of urinary tract infections and calculus formation. This congenital defect is incidentally found by urography during the examination for urolithiasis or urinary tract infections or calculus formation. The images on radograms can be confused with obstructive or refluxing hydronephrosis or postinflamtory changes typical for pyelonephritis chronica. In case of megacalycosis surgical treatment is unnecessary. Patients with this condition should be followed-up with ultrasound and prevention of urinary tract infections or urolithiasis. Here we would like to report on the case of megacalycosis in a ten-year-old girl reffered to our deprtament due to UTI. Diagnosis of megacalycosis was established by typical urography findings: dilatation of renal calyces, no distention or obstruction of renal pelvic and ureter. The renal function was normal. No evidence of abnormality in cystoureterogram and uroflowmetry test was detected.
