[Vesicoureteral reflux in children with prenatal suspicion of urinary tract abnormalities]. / Odplyw pecherzowo-moczowodowy u dzieci z prenatalnym podejrzeniem wady ukladu moczowego.

AIM: The aim of the study was to assess indications to voiding cystourethrography (VCUG) in children with suspicion of urinary tract (UT) abnormalities in prenatal ultrasonography (US). MATERIAL AND METHODS: We studied 93 children aged 1 day to 7 months (mean 1.4 +/- 1.3 months). Prenatal USG was done between 18-41 week of gestational age (mean 32.6 +/- 5.6). Congenital anomalies of UT were suspected in 88% fetuses with dilatation of UT and in 12% fetuses with other changes in UT. Postnatal US was done in all children between 1-122 day of life (mean 18.2 +/- 21.5); VCUG between 1 day to 13 months (mean 2.1 +/- 2.3 months), in this in 75 (81%) infants in the first months of life. RESULTS: Abnormal result of postnatal US had 84 (90%) children (dilatation of pyelocalyceal system and/or ureter, duplex kidney, multicystic dysplastic kidney, ureterocele). We found normal VCUG in 67 (72%) children, abnormal in 26 (28%). Vesicoureteral reflux (VUR) to 28 kidneys was detected in 20 (21.5%) children (1st--1 kidney, 2nd--14, 3rd--3, 4th--6 and 5th--4 kidneys); another anomalies in 6 (in 2 posterior urethral valves). VUR was observed in 17.3% VCUG performed before 3 months of age and in 38.9% performed later (p<0.05). VUR was recognized: in 17.2% kidneys with normal prenatal US and in 16.4% kidneys with dilatation of UT (NS); in 6 (8%) kidneys with normal postnatal US and 22 (29.8%) with abnormal (p=0.05). There was not statistically significant difference in frequency of VUR in kidney with normal (0-5 mm) and abnormal postnatal renal pelvic diameter (RPD) (11.3% vs 19%, NS). The sensivity and specifity of normal postnatal USG in detection VUR were 79% and 56% respectively, and of normal postnatal RPD were 61% and 46% respectively. CONCLUSIONS: 1. Indication to performing VCUG in children with prenatally detected hydronephrosis should be persistent dilatation of pyelocalyceal system and/or ureter in postnatal US or another abnormalities in UT. 2. Normal prenatal and postnatal USG does not exclude presence of VUR. 3. VCUG in children with prenatally detected hydronephrosis should be performed about 3 months of life, in specially situation earlier.

Urological anomalies in children with renal agenesis or multicystic dysplastic kidney.

This study aimed to determine the frequency of associated urological abnormalities in children with unilateral renal agenesis (RA) or multicystic dysplastic kidney (MCDK). In total, 38 children (10 girls, 28 boys) were studied: 21 with RA and 17 with MCDK. In 14 children (37%) anomalies of the urinary tract were suspected prenatally in ultrasound studies. In the remaining 24 children the diagnosis of RA/MCDK was made postnatally: in 13 (34%) in the first 7 days of life, in 11 (29%) at the age of 8 days to 34 months, mean 10.6+/-8.05 months. Voiding cystourethrography was done in 36 (95%) children, the isotopic 99mTc-EC/DMSA scan of the kidney in 29 (67%), and urography in 8. Urological anomalies were present in 11 (29%) children: in 7 (33%) with RA and in 4 (24%) with MCDK. Vesicoureteral reflux was diagnosed in 8 children: grade II in 4, III in 3, and IV in 1 (in 1 child to duplicated, in 1 to ectopic kidney); ureterovesical junction obstruction in 2 (9.5%); and ureteropelvic junction obstruction in 1 (4.8%). Among them, 2 children demanded surgery on the contralateral urinary tract: pyeloplasty in 1, antireflux procedure in 1; while 9 children were treated conservatively. Compensatory hypertrophy of the contralateral kidney was found in 90% of children. Thus due to an increased risk of pathological changes in the single functioning kidney, lifelong nephrological care is recommended in patients with unilateral RA/MCDK.

Urinary levels of interleukin-6 and interleukin-8 in children with urinary tract infections to age 2.

BACKGROUND: The aim of this study was to assess relations between the clinical course of UTI, IL-6 and IL-8 levels, and the presence of inflammatory changes detected by renal scintigraphy using 99mTc-DMSA (DMSA). MATERIAL/METHODS: We studied 33 children aged 1-24 months (mean 7.1+/-5.8 months) with first-time UTI. The subjects were divided in two groups: with fever (group I, n=10) and without fever (group II, n=23). Inflammatory markers (ESR, CRP, leukocyte count), urinary IL-6 and IL-8 level, and DMSA scan were evaluated in all children. RESULTS: Urinary IL-6 and IL-8 levels [IL-6, IL-8/creatinine (pg/mg)] were significantly higher in group I than in group II (Il-6 level: 39.4+/-41.1 vs. 6.3+/-13.7, p<0.01; IL-8 level: 791.1+/-1143.6 vs. 36+/-87.9, p<0.001). We found positive correlation between urinary IL-6 and IL-8 levels and ESR, CRP, and leukocyte count (IL-6: r=0.43, p<0.05; r=0.46, p<0.05; and r=0.59, p<0.001, respectively; IL-8: r=0.55, p<0.05; r=0.72, p<0.0001; and r=0.44, p<0.05, respectively). We found no relation between urinary cytokine levels and the presence of inflammatory changes detected by DMSA scanning, despite slightly higher mean urinary cytokine levels in children with inflammatory changes in DMSA scan. CONCLUSIONS: We found significantly higher IL-6 and IL-8 levels in children with febrile UTI and elevated inflammatory markers. IL-6 and IL-8 levels do not differentiate between acute pyelonephritis and UTI in children to age 24 months.