Abstract
Objective
To evaluate the clinical spectrum and patterns of clinical presentation in congenital anomalies of kidney and urinary tract.
Methods
We enrolled 307 consecutively presenting children with congenital anomalies of kidney and urinary tract at the pediatric nephrology clinic. Patients were evaluated clinically, with serum biochemistry, appropriate imaging and radionuclide scans.
Results
The most common anomaly was primary vesicoureteric reflux (VUR) (87, 27.3%), followed by pelviureteral junction obstruction (PUJO) (62,20.1%), multicystic dysplastic kidney (51 16.6%), non-obstructive hydronephrosis (32, 10.4%) and posterior urethral valves (PUV) (23, 7.4%). 247 (80.4%) anomalies had been identified during the antenatal period. Another 33 (10.7%) were diagnosed during evaluation of urinary tract infection, and 21 (6.8%) during evaluation for hypertension at presentation. Obstructive anomalies presented earlier than non-obstructive (7 (3, 22.5) vs 10 (4, 24) mo: (P=0.01)). The median (IQR) ages of presentation for children with PUV (n=23), VUR (n=87) and PUJO (n=62) were 4 (2, 14) mo, 10 (5, 27) mo, and 7 (3, 22.5) mo, respectively. Nine (2.9%) children had extrarenal manifestations.
Conclusions
The median age at clinical presentation for various subgroups of anomalies indicates delayed referral. We emphasize the need for prompt referral in order to initiate appropriate therapeutic strategies in children with congenital anomalies of kidney and urinary tract.
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References
Harambat J, van Stralen KJ, Kim JJ, Tizard EJ. Epidemiology of chronic kidney disease in children. Pediatr Nephrol. 2012;27:363–73.
North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) (2008) 2008. Annual report. The EMMES Corporation, Rockville, MD. Available from: https://web.emmes.com/study/ped/annlrept/Annual%20Report%20-2008.pdf. Accessed May 14, 2019
Mong Hiep TT, Ismaili K, Collart F, Damme-Lombaerts R, Godefroid N, Ghuysen MS, et al. Clinical characteristics and outcomes of children with stage 3–5 chronic kidney disease. Pediatr Nephrol. 2010;25:935–40.
Hattori S, Yosioka K, Honda M, Ito H, Japanese Society for Pediatric nephrology. The 1998 report of the Japanese National Registry data on pediatric end-stage renal disease patients. Pediatr Nephrol. 2002;17:456–61.
KDIGO Clinical Practice Guidelines for Acute Kidney Injury 2012. Available from: https://kdigo.org/wp-content/uploads/2016/10/KDIGO-2012-AKI-Guideline-English.pdf. Accessed May 14, 2019
Indian Society of Pediatric Nephrology, Vijayakumar M, Kanitkar M, Nammalwar BR, Bagga A. Revised statement on management of urinary tract infections. Indian Pediatr. 2011;48:709–17.
National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. Am J Kidney Dis. 2002;39:S1–266.
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. Pediatrics. 2004;114:555–76.
Nguyen HT, Herndon CDA, Cooper C, Gatti J, Kirsch A, Kokorowski P, et al. The Society for Fetal Urology Consensus Statement on the Evaluation and Management of Antenatal Hydronephrosis. J Pediatr Urol. 2010;6:212–31.
Sinha A, Bagga A, Krishna A, Bajpai M, Srinivas M, Uppal R, et al. Revised guidelines on management of antenatal hydronephrosis. Indian Pediatr. 2013;50:215–31.
WHO child growth standards: Weight-for-age, World Health Organization; 2006. Available from: https://www.who.int/childgrowth/standards/weight_for_age/en/. Accessed May 14, 2019.
Lebowitz RL, Olbing H, Parkkulainen KV, Smellie JM, Tamminen-Möbius TE. International System of Radiographic Grading of Vesicoureteric Reflux. International Reflux Study in Children. Pediatr Radiol. 1985;15:105–9.
Soliman NA, Ali RI, Ghobrial EE, Habib EI, Ziada AM. Pattern of clinical presentation of congenital anomalies of the kidney and urinary tract among infants and children. Nephrol (Carlton). 2015;20:413–8.
Ahmadzadeh A, Tahmasebi M, Gharibvand MM. Causes and outcome of prenatally diagnosed hydronephrosis. Saudi J Kidney Dis Transplant 2009;20:246–50.
Aksu N, Yavapcan O, Kangin M, Kara OD, Aydin Y, Erdoðan H, et al. Postnatal management of infants with antenatally detected hydronephrosis. Pediatr Nephrol. 2005:20:1253.
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Kumar, B.H., Krishnamurthy, S., Chandrasekaran, V. et al. Clinical Spectrum of Congenital Anomalies of Kidney and Urinary Tract in Children. Indian Pediatr 56, 566–570 (2019). https://doi.org/10.1007/s13312-019-1556-9
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DOI: https://doi.org/10.1007/s13312-019-1556-9