Objective: The purpose of this study was to identify predictive factors of fetal urethral obstruction. Methods: One hundred and forty-eight children with fetal hydronephrosis were admitted, submitted to a systematic protocol and prospectively followed. Possible predictive factors of urethral obstruction associated with fetal echography and clinical findings on admission were studied. The analysis was conducted in two steps. In a univariate analysis, variables associated with urethral obstruction were identified by the χ² test or by Fisher’s exact test. Then, the variables that were significantly associated with urethral obstruction were included in a multiple logistic regression analysis. Results: After final adjustment by multiple logistic regression analysis, only two variables were identified as independent predictors of fetal urethral obstruction: oligohydramnios (odds ratio, OR = 5, 95% confidence interval, CI, = 1.3–15, p = 0.01) and megacystis (OR = 9, 95% CI = 2.0–40, p = 0.004). The sensitivity and specificity of the combination of both variables were 60 and 98.5%, respectively. Conclusions: The presence of oligohydramnios and megacystis on prenatal ultrasound is highly predictive of fetal urethral obstruction.

With the increasing use of obstetric echography fetal hydronephrosis has been reported more frequently. The purpose of this study was to identify prognostic factors associated with adverse outcome, such as renal failure and death, in fetal hydronephrosis. One hundred and forty-eight children with fetal hydronephrosis were admitted, submitted to a systematic protocol, and prospectively followed. Prognostic factors associated with fetal echography and clinical and laboratory findings on admission were studied. The median follow-up was 39 months. The analysis was conducted in two steps. In a univariate analysis, variables associated with adverse outcome were identified by the Kaplan-Meier method. The variables that were significantly associated with adverse outcome were then included in a multivariate analysis. This analysis, using the multivariate Cox's model, was performed to identify variables that were independently associated with a worse prognosis. Only variables that remained independently associated with adverse outcome were included in the final model. After final adjustment by Cox's multivariate model, three variables were identified as independent predictors of adverse outcome: oligohydramnios, prematurity, and glomerular filtration rate lower than 20 ml/min. Thus, in the presence of oligohydramnios, prematurity, and abnormal renal function, the medical team must plan appropriate follow-up for infants at health centers prepared to investigate and treat uropathies in newborns.

The most common cystic lesion recognized antenatally is multicystic dysplastic kidney (MCDK). Recently, conservative management without nephrectomy has been advocated. The purpose of this study was to report our experience in the conservative management of unilateral MCDK. Between 1989 and 1997, 20 children with MCDK detected by prenatal ultrasonography (US) were prospectively followed. At birth, US confirmed the prenatal findings in all cases. All patients were submitted to radioisotope scans and a micturating cystogram. Follow-up US examinations were performed annually. Mean age at diagnosis during the prenatal period was 31 weeks of gestation (range 24-38). Median follow-up time was 33 months (range 7-91). Follow-up US was performed in 19 children; 13 (68%) showed partial involution, 4 (21%) complete involution, and 2 (11%) an increase in unit size. The mean age at complete or partial involution of the lesion was 18 months. No children developed hypertension or tumors, and all maintained normal growth. In conclusion, the natural history of MCDK is usually benign, and serial US examinations show that affected kidneys frequently show involution with time.

The in vitro anti‐fungal activity of diorganotin(V) carboxylate complexes, [N‐(2‐carboxyphenyl)salicylideneiminato] dimethyltin(IV) (1), bis(µ3‐oxo)bis(µ‐O‐aminobenzoato‐O,O′)bis(O‐aminobenzoato)tetrakis[dimethyltin(IV)] (2) and bis(O‐ aminobenzoato‐O,O′)di‐n‐butyltin(IV) (3) has been screened against Candida albicans. The complexes, prepared by minor modifications of a literature method, have been fully characterized. The biological activities of complexes 1–3 on cultures of Candida albicans have been studied and the related mechanism has been investigated. No changes in DNA integrity or in the mitochondria function have been observed. However, all the tin compounds were found to reduce the ergosterol biosynthesis. The compounds have inhibitory concentrations (IC50) in the range of 7.5–20.0 µg ml−1, with compound 3 the most active. These results were compared with those provided by the literature, using myconazole, amphotericin B and fluconazole as standards. Scanning electron microscopy and transmission electron microscopy of the cells treated with complexes 1–3, revealed severe damage on the C. albicans cells compromising the cellular integrity, suggesting that the organotin complexes act on the cell membrane, in view of cytoplasm leaking and cellular deformation. The data indicate for 1–3 a mechanism of action similar to that of azole drugs, such as ketoconazole or fluconazole, normally used in Candida infections. Copyright © 2008 John Wiley & Sons, Ltd.