Early detection of congenital anomalies of the kidney and urinary tract: cross-sectional results of a community-based screening and referral study in China

Abstract

ObjectiveTo establish an effective screening model of congenital anomalies of the kidney and urinary tract (CAKUT) using ultrasound among neonates in Shanghai, China.DesignCross-sectional study.SettingA three-level screening model for CAKUT in neonates based on the child healthcare system was established since 2010 in Minhang District, Shanghai, China.ParticipantsDuring 2010–2015, neonates with criteria such as preterm, low birth weight and so on were eligible to participate in the study. Cases with renal pelvis dilatation (RPD) and other abnormal renal findings were managed based on presumed strategies.Main outcome measuresThe proportion of RPD and other renal and urinary tract anomalies; number of diagnosed CAKUT under integrated management, especially obstructive uropathy. The anterior–posterior renal pelvic diameter (APRPD) cut-off points for likelihood of obstructive uropathy and need for surgery.ResultsA total of 8827 infants were consecutively screened. Absolute and relative rates of different degrees of RPD classified by APRPD were: mild (5–9.9 mm), 984 (11.1%); moderate (10–14.9 mm), 176 (2.0%); severe (≥15 mm), 20 (0.2%). Of 639 followed cases with RPD, 11 were diagnosed as obstructive uropathies. Of these, nine patients underwent surgery, at median age 2 months. A total 85.4% of mild, 62.5% of moderate and 30.0% of severe RPD cases resolved spontaneously. Other renal and urinary morphological abnormalities were diagnosed in 15 (0.2%) patients. The APRPD cut-off points for significant obstructive uropathy and need for surgery were 9.7 mm and 13.5 mm, respectively.ConclusionsThis three-level screening model is an effective and feasible strategy for early detection and intervention of CAKUT in the early postnatal period, especially for patients with high-grade RPD and other renal and urinary malformations. This strategy could be useful in China and other developing areas with limited medical resources.

Risk Factors Associated With Renal and Urinary Tract Anomalies Delineated by an Ultrasound Screening Program in Infants

“…However, prenatal ultrasonographic diagnosis may fail to detect these congenital anomalies in oligoamnios and other rare situations ( 4 ). Lots of attempts have been made for CAKUT screening during the early postnatal period ( 5 – 8 ). The current study presents such screening in 1-month-old infants and follow-up in 6 months conducted in the medical centers in Zhongshan City, China.…”

Frequency of Congenital Anomalies of the Kidney and Urinary Tract by Means of Ultrasonography in Neonates at a Tertiary-Care Hospital

“…This was followed by bilateral cystic kidney in 50/587 cases. In a Chinese study, urinary ultrasound screening was performed in 8827 infants 22 . Eleven cases of hydronephrosis, seven cases of unilateral renal aplasia, two cases of renal duplication, two cases of renal dysplasia, one case of multicystic dysplastic kidney, one case of renal ectopia, one case of ureterectasia, and one case of renal cyst were observed.…”

A Case of Left Retroexternal Iliac Artery Megaureter Associated with Additional Renal and Vascular Congenital Anomalies

“…One retrospective study of congenital malformations showed that 73% of cases of congenital hydronephrosis were diagnosed prenatally [ 8 ]. In countries where prenatal ultrasound examination is rare, postnatal ultrasound in children with UTI, or those at higher risk, could also detect congenital abnormalities [ 36 , 37 ]. According to other publications, the incidence of prenatally diagnosed megaureter is not currently known and may be due to the fact that detection of a dilated ureter by ultrasound prenatally is a difficult endeavor [ 8 ].…”