Neonates with extra-renal pelvis: the first 2 years

Katzir, Zeev; Witzling, Michaela; Nikolov, Gallina; Gvirtz, Gabriela; Arbel, Eliana; Kohelet, David; Boaz, Mona; Smetana, Shmuel; Lorberboym, Mordechai

doi:10.1007/s00467-005-1851-7

Cited by 8 publications

(5 citation statements)

References 20 publications

(19 reference statements)

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“…The UTI rate in our study group was higher than expected in the normal population: 12.7% in girls vs 7% expected and 6.2% in boys vs 2% expected [22]. Other authors have also noted an increased UTI rate in children with renal dilatation, especially those with calyceal dilatation [1,23,24], but Dremsek et al [2] found the reverse. All five of the children developing severe renal abnormality had calyceal fullness at their 1-week or 6-week sonogram, and one had ureteric dilatation and fluctuation of the renal pelvis also.…”

Section: Discussioncontrasting

confidence: 59%

“…From 1-4% of all children are investigated in the postnatal period because of foetal renal pelvic dilatation [1][2][3]. The proportion undergoing further investigation depends on the foetal renal pelvic cut-off level selected for further investigation.…”

Section: Discussionmentioning

confidence: 99%

“…Foetal renal pelvic dilatation is observed in approximately 1-4% of pregnancies [1][2][3], depending on the definition of dilatation. Postnatal investigation recommendations vary from renal ultrasound, with investigation for vesicoureteral reflux in all patients [4][5][6][7], to investigation for reflux only in those with abnormal postnatal renal ultrasound [2,6,[8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Management in children of mild postnatal renal dilatation but without vesicoureteral reflux

et al. 2009

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Infants with mild postnatal renal dilatation but without vesicoureteral reflux pose a challenge. For how long and in what way should they be followed? From May 1989 to December 2006, we prospectively followed 1,795 pregnancies in which the foetal renal pelvis measured 4 mm or greater. Voiding cystourethrography (VCUG) and renal ultrasound were performed on 1,315 infants at 6 weeks of age. Our study group comprised 208 (167 male) infants with normal VCUG findings who had a renal pelvis of 6-11 mm. We followed them for 1-17 years (mean 11 years). Medical and radiological records were reviewed to determine any urinary symptoms and final outcome. They underwent, on average, four further imaging tests. The renal dilatation had resolved by 24 months in approximately 70%. Urinary tract infection (UTI) developed in 16 (8%). Calyceal dilatation was more likely in those developing UTI (P=0.02). Twenty-two (10.6%) had a radiologically demonstrated urinary tract abnormality. Of the five who had renal scarring or severe obstruction, four became symptomatic. Most infants with mild postnatal renal dilatation can be investigated with only one further sonogram at 24 months of age. Mild postnatal renal dilatation is associated with subsequent UTI or renal tract abnormality in 18%. Severe renal abnormality occurred in 2.4%.

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Section: Discussioncontrasting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Management in children of mild postnatal renal dilatation but without vesicoureteral reflux

et al. 2009

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“…However, renal Doppler sonogram is not a practical method in uncooperative young children. Katzir et al reported that neonates with extra renal pelvis had an increased UTI incidence unrelated to VUR within the first two years 9) . In this study, extra renal pelvis was included as a parameter of hydronephrosis.…”

Section: Discussionmentioning

confidence: 99%

Association of Renal and Bladder Ultrasonography Findings with Urinary Tract Infection Recurrence, High-Grade Vesicoureteral Reflux, and Renal Scarring

et al. 2015

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Introduction: This study investigated whether renal and bladder ultrasonography (RBUS) findings performed in children with the first incidence of febrile urinary tract infection (UTI) can predict UTI recurrence, high-grade vesicoureteral reflux (high-grade VUR), or acquired renal scarring (aRS). Methods: In all, 917 children who were admitted to our hospital from January 2001 to October 2010, owing to the first incidence of febrile UTI were enrolled in this study. All children underwent RBUS during admission. The mean followup was 7.9 months (standard deviation [SD]±13.3). UTI recurrence rates were calculated according to various clinical parameters. By using bivariate and multiple logistic regression analyses, we determined whether age, sex, abnormal RBUS findings, abnormal dimercaptosuccinic acid renal scan findings, or RBUS findings parameters were predictive of UTI recurrence, high-grade VUR, or aRS. Results: On RBUS, hydronephrosis and congenital anomaly of the kidney and urinary tract significantly predicted UTI recurrence. A small kidney, hydroureter, hydronephrosis, cortical thinning, and increased parenchymal echogenicity significantly predicted high-grade VUR. However, their odds ratios (OR) are low compared to normal RBUS findings (recurrent UTI: OR 0.432 and 0.354 vs. 0.934, respectively, high-grade VUR: .019, 0.329, 0.126, 0.058, and 0.188 vs. 2.082, respectively). No RBUS findings significantly predicted aRS. Recurrent UTI, highgrade VUR, and abnormal RBUS findings significantly predicted aRS (OR of 4.80, 4.61, and 2.58, respectively). Conclusion: RBUS is necessary to exclude severe congenital renal scarring, obstructive uropathy, and renal abscess at the first incidence of febrile UTI and is helpful in determining the need for subsequent clinical imaging. .

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“…Isolated dilation of the extrarenal pelvis is usually considered a benign finding (25). One study showed that while infants extra-renal pelvis dilation have slightly higher rates of UTI, it resolves in 98% of patients on followup (26). Furthermore, dilation of the intra-renal pelvis has by far as more significant prognostic values, as highlighted by the adoption of anterio-posterior renal pelvis diameter by the UTD classification (27).…”

Section: Diagnosis and Initial Evaluationmentioning

confidence: 99%

Managing Ureteropelvic Junction Obstruction in the Young Infant

Passoni

Peters

2020

Front. Pediatr.

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In the last decade, management of congenital UPJ obstruction has become progressively observational despite the lack of precise predictors of outcome. While it is clear that many children will have resolution of their hydronephrosis and healthy kidneys, it is equally clear that there are those in whom renal functional development is at risk. Surgical intervention for the young infant, under 6 months, has become relatively infrequent, yet can be necessary and poses unique challenges. This review will address the clinical evaluation of UPJO in the very young infant and approaches to determining in whom surgical intervention may be preferable, as well as surgical considerations for the small infant. There are some clinical scenarios where the need for intervention is readily apparent, such as the solitary kidney or in child with infection. In others, a careful evaluation and discussion with the family must be undertaken to identify the most appropriate course of care. Further, while minimally invasive pyeloplasty has become commonly performed, it is often withheld from those under 6 months. This review will discuss the key elements of that practice and offer a perspective of where minimally invasive pyeloplasty is of value in the small infant. The modern pediatric urologist must be aware of the various possible clinical situations that may be present with UPJO and feel comfortable in their decision-making and surgical care. Simply delaying an intervention until a child is bigger may not always be the best approach.

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Neonates with extra-renal pelvis: the first 2 years

Cited by 8 publications

References 20 publications

Management in children of mild postnatal renal dilatation but without vesicoureteral reflux

Management in children of mild postnatal renal dilatation but without vesicoureteral reflux

Association of Renal and Bladder Ultrasonography Findings with Urinary Tract Infection Recurrence, High-Grade Vesicoureteral Reflux, and Renal Scarring

Managing Ureteropelvic Junction Obstruction in the Young Infant

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