Profile and Outcome of Pelviureteric Junction Obstruction

Abstract

Abstract:Obstructive uropathy represents one of the largest fractions of identifiable causes of renal failure in pediatric populations. This is one of the largest series of PUJ obstructions reported in children. PUJ obstruction is a relatively common congenital anamolyes in neonates and children and a cause of ESRD in developing countries. This series expands our knowledge about the clinical presentation and course of this disease. Pelviureteric junction (PUJ) obstruction is a partial or total blockage of the flow of urine that occurs where the ureter enters the kidney and is the most common cause of significant dilatation of the collecting system in the fetal kidney. We retrospectively analyzed children diagnosed as PUJ obstruction between the periods of 2008-2010 who presented to our institute. Forty four children were diagnosed to have PUJ obstruction. The median age at presentation was 11 months, with range of 3 months to 11 years. Male children constituted 34 (77.3%) cases. Unilateral PUJ with left sided involvement was more common (52.3%). Antenatal diagnosis was made in 18 (40.9%) cases. The common clinical presentations were fever, urinary tract infection (UTI) and abdominal pain. Hypertension was present in five (11.3%) patients and renal failure at presentation was seen in eight (18.2%) patients. Associated urogenital anomalies were present in twelve (27.3%) patients, with medullary cystic kidney disease (MCKD) being the most commonassociated anomaly. Prophylactic antibiotics were not prescribed to patients. Urinary tract infection was present in fourteen (31.9%) patients with E. coli being the most common organism (75%). Conservative management with regular follow up was done for 32 patients and the remaining twelve patients underwent pyeloplastyin view of gross hydronephrosis, and four (33.3%)of these patients later underwent nephrectomy for a nonfunctioning kidney. Antenatal screening is mandatory to make an early diagnosis and for further management and close follow upof PUJ obstruction. Randomized control trials and longer follow up studies are needed for evidence to suggest the optimal management.

Clinical profile of infantile pelviureteric junction obstruction

“…Boys (35/44) were more commonly affected. Clinical presentations were varied and complex; AHN (40) (Figure 1), palpable kidney (8), urinary tract infections (UTI) (6), acute renal failure (ARF) (1), fetal giant intraabdominal cyst (1), nephrolithiasis (1), failure to thrive (1). Downs syndrome (1), bilateral (B/L) cataract (1) and craniosynostosis (1) were associated anomalies.…”

“…Median of anteroposterior kidney diameter was 2.5cms. MCU, IVP, retrograde ureterography (RGP) revealed in addition B/L duplex kidney with lower moiety (LMO) obstruction (2), vesicoureteric obstruction (VUO)/ (2), reflux (VUR) (2), posterior urethral valve PUV (1) and Prostatic utricle (PU) (1). Median of differential function for pyeloplasty was 28%.…”

“…4 Infantile PUJO are detected commonly on evaluation of antenatal hydronephrosis, palpable kidney, urinary tract infections, acute renal failure and failure to thrive. 1 Antenatal giant intra-abdominal cyst is one rare of presentations for infantile PUJO. 5 Giant hydronephrosis are palpable, crosses the midline, and often present as gross abdominal distention in neonates.…”

“…1 Congenital PUJO etiology are alterations in muscle/ collagen elements, mucosal polyp /valve, and aberrant vessel at the pelviureteric junction. 1 Indications of pyeloplasty are palpable kidney, obstruction with differential function <40%, and deteriorating of renal function. 1 We are reporting varied presentations and successful surgical management of infantile PUJO.…”

“…1 Indications of pyeloplasty are palpable kidney, obstruction with differential function <40%, and deteriorating of renal function. 1 We are reporting varied presentations and successful surgical management of infantile PUJO.…”