Progression to End-Stage Renal Disease in Children with Obstructive Uropathy

Urosepsis in infants with vesicoureteral reflux masquerading as the salt-losing type of congenital adrenal hyperplasia

“…More specifically, the electrolyte abnormalities appear to be the result of transient tubular unresponsiveness to aldosterone, with excessive sodium loss in spite of hyponatremia, normal or low potassium excretion in the presence of hyperkalemia, and high urinary pH despite metabolic acidosis [4]. Although the abnormalities of electrolytes of the three infants reported here promptly reverted to normal after treatment, occasionally a residual tubular defect persists and results in prolonged polyuria and in some progressive renal failure [11].…”

In utero Bladder Diversion – Problems with Patient Selection

“…Such would be expected if the fetal nephron regenerates over time with relief of the obstruction. There is a high incidence of renal failure 9 years after postnatal shunting despite normal renal function postshunt [15], suggesting progressive disease despite relief of the obstruction. These observations beg two questions.…”

Suspected Pyelo-Ureteral Junction Obstruction in the Fetus: When to Do What? I. A Clinical Update

“…The presence of a significant obstruction was not verified, and renal function was not studied pervadingly in these series [8][9][10][11][12][13][14][15][16][17][18][19][20][21], Most importantly, comparisons with older patients with valid function analyses are lack ing, except in two key reports [24,25]. Instead, six stud ies [26][27][28][29][30][31] are quoted which are claimed to prove the benefit of early repair; per se good studies, but misinter preted and cited in a very biased manner. Of a total of 72 children [26][27][28][29][30], 65 suffered from various urological conditions that do not fit in the present context, since all sorts of obstructions are indeed not of the same kind, severity and prognosis ( 15 neurogenic bladders or blad der neck obstructions with or without reflux; 9 primary refluxes (!…”

“…PUJOs, and no clinical details were given [31]. Thus, altogether these studies contribute only 5 cases of PUJO (all, however, without verification of the obstruction!)…”