Solitary functioning kidney in children: clinical implications

ABSTRACT Introduction: Children with solitary functioning kidney (SFK) are prone to develop long term problems, which are not well represented in the literature. The extent to which the presence of associated congenital anomalies of kidney and urinary tract (CAKUT) further de-stabilize renal function is to be addressed. Objective: This study was conducted to evaluate the etiology, presentation, presence of CAKUT, and renal damage in children with SFK. Methods: All children with SFK who presented to the department of pediatric surgery from March 2014 to May 2016 were included in the study. Children with malignancy were excluded from the study. Results: Of the 20 patients with SFK, 14 (70%) had primary SFK (8 with agenesis and 6 with multicystic dysplastic kidney), 6 (30%) belonged to secondary SFK group, among them 3 had pelviureteric junction obstruction, 2 had posterior urethral valves and 1 had vesicoureteric reflux. Eight (40%) had associated CAKUT, 4 (20%) were asymptomatic while 8 (40%) had UTI and 6 (30%) had hypertension. Ten (50%) patients had reduced glomerular filtration rate (GFR) suggesting compromised renal function. Conclusion: Children with SFK have high morbidity especially when associated with ipsilateral CAKUT. Long-term periodical follow up is essential in these patients to improve clinical outcome

Can urinary biomarkers be used in the outcome assessment of pyeloplasty in children?

Abstract Background To compare the urinary biomarkers—beta 2-microglobulin (β2M), monocyte chemotactic peptide-1 (MCP-1), and transforming growth factor-beta (TGF-β1)—in the outcome assessment of children with pelviureteric junction obstruction (PUJO) undergoing pyeloplasty. Methods A prospective study was conducted on children with PUJO who had pyeloplasty in a tertiary care center from July 2016 to March 2018. Urine samples were obtained from freshly voided urine samples before surgery and after 6 months of pyeloplasty. Ratio between the levels of biomarkers and urinary creatinine before and after surgery were compared. Results A total of 72 patients had pyeloplasty during this period. The mean levels of standardized urinary β2M, MCP-1 and TGF-β1 before surgery were 3.94 ± 4.06, 96.63 ± 117.68 and 310.65 ± 423.87, respectively, which was significantly higher than the corresponding values in the postoperative period, obtained after 6 months of surgery; postoperative mean values were 3.12 ± 3.95, 25.28 ± 32.06, 109.95 ± 118.72 (P &lt; 0.001), respectively. Using Wilcoxon signed-rank test, fall of MCP-1 and TGF-β1 was more significant compared to β2M. Conclusion Urinary biomarkers (β2M, MCP-1 and TGF-β) offer an effective way of outcome assessment of pyeloplasty for PUJO in children, especially MCP-1 and TGF-β1. </jats:sec

Management dilemma in Pelvi-Ureteric Junction Obstruction : Is Transit Time the answer?

Abstract Purpose Pelvi-ureteric junction obstruction (PUJO) is the leading cause for Hydronephrosis in children. Diuretic renography used in the pre and post operative evaluation of Pyeloplasty may not be reliable in predicting the outcome. Methods A prospective study was conducted from October 2018 – November 2020, including all children with unilateral PUJO undergoing Pyeloplasty. Renal Diuretic renography scans done in the pre and post operative periods were assessed for Transit time. The time taken for the isotope to reach the renal pelvis was noted by a single observer as the Transit time, from the dynamic frames of the Diuretic renogram. Results Of the 65 children, 74% were boys. The transit time (median) in the preoperative renography was 10minutes, whereas the same was 4minutes 45seconds in the postoperative period, the decrease was statistically significant. On evaluation of Transit time with ROC (Receiver Operating Characteristics) curve, a cut off of 4minutes and 25 seconds was arrived at, which could identify the delayed drainage reliably. Conclusion Improvement in Transit time is a reliable predictor of renal function improvement after Pyeloplasty, comparing favorably in relation to split renal function.</jats:p

High grade renal trauma due to blunt injury in children: do all require intervention?

ABSTRACT Introduction: The aim of this study was to analyze the presentation and management of major grade renal trauma in children. Method: A retrospective study was performed including data collected from the patients who were admitted in Pediatric surgery with major grade renal injury (grade 3 and more) from January 2015 to August 2018. Demography, clinical parameters, management, duration of hospital stay and final outcome were noted. Results: Out of 13 children (9 males and 4 females), with age range 2-12 years (mean of 8 years), reported self-fall was the commonest mode of injury followed by road traffic accident. The majority (10/13, 75%) had a right renal injury. Eight children had a grade IV injury, one had a grade V injury, and four children had grade III injury. Duration of hospital stay varied from 3 to 28 (mean of 11.7) days. Three children required blood transfusion. One child required image guided aspiration twice and two required pigtail insertion for perinephric collection. All the 13 children improved without readmission or need for any other surgical intervention. Conclusion: Children with major grade renal trauma due to blunt injury can be successfully managed without surgical intervention and minimal intervention may only be needed in select situations