Morphology of Urodynamic Disorders at Congenital Hydronephrosis in Infants and Young Children
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Cardiovascular risks in children with congenital anomalies of the kidney and urinary tract
Congenital anomalies of the kidney and urinary tract (CAKUT) occupy a leading place in the structure of nephro-urological pathology and are often accompanied by changes in the cardiovascular system, which requires an interdisciplinary approach in the management of this category of patients. Purpose: assessment of the nature and frequency of cardiovascular disorders in children with CAKUT to optimize their follow-up monitoring. The study included 190 children with CAKUT, of which 24 (15.0 %) had duplicated ureters; 30 (18.75 %) — hypoplasia; 40 (25.0 %) — cysts; 30 (18.75 %) — an autosomal dominant type of polycystosis, 36 (22.5 %) — varying degrees of severity of hydronephrosis, and 30 practically healthy children without kidney pathology (group 2). The age of children by groups: 34 children were up to 3 years, 41 children — 3–6 years, 59 children — 7–11 years, and 26 children — 12–15 years. In group 1, there were 73 (45.6 %) boys and 87 (54.4 %) girls aged 4 to 16 years (mean age 8±5.82 years), and in group 2, there were 13 (43.3 %) boys and 17 (56.7 %) girls aged 4 to 15 years (average age 6±6.73 years). A comprehensive examination of the urinary and cardiovascular systems using ultrasound diagnostics and Holter monitoring of pulse, ECG, and blood pressure was carried out. Statistical processing was performed using Statistica 8.0 for Windows (Statsoft Inc., USA). Conclusions. With CAKUT, chronic infection was often recorded in children with duplicated ureters (91.7 %) and hydronephrosis (88.9 %); persistent and increased crystalluria was noted in every third patient (33.3 %) with duplicated ureters, in 47.2 % of children with hydronephrosis, and in almost 2/3 of patients (73.3 %) with polycystosis. In children with CAKUT syndrome, CHD was detected in 15.0 % of cases; the frequency of small developmental heart anomalies is high with the prevalence of left ventricular false tendon (38.9 %) and mitral valve prolapse (33.6 %). This justifies the need to include an examination by a pediatric cardiologist 1–2 times a year with an additional examination of the cardiovascular system (ECG, heart ultrasound, and daily monitoring of blood pressure) in the standard of follow-up monitoring of children with CAKUT.
Cardiovascular risks in children with congenital anomalies of the kidney and urinary tract
Congenital anomalies of the kidney and urinary tract (CAKUT) occupy a leading place in the structure of nephro-urological pathology and are often accompanied by changes in the cardiovascular system, which requires an interdisciplinary approach in the management of this category of patients. Purpose: assessment of the nature and frequency of cardiovascular disorders in children with CAKUT to optimize their follow-up monitoring. The study included 190 children with CAKUT, of which 24 (15.0 %) had duplicated ureters; 30 (18.75 %) — hypoplasia; 40 (25.0 %) — cysts; 30 (18.75 %) — an autosomal dominant type of polycystosis, 36 (22.5 %) — varying degrees of severity of hydronephrosis, and 30 practically healthy children without kidney pathology (group 2). The age of children by groups: 34 children were up to 3 years, 41 children — 3–6 years, 59 children — 7–11 years, and 26 children — 12–15 years. In group 1, there were 73 (45.6 %) boys and 87 (54.4 %) girls aged 4 to 16 years (mean age 8±5.82 years), and in group 2, there were 13 (43.3 %) boys and 17 (56.7 %) girls aged 4 to 15 years (average age 6±6.73 years). A comprehensive examination of the urinary and cardiovascular systems using ultrasound diagnostics and Holter monitoring of pulse, ECG, and blood pressure was carried out. Statistical processing was performed using Statistica 8.0 for Windows (Statsoft Inc., USA). Conclusions. With CAKUT, chronic infection was often recorded in children with duplicated ureters (91.7 %) and hydronephrosis (88.9 %); persistent and increased crystalluria was noted in every third patient (33.3 %) with duplicated ureters, in 47.2 % of children with hydronephrosis, and in almost 2/3 of patients (73.3 %) with polycystosis. In children with CAKUT syndrome, CHD was detected in 15.0 % of cases; the frequency of small developmental heart anomalies is high with the prevalence of left ventricular false tendon (38.9 %) and mitral valve prolapse (33.6 %). This justifies the need to include an examination by a pediatric cardiologist 1–2 times a year with an additional examination of the cardiovascular system (ECG, heart ultrasound, and daily monitoring of blood pressure) in the standard of follow-up monitoring of children with CAKUT.
BACKGROUND. Congenital abnormalities of the kidneys and urinary tract in children are included in the concept of CAKUT (congenital anomalies of the kidney and urinal tract) - a syndrome and are often accompanied by changes in the cardiovascular system, which requires an interdisciplinary approach when observing them. THE AIM: to evaluate the nature and frequency of morphofunctional disorders ofthe cardiovascular system in children with CAKUT syndrome and optimize their medical follow-up. PATIENTS AND METHODS. 120 children were examined-90 with CAKUT syndrome (group 1) (24 - the doubling of the urinary tract, 36 - with congenital hydronephrosis, 30 - with polycystic kidney disease), and 30 practically healthy children (group 2). In group 1, there were 38 (42.2%) boys and 52 (57.8%) girls aged 4 to 16 years (average age 8±5.82 years), in group 2-13 (43.3%) boys and 17 (56.7%) girls aged 4 to 15 years (average age 6±6.73 years). A comprehensive examination of the urinary and cardiovascular systems was performed using ultrasound diagnostics and Holter monitoring of ECG and blood pressure. Statistical processing was performed using the program "Statistica 8.0"("Stat Soft Inc., USA"). RESULTS. In CAKUT syndrome, often chronic infection was registered in children with a doubling of MVP (91.7%), hydronephrosis (88.9%). Persistent and increased crystalluria was observed in every third patient (33.3%) with a doubling of MVP, in 47.2% of children with hydronephrosis, and in almost 2/3 of patients (73.3%) with the polycystic disease. In children with CAKUT syndrome, congenital heart disease was detected in 15.0% of cases, with a high frequency of small heart abnormalities with a predominance ofthe left ventricular false chord (38.9%) and mitral valve prolapse (33.6%). CONCLUSION. The data obtained by us justify the need to include in the standard of dispensary observation of children with urinary tract congenital malformation examination by a pediatric cardiologist 1 -2 times a year with additional examination ofthe cardiovascular system (ECG, heart ultrasound, and daily blood pressure monitoring).
Изучены особенности регрессии врожденного гидронефроза в зависимости от его стадии и сроков наблюдения в отдаленном периоде после коррегирующих пластических операции в области лоханочно-мочеточникового сегмента у 81 детей, в возрасте от 1года - до14 лет, с I, II и III стадией врожденного гидронефроза с одной (53) и с обеих сторон (28), без послеоперационных осложнений. У больных с I стадией врожденного гидронефроза через 3-6 месяцев после операции, наблюдалась быстрая регрессия врожденного гидронефроза. Ренально - кортикальный индекс полностью нормализовался, тогда как у больных с II стадией врожденного гидронефроза тенденция к регрессии резко замедляется. Уменьшение ренально-кортикальный индекс до нормальных показателей наблюдались лишь через 1-2 года. При III стадии врожденного гидронефроза показатели ренально-кортикальный индекс в отдалённом периоде уменьшается не более чем на 40 %, а через 3 года на 50% по сравнению с показателями дооперационного периода. Мы ни в одном случае при III стадии врожденного гидронефроза не отметили сокращения размеров чашечно-лоханочной системы до уровня, соответствующего здоровому органу, не зависимо от сроков операции. Сравнительные исследования врожденного гидронефроза до - и в отдаленном периоде после операции показали, что степень и интенсивность уменьшения размеров чашечно-лоханочной системы была тем выше, чем меньше были её исходные размеры. Полученные данные говорит о необходимости ранней диагностики врожденного гидронефроза и выполнении оперативных коррекций в ранние сроки заболевания.
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