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

Josephson, Staffan

doi:10.1159/000463927

Cited by 11 publications

(7 citation statements)

References 55 publications

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“…Postnatal follow-up has shown that some hydronephro ses resolve spontaneously [1][2][3] and modem diagnostic tools have disclosed that many cases lack significative obstruction [4], Some never suffer progressive renal de terioration, even in the presence of a significant obstruc tion [4], and autopsies of patients up to the age 80 have exposed clinically unrecognized pelvic dilatations, which were unrelated to the cause of death [5]. These observa tions have led to an intense debate over when to do what.…”

mentioning

confidence: 99%

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Suspected Pyelo-Ureteral Junction Obstruction in the Fetus: When to Do What? II. Experimental Viewpoints

Josephson

1991

Eur Urol

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confidence: 99%

“…A recent review of the clinical literature [4] showed that a surprisingly large number of patients are without a renal function defect, and there is otherwise no consis tent progressive trend. Those with a function defect recover, to some extent, on release.…”

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Suspected Pyelo-Ureteral Junction Obstruction in the Fetus: When to Do What? II. Experimental Viewpoints

Josephson

1991

Eur Urol

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“…It is well described that unilateral PUJO is a benign condition that carries a low risk for renal damage, and acute clinical consequences associated with PUJO in the neonatal period seem to occur rarely. Even in the most severe grade of PUJO, urgent studies and intervention are deferred for several weeks after birth, because the condition will resolve spontaneously and the function will not decrease in most of the kidneys 4,5 . There are, however, exceptional PUJO that require emergent treatment in neonatal periods.…”

Section: Discussionmentioning

confidence: 99%

“…It is well described that unilateral PUJO is the benign condition that carries a low risk for renal damage. Even in the most severe grade of PUJO, urgent studies and intervention are deferred for several weeks after birth, because the condition resolves spontaneously and the function does not decrease in most of the kidneys 4,5 …”

Section: Introductionmentioning

confidence: 99%

Urological emergency in neonates with congenital hydronephrosis

et al. 2007

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Objective: It is well described that unilateral pelviureteric junction obstruction (PUJO) is a benign condition, because the dilatation resolves spontaneously and the function does not decrease in most of the kidneys. However, there is exceptional PUJO that requires emergent treatment in neonatal periods. The aim of this article is to report the urological emergency and management in neonates with PUJO. Materials and Methods: Nine children (seven boys and two girls) with PUJO who underwent neonatal emergent treatment during the last 13 years were reviewed. Renal function was evaluated according to decay curve of serum creatinine (SCr) levels corresponding to gestational age (GA) at delivery. Physical examination, ultrasonographic monitoring, and chest and abdominal plain radiographs were repeated in each neonate. Results: Eight patients were detected prenatally. In five patients, multicystic dysplastic kidney (MCDK) was demonstrated on the contralateral side. Three patients underwent percutaneous puncture of fetal hydronephrosis. Decrease of amniotic fluid was evident in three fetuses. Indications for emergent treatment included mass effect from hydronephrosis in three patients, renal dysfunction in five, and severe urinary tract infection in one. During neonatal periods, a percutaneous nephrostomy tube was placed in seven, and open nephrostomy in one with anorectal malformation. Repeated punctures of the dilated renal pelvis were done in one patient. Renal function after pyeloplasty was stable in eight patients, while it was moderately decreased in one who was associated with oligohydramnios in utero. Conclusion: Indications for emergent treatment in neonates with PUJO included mass effect from giant hydronephrosis, renal dysfunction and severe urinary tract infection. At birth, respiratory and circulatory conditions must first be stabilized. In neonates with hydronephrosis of the solitary kidney or severe bilateral PUJO, serial SCr should be monitored to evaluate renal function. Decrease of amniotic fluid suggested renal functional compromise that would not recover after urological management.

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“…in these days when the question 'when to do what' with prenatally diagnosed, clinical hydronephroses is much discussed [1], The age difference is also of great interest from developmental and uronephrological viewpoints. We have therefore in a long series of studies investigated the effects of experimental, partial ureteric obstruction, created in newborn and adult rats [2].…”

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Partial Ureteric Obstruction in Weanling Rats

Josephson

Lännergren²,

Eklöf³

1992

Urol Int

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A partial obstruction of the left ureter was created in weanling (3-week-old) rats. Renal function was studied after 7-9 weeks and compared to that in age-matched controls. Arterial blood pressure was found substantially increased. During normal hydration, the hydronephrotic kidney had low excretions of urine, potassium, osmoles and, especially, sodium. The contralateral, intact side showed no compensatory traits. On volume expansion, the hydronephrotic kidney demonstrated an unimpaired reacting capacity, leading to normalization of urine, sodium and osmole excretions and even to supernormal renal blood flow, glomerular filtration and potassium excretion. On the intact side, the excretion of potassium was increased like that on the hydronephrotic one, while excretions of urine, sodium and osmoles were increased even more. The fact that the intact kidney handled most of the urine excretion was interpreted as the result of a mechanism protecting the obstructed kidney from additional pressure insults while homeostasis was maintained. The arterial hypertension may result from the combination of retention of fluid and sodium by the hydronephrotic kidney and the absence of compensation by the intact kidney during normal hydration – like that in everyday life. The functional changes during normal hydration were generally more severe than those we found after obstruction in neonatal and adult rats, in which arterial hypertension was never observed. The clinical implication would be that the kidney may be less tolerant to pressure rises during the infant year. Changes due to obstruction are known to occur rapidly, but after that neither progress nor reverse. It therefore seems advisable to intensify the monitoring during this sensitive period of antenatally detected cases, selected for nonoperative follow-up according to modern principles, in order to detect sudden amplifications of their congenital obstruction.

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

Cited by 11 publications

References 55 publications

Suspected Pyelo-Ureteral Junction Obstruction in the Fetus: When to Do What? II. Experimental Viewpoints

Suspected Pyelo-Ureteral Junction Obstruction in the Fetus: When to Do What? II. Experimental Viewpoints

Urological emergency in neonates with congenital hydronephrosis

Partial Ureteric Obstruction in Weanling Rats

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