The clinical manifestations of intermittent hydronephrosis and their relationship with renal function in pediatric patients

Chen, Zhoutong; Lin, Houwei; Xu, Min; Xu, Guofeng; Fang, Xiaoliang; He, Lei; Geng, Hui

doi:10.1016/j.jpurol.2020.04.026

Cited by 8 publications

(7 citation statements)

References 21 publications

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“…Baseline DRF in patients with symptomatic hydronephrosis is typically well-preserved. In a study conducted by Scott Sparks et al, 28.81% of patients had preoperative DRF less than 40% [5], while in Chen et al's study, it was 30.77% [4]. In our study, 28.4% of patients had baseline DRF less than 40%.…”

Section: Discussioncontrasting

confidence: 48%

“…This has raised concerns about worse DRF in patients with hydronephrosis detected prenatally. In a study by Chen et al [4], it was found that the age of onset in patients with congenital hydronephrosis is earlier than in postnatal hydronephrosis, which may be related to a poorer baseline hydronephrosis condition in patients with congenital hydronephrosis. We believe that there are several main reasons why patients diagnosed with hydronephrosis before the onset of pain are better able to preserve DRF.…”

Section: Diagnosis Time and Sidementioning

confidence: 97%

“…Recurrent symptoms of abdominal pain may result in intermittent tension and ischemia of the pelvis, leading to infection or in ammatory episodes. Chen et al [4] demonstrated that impaired renal function in UPJO patients with intermittent abdominal pain was associated with a longer duration of the attack and a large APD during the attack. Fu et al [3] suggested that earlier diagnosis of intermittent hydronephrosis can prevent acute or chronic dysfunction.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors Analysis for Baseline Renal Function Impairment in Patients with Ureteropelvic Junction Obstruction and Intermittent Abdominal Pain

et al. 2023

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Objective This study aimed to investigate whether ultrasound parameters during non-painful episodes could indicate impaired differential renal function (DRF) in patients with ureteropelvic junction obstruction (UPJO) and intermittent abdominal pain. Methods We conducted a retrospective review of all cases of unilateral UPJO with intermittent abdominal pain undergoing their first pyeloplasty between March 2019 and October 2021. Clinical characteristics, such as gender, affected side, age at the first onset of pain, waiting time for pyeloplasty, age, and concurrent symptoms, were collected. Ultrasound examination (US) was used to measure the anteroposterior diameter (APD) and renal parenchyma thickness (PT) during intermittent pain episodes and dynamic renal scintigraphy (RDS) was used to assess DRF. Results This study investigated the characteristics and demographics of 109 patients with UPJO. Of the patients, 28.4% had baseline DRF less than 40%, and factors affecting baseline DRF were analyzed. Patients diagnosed with hydronephrosis before the onset of pain had a lower risk of DRF impairment compared to those diagnosed after the onset of pain (p = 0.021). Patients with impaired renal function had larger APD and thinner PT values on ultrasound (p = 0.002, p༜0.001). Abdominal pain accompanying symptoms were found to be associated with DRF impairment (p = 0.044). Multifactorial analysis identified that right UPJO, diagnosis of UPJO after pain onset, large APD, and thin PT were risk factors for baseline DRF damage in patients with intermittent abdominal pain (p༜0.05). Conclusion Patients with right-sided UPJO, UPJO diagnosed after a pain episode, and those with larger APD and thinner PT on ultrasound during pain-free intervals were more likely to have DRF impairment.

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Section: Discussioncontrasting

confidence: 48%

Section: Diagnosis Time and Sidementioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Risk Factors Analysis for Baseline Renal Function Impairment in Patients with Ureteropelvic Junction Obstruction and Intermittent Abdominal Pain

et al. 2023

Preprint

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“…None of the biomarkers were significantly different in the older patient group. This issue can be discussed under the basis of potentially different mechanisms of obstruction, as older children tend to develop hydronephrosis due to aberrant vessels, which causes intermittent hydronephrosis and kidney damage and may be influenced by the incidence of Dietl's crisis, and time-dependent injury of renal function can occur when the duration of obstruction is longer ( 32 ). The cumulative APD/mid-parenchymal ratio was significantly different between operated and non-operated patients irrespective of age.…”

Section: Discussionmentioning

confidence: 99%

Urine Biomarkers Combined With Ultrasound for the Diagnosis of Obstruction in Pediatric Hydronephrosis

et al. 2022

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Introduction: To establish the efficacy of ultrasound (US) combined with urine biomarkers in differentiating patients who require surgical management from those who do not, avoiding invasive investigations.Materials and Methods: From February 2019 to February 2021, all pediatric patients who presented with hydronephrosis were selected for the study. All renal units (RU) were evaluated by US, and fresh frozen voided urine samples were collected at the time of inclusion. Hydronephrosis grade was evaluated by the Society for Fetal Urology (SFU) and an alternative grading system (AGS). Patients who had high-grade hydronephrosis on US were referred to renal scan (RS) or intervention, when there was an increase of dilatation in subsequent follow-up images. Fresh frozen urine from the control group with no history of renal diseases and no renal anomalies on US was collected. We compared differences of US parameters combined with urine biomarkers between surgically and non-surgically managed patients and between the groups of patients when they were stratified by different RS findings and analyzed whether urinary biomarkers give any additional value to US. Instead of the anterior–posterior diameter (APD), we used its ratio with mid-parenchymal thickness. The additional efficacy of biomarkers to US was calculated when the US component was derived to a cumulative APD/mid-parenchymal ratio.Results: Sixty-four patients with hydronephrosis were prospectively included in the study accounting for a total of 81 patient visits and 162 RUs evaluated. A control group of 26 patients was collected. The mean age at inclusion in the hydronephrosis group was 43.7(±45.5) months, and a mean age in a control group was 61.2(±41.3) months. The cumulative APD/mid-parenchymal ratio combined with urinary albumin, β2 microglobulin (β2-M), and urinary neutrophil gelatinase-associated lipocalcin may have a better performance in the prediction of surgical intervention than the cumulative APD/mid-parenchymal ratio alone (p = 0.1). The best performance to detect the increased tissue transit time and obstructive curve on RS was demonstrated by the β2-M creatinine ratio. An increased cumulative APD/mid-parenchymal ratio with biomarkers together had a fairly good sensitivity and specificity for detection of DRF < 40%.Conclusions: According to our data, the APD/mid-parenchymal ratio alone has good efficacy in prediction of surgery and abnormal RS findings especially when combined with urine biomarkers.

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“…The incidence of crossing lower polar vessels is 11% to 20% of PUJ obstruction cases. 3 The absence of associated urologic symptoms contributes to the late referral to a paediatric urologist. 4 Fluid loading or feeding in young children causes Dietl's crisis and children often become symptomatic during the forced diuresis phase of dynamic scintigraphy scan with a diuretic.…”

Section: Descriptionmentioning

confidence: 99%

Dietl’s crisis: an under appreciated clinical entity in the paediatric population

et al. 2021

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The clinical manifestations of intermittent hydronephrosis and their relationship with renal function in pediatric patients

Cited by 8 publications

References 21 publications

Risk Factors Analysis for Baseline Renal Function Impairment in Patients with Ureteropelvic Junction Obstruction and Intermittent Abdominal Pain

Risk Factors Analysis for Baseline Renal Function Impairment in Patients with Ureteropelvic Junction Obstruction and Intermittent Abdominal Pain

Urine Biomarkers Combined With Ultrasound for the Diagnosis of Obstruction in Pediatric Hydronephrosis

Dietl’s crisis: an under appreciated clinical entity in the paediatric population

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