Ultrasound Screening of Healthy Infants for Urinary Tract Abnormalities

Steinhart, Jacob M.; Kuhn, Jerald P.; Eisenberg, Bernard; Vaughan, Russell L.; Maggioli, Albert J.; Cozza, Thomas F.

doi:10.1016/s0022-5347(17)41129-3

Cited by 21 publications

(29 citation statements)

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“…1,2 In the pediatric population, structural renal anomalies occur in 1 to 3 per 100 live births. [3][4][5] Kohelet and Arbel 6 noted that among 70 consecutive children who had isolated preauricular tags and were examined by renal ultrasonography, 6 (8.6%) had urinary tract abnormalities (5 with hydronephrosis, 1 with horseshoe kidney). In a separate study, among 69 children who had preauricular sinuses and were examined by renal ultrasound, 3 (4.3%) demonstrated renal anomalies (2 with hydronephrosis, 1 with branchio-oto-renal (BOR) syndrome and an absent left kidney and hypoplastic right kidney).…”

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Syndromic Ear Anomalies and Renal Ultrasounds

et al. 2001

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ABSTRACT. Objective. Although many pediatricians pursue renal ultrasonography when patients are noted to have external ear malformations, there is much confusion over which specific ear malformations do and do not require imaging. The objective of this study was to delineate characteristics of a child with external ear malformations that suggest a greater risk of renal anomalies. We highlight several multiple congenital anomaly (MCA) syndromes that should be considered in a patient who has both ear and renal anomalies.Methods. Charts of patients who had ear anomalies and were seen for clinical genetics evaluations between 1981 and 2000 at Cedars-Sinai Medical Center in Los Angeles and Dartmouth-Hitchcock Medical Center in New Hampshire were reviewed retrospectively. Only patients who underwent renal ultrasound were included in the chart review. The literature was reviewed for the epidemiology of renal anomalies in the general population and in MCA syndromes with external ear anomalies. We defined a child as having an external ear anomaly when he or she had any of the following: preauricular pits and tags; microtia; anotia; or cup, lop, and other forms of dysplastic ears. A child was defined as having a renal anomaly if an ultrasound revealed any of the following: unilateral or bilateral renal agenesis; hypoplasia; crossed ectopia; horseshoe, pelvic, cystic kidney; hydronephrosis; duplicated ureters; megaureter; or vesicoureteric reflux.Results. Because clinical genetics assessments were made by the same clinician at both sites (J.M.G.), data were combined. A total of 42 patients with ear anomalies received renal ultrasound; 12 (29%) of them displayed renal anomalies. Of the 12 patients with renal anomalies, 11 (92%) also received a diagnosis of MCA syndrome. Eleven of 33 patients (33%) with MCA syndromes had renal anomalies, whereas 1 of 9 patients (11%) with isolated ear anomalies had renal anomalies. Specific disorders seen were CHARGE association, Townes-Brocks syndrome, branchio-oto-renal syndrome, Nager syndrome, and diabetic embryopathy.Conclusions. We conclude that ear malformations are associated with an increased frequency of clinically significant structural renal anomalies compared with the general population. This is due to the observation that auricular malformations often are associated with specific MCA syndromes that have high incidences of renal anomalies. These include CHARGE association, TownesBrocks syndrome, branchio-oto-renal syndrome, Nager syndrome, Miller syndrome, and diabetic embryopathy. Patients with auricular anomalies should be assessed carefully for accompanying dysmorphic features, including facial asymmetry; colobomas of the lid, iris, and retina; choanal atresia; jaw hypoplasia; branchial cysts or sinuses; cardiac murmurs; distal limb anomalies; and imperforate or anteriorly placed anus. If any of these features are present, then a renal ultrasound is useful not only in discovering renal anomalies but also in the diagnosis and management of MCA syndromes themselves. A renal ult...

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Syndromic Ear Anomalies and Renal Ultrasounds

et al. 2001

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“…1 The increasingly widespread use of prenatal diagnostic techniques has revealed that MCRD is apparently even more prevalent than had been assumed. 2 The association of hypertension, malignancy, and incomplete involution in MCRD mandate long-term follow-up, and much controversy has surrounded the question of whether nephrectomy is indicated routinely on diagnosis. 3,4 To assess the natural history of this condition and, for purposes of proper management, the associated urinary malformations, we conducted a 19-year retrospective study of all infants with MCRD who had been diagnosed and treated in our tertiary care medical center.…”

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Involution Rate of Multicystic Renal Dysplasia

et al. 1998

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ABSTRACT. Objective. To document the involution rate and long-term results of management of multicystic dysplastic kidney.Materials and Methods. Data were collected retrospectively for all 23 infants (16 boys) with multicystic dysplastic kidney who were treated at our center over the last 19 years (1977)(1978)(1979)(1980)(1981)(1982)(1983)(1984)(1985)(1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995). The diagnosis was based on prenatal ultrasound in 18 patients and on palpable abdominal mass in 5, and confirmed in all patients by postnatal ultrasound and radioisotope scan. Voiding cystography was performed in 18 patients to exclude vesicoureteral reflux. Mean follow-up was 46 months (range, 3 months to 5 years) and included serum creatinine measurements and renal ultrasonography.Results. Two groups of patients were identified. Ten (43.6%) with other urologic abnormalities (group A) and 13 patients without other urologic abnormalities (group B). Vesicoureteral reflux was observed in 4 patients. Nephrectomy was performed in 4 patients, all from group B. The other 19 patients were treated conservatively. Complete involution was observed in 8 patients in group A and 6 in group B after a mean follow-up period of 9.2 and 10 months, respectively. Two patients, 1 from each group, later underwent nephrectomy not because of no involution but because of an increase in the size of the kidney involved.Conclusion. Patients with multicystic renal dysplasia have significant associated urologic malformations, and the natural history of the disease is unpredictable. All patients require appropriate investigation of the urinary tract and long-term follow-up.The most outstanding finding of the study is the much higher involution rate of multicystic renal dysplasia and the rate of associated urologic abnormalities than that reported in the literature. Surgery remains an option for the patients in the absence of no involution. Pediatrics 1998;102(6). URL: http://www.pediatrics.org/cgi/content/ full/102/6/e73; multicystic dysplastic kidney, surgery, conservative.ABBREVIATIONS. MCRD, multicystic renal dysplasia; UPJ, ureteropelvic junction; VUR, vesicoureteral reflux; UVJ, ureterovesical junction. M ulticystic renal dysplasia (MCRD) is the most common form of cystic disease of the kidney in childhood.1 The increasingly widespread use of prenatal diagnostic techniques has revealed that MCRD is apparently even more prevalent than had been assumed. 2 The association of hypertension, malignancy, and incomplete involution in MCRD mandate long-term follow-up, and much controversy has surrounded the question of whether nephrectomy is indicated routinely on diagnosis. 3,4 To assess the natural history of this condition and, for purposes of proper management, the associated urinary malformations, we conducted a 19-year retrospective study of all infants with MCRD who had been diagnosed and treated in our tertiary care medical center. MATERIALS AND METHODSWe reviewed the charts and radiologic records of the 25 patients with MCRD who w...

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“…Routine renal screening in isolated SUA should only be performed if the prevalence of renal anomalies is higher than in the general population. The prevalence of renal abnormalities seen in the general population is approximately 1% [11,13,14] . In neonates with isolated SUA, conflicting results have been reported regarding the prevalence of renal anomalies, ranging from 0 to as high as 33% [9] .…”

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confidence: 99%

“…We compared the results of our study group with prevalence data of renal anomalies as reported in the general population [11,13,14] .…”

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confidence: 99%

Is Screening for Renal Anomalies Warranted in Neonates with Isolated Single Umbilical Artery?

Boom

Holthe²,

Šrámek³

et al. 2009

Neonatology

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Aim: To determine the prevalence of renal anomalies in patients with an isolated single umbilical artery (SUA). Methods: We performed a retrospective study of all renal ultrasound examinations assessed at our centre between January 1998 and December 2008 in neonates with SUA with or without associated anomalies. Results: Renal ultrasound examination was performed in 65 neonates with SUA (57 neonates with isolated SUA and 8 neonates with nonisolated SUA). The prevalence of renal anomalies in the group with and without isolated SUA was 2% (1/57) and 38% (3/8), respectively. Only one patient with isolated SUA had a mild renal abnormality without clinical consequences. Conclusions: The prevalence of renal anomalies in neonates with isolated SUA is low. We suggest that routine ultrasound screening for renal anomalies is not warranted in neonates with isolated SUA.

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Ultrasound Screening of Healthy Infants for Urinary Tract Abnormalities

Cited by 21 publications

References 0 publications

Syndromic Ear Anomalies and Renal Ultrasounds

Syndromic Ear Anomalies and Renal Ultrasounds

Involution Rate of Multicystic Renal Dysplasia

Is Screening for Renal Anomalies Warranted in Neonates with Isolated Single Umbilical Artery?

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