Urological emergency in neonates with congenital hydronephrosis

Abstract

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.

Congenital giant hydronephrosis: A rare cause for upper abdominal mass in the newborn

“…In a study by Shimada et al .,[2] of 562 children treated for PUJO over a period of 14 years, only nine (1.6%) children required urgent urinary tract drainage in the neonatal period for renal dysfunction (5, 0.88%), giant hydronephrosis with mass effect (3, 0.53%) and severe urinary tract infection (1, 0.17%), respectively. It is noteworthy that of the eight fetuses detected to have unilateral hydronephrosis antenatally, contralateral kidney was normal only in three while the remaining five (62.5%) fetuses were diagnosed to have multicystic dysplastic kidney.…”

“…Very rarely, gross hydronephrosis may be apparent at birth by virtue of its mass effect. [2] We report a rare case of antenatally detected PUJ obstruction with grade III Society of Fetal Urology (SFU) hydronephrosis[3] presenting as upper abdominal mass lesion at birth.…”

Are children with congenital solitary kidney at risk for lifelong complications? A lack of prediction demands caution

“…Still, nonsurgical postnatal treatment of PUJO seems safe and promising in unilateral and most likely in bilateral cases with normal kidney function [67,68]. Therefore, in the presence of CSFK, frequent monitoring is mandatory to evaluate the indications for surgical treatment [69] when renal deterioration is the consequence of both dilation and obstruction [70,71]. Infants with PUJO in CSFK who have severe pelvis dilatation (grade 3 or 4) and decreased renal function require early surgical therapy [72] or selective internal ureteric stenting [73].…”

Expression of renal aquaporins is down-regulated in children with congenital hydronephrosis

“…Congenital hydronephrosis due to pelviureteral junction obstruction (PUJO) is a frequent cause of renal failure in infants and children [1]. Developmental renal and urinary tract abnormalities have been reported to be responsible for up to 54% of chronic renal insufficiency cases with a predominance of congenital obstructive nephrouropathies [2].…”