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Long-term follow-up of renal function in patients after surgery for obstructive uropathy

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Abstract

In this prospective study, selected biochemical markers of glomerular and tubular function, proteinuria, and ultrasound findings in 62 pediatric patients who underwent surgery for obstructive uropathy were examined. Patients were younger than 12 months, normocreatininemic at the time of surgery, and examined at a mean age of 6.3 ± 0.9 years. Out of the markers tested, serum concentration of cystatin C was significantly higher in patients when compared with the control group (p < 0.001), and serum creatinine concentration was within reference interval in all patients. With respect to tubular function, 26% of patients had decreased concentration ability. Proteinuria was detected in 4.8% of patients. On ultrasound, 66.7% of kidneys after surgery had residual dilatation of the renal pelvis. The patients thrive well, and their somatic parameters do not differ from their peers. Half of the patients had one or more urinary tract infections from the date of surgery to the date of examination. Study results support the need for long-term nephrologic follow-up in patients after surgery for obstructive uropathy. The hypothesis that renal function in patients undergoing surgery aged younger than 3 or 6 months is better when compared with those aged 6 to 12 months has not been confirmed.

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References

  1. Warshaw BL, Edelbrock HH, Ettenger RB, Malekzadeh MH, Pennis AJ, Uittenbogaart CT, Fine RH (1982) Progression to end-stage renal disease in children with obstructive uropathy. J Pediatr 100:183

    Article  CAS  Google Scholar 

  2. Elder JS, Stansbrey R, Dahms BB, Selzman AA (1995) Renal histological changes secondary to ureteropelvic junction obstruction. J Urol 154:719–722

    Article  CAS  Google Scholar 

  3. Paduano L, Giglio L, Bembi B, Peratoner LD, Benussi G (1991) Clinical outcome of fetal uropathy. II. Sensitivity of echography for prenatal detection of obstructive pathology. J Urol 146:1097–1098

    Article  CAS  Google Scholar 

  4. Roth KS, Carter WH, Chan JCM (2001) Obstructive nephropathy in children: Long-term progression after relief of posterior urethral valve. Pediatrics 107:1004–1010

    Article  CAS  Google Scholar 

  5. Drozdz D, Drozdz M, Gretz N, Mohring K, Mehls O, Scharer K (1998) Progression to end-stage renal disease in children with posterior urethral valves. Pediatr Nephrol 12:630–636

    Article  CAS  Google Scholar 

  6. Airede A, Bello M, Weerasinghe HD (1997) Acute renal failure in the newborn: incidence and outcome. J Pediatr Child Health 33:246–249

    Article  CAS  Google Scholar 

  7. Chevalier RL, Peters CA (2003) Congenital urinary tract obstruction: Proceedings of the state-of-the-art strategic planning workshop- National Institute of Health, Bethesda, Maryland, USA, 11–12 March 2002. Pediatr Nephrol 18:576–606

    Article  Google Scholar 

  8. Podracka L, Kovacs L (2004) Epidemiologia chronickej renalnej insuficiencie u deti na Slovensku. Cs Pediat 59:331–336

    Google Scholar 

  9. Gunn TR, Mora JD, Pease P (1995) Antenatal diagnosis of urinary tract abnormalities by ultrasonography after 28 weeks’ gestation: incidence and outcome. Am J Obstet Gynecol 172:479–486

    Article  CAS  Google Scholar 

  10. Tam JC, Hodson EM, Choong KK, Cass DT, Cohen RC, Gruenewald SM, Hayden LJ (1994) Postnatal diagnosis and outcome of urinary tract abnormalities detected by antenatal ultrasound. Med J Aust 160:633–637

    Article  CAS  Google Scholar 

  11. Livera LN, Brookfield DS, Egginton JA, Hawnaur JM (1989) Antenatal ultrasonography to detect fetal renal abnormalities: a prospective screening programme. BMJ 298:1421–1243

    Article  CAS  Google Scholar 

  12. Sairam S, Al-Habib A, Sasson S, Thilaganathan B (2001) Natural history of fetal hydronephrosis diagnosed on mid-trimester ultrasound. Ultrasound Obstet Gynecol 17:191–196

    Article  CAS  Google Scholar 

  13. Èerveòová O, Zatlukalová A, Chovancová D (1996) Sucasný stav skríningu obstrukcných uropatií na Slovensku. Slov Radiol 3:125–127

    Google Scholar 

  14. Mami B, Paolata A, Palmara A, Marrone T, Manganaro R, Lo Monaco I, Gemelli M (2005) Comparison between pre- and postnatal echographic screening of malformative uropathies. Minerva Ginecol 57:185–188

    CAS  PubMed  Google Scholar 

  15. Schwartz GJ, Haycock GB, Edelman CM Jr, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–263

    CAS  Google Scholar 

  16. Schwartz GJ, Brion LP, Spitzer A (1987) The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin North Am 34:571–590

    Article  CAS  Google Scholar 

  17. Filler G, Lepage N (2003) Should the Schwartz formula for estimation of GFR be replaced by cystatin C formula? Pediatr Nephrol 18:981–985

    Article  Google Scholar 

  18. Filler G, Priem F, Vollmer I, Gellerman J, Jung K (1999) Diagnostic sensitivity of serum cystatin C for impaired glomerular rate. Pediatr Nephrol 13:501–505

    Article  CAS  Google Scholar 

  19. Miltenyi M (1979) Urinary protein excretion in healthy children. Clin Nephrol 12:216–221

    CAS  PubMed  Google Scholar 

  20. Weitzel D (1978) Nierenvolumenbestimmungen im Kindesalter. In: Kratochwil A, Reinold E (eds): Ultraschalldiagnostik. Thieme, Stuttgart

    Google Scholar 

  21. Gloor JM, Ogburn PL, Breckle RJ, Morgenstern BZ, Milliner DS (1995) Urinary tract anomalies detected by prenatal ultrasound at Mayo Clinic Rochester. Mayo Clin Proc 70:526–531

    Article  CAS  Google Scholar 

  22. Mayor G, Genton N, Torrado A, Guirnard JP (1975) Renal function in obstructive nephropathy: long-term effect of reconstructive surgery. Pediatrics 56:740–747

    CAS  PubMed  Google Scholar 

  23. Winberg J, Bergstrom T, Jacobsson B (1975) Morbidity, age and sex distribution, recurrences and renal scarring in symptomatic urinary tract infection in childhood. Kidney Int Suppl 4:S101–S106

    CAS  PubMed  Google Scholar 

  24. Fergusson DM, Horwood LJ, Shannon FT (1986) Factors related to the age of attainment of nocturnal bladder control: an 8-year longitudinal study. Pediatrics 78:884–887

    CAS  PubMed  Google Scholar 

  25. Chevalier RL (1992) Response of the developing kidney to nephron loss. In: Edelman CM Jr (ed) Pediatric kidney disease. 2nd ed. Little, Brown, Boston pp 443–460

    Google Scholar 

  26. Bökenkamp A, Domanetzki M, Zinck R, Schumann G, Brodehl J (1998) Reference values for cystatin C serum concentrations in children. Pediatr Nephrol 12:125–129

    Article  Google Scholar 

  27. Tian S, Kusano E, Ohara T, Itoh Y, Kawai T, Asano Y (1997) Cystatin C measurement and its practical use in patients with various diseases. Clin Nephrol 48:104–108

    CAS  Google Scholar 

  28. Helin I, Axenram M, Grubb A (1998) Serum cystatin C as a determinant of glomerular filtration rate in children. Clin Nephrol 49:221–225

    CAS  Google Scholar 

  29. Ylinen EA, Ala-Houhala M, Harmoinen AP, Knip M (1999) Cystatin C as a marker for glomerular filtration rate in pediatric patients. Pediatr Nephrol 13:506–509

    Article  CAS  Google Scholar 

  30. Frkiaer J, Christensen BM, Marples D, Djurhuus JC, Jensen UB, Knepper MA, Nielsen S (1997) Downregulation of aquaporin-2 parallels changes in renal water excretion in unilateral obstruction. Am J Physiol 273:213–223

    Google Scholar 

  31. Pascual L, Oliva J, Vega PJ, Principi I, Valles P (1998) Renal histology in ureteropelvic junction obstruction: are histological changes a consequence of hyperfiltration? J Urol 160:976–979

    Article  CAS  Google Scholar 

  32. Palmer LS, Maizels M, Cartwright PC, Fernbach S, Conway JJ (1998) Surgery versus observation for managing obstructive grade 3 to 4 unilateral hydronephrosis: a report from the Society for Fetal Urology. J Urol 159:222–228

    Article  CAS  Google Scholar 

  33. Tapia J, Gonzales R (1995) Pyeloplasty improves renal function and somatic growth in children with ureteropelvic junction obstruction. J Urol 154:218–222

    Article  CAS  Google Scholar 

  34. King LR (1995) Hydronephrosis. When is obstruction not obstruction? Urol Clin North Am 22:31–42

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors are grateful to Professor C.H. Schrõder for his advice in the preparation of the manuscript. This study was supported by a grant VEGA1/0524/03 from the Slovak Ministry of Education.

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Authors and Affiliations

  1. 1st Department of Pediatrics, University Children’s Hospital, Comenius University in Bratislava, Bratislava, Slovakia

    Daniela Miklovicova, Olga Cervenova, Andrea Cernianska & Zuzana Jancovicova

  2. Slovak University of Technology in Bratislava, Bratislava, Slovakia

    Ladislav Dedik

  3. Department of Clinical Biochemistry, University Children’s Hospital, Comenius University in Bratislava, Bratislava, Slovakia

    Alena Vasilenkova

  4. 1st Department of Pediatrics, University Children’s Hospital, Limbova 1, Bratislava, 833 40, Slovakia

    Daniela Miklovicova

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  1. Daniela Miklovicova
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Correspondence to Daniela Miklovicova.

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Miklovicova, D., Cervenova, O., Cernianska, A. et al. Long-term follow-up of renal function in patients after surgery for obstructive uropathy. Pediatr Nephrol 23, 937–945 (2008). https://doi.org/10.1007/s00467-007-0741-6

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  • DOI: https://doi.org/10.1007/s00467-007-0741-6

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