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Archivos de Pediatría del Uruguay

versión On-line ISSN 1688-1249


HALTY, Margarita et al. Anomalías nefrourológicas congénitas en niños hospitalizados. Arch. Pediatr. Urug. [online]. 2013, vol.84, suppl.1, pp.48-54. ISSN 1688-1249.

Introduction: congenital abnormalities of urinary tract and kidneys rank second in frequency of structural abnormalities on antenatal ultrasound. Early diagnosis allows to  prevent urinary tract infections, to treat urinary tract obstruction and to avoid or slow the decline in renal function. In our country 30,4% of patients younger than 15 years old on chronic dialysis have a kidney failure because of a congenital abnormality. The aims of this study were to know the hospitalization rate and to describe clinic and evolutionary characteristics of hospitalized children with a congenital abnormality of urinary tract and kidneys diagnosed by antenatal/ postnatal ultrasound. Patients and methods: a descriptive and prospective study was performed. Hospitalized children in HP-CHPR, between 01/07/2012 and 30/06/2013, with pathologic ultrasound of kidneys or urinary tract, were included. Children with bladder dysfunction or glomerulopathy were excluded. We considered age, gender, ultrasound findings, definitive diagnosis, clinic manifestations, treatment and outcome. Results: we included 44 children. Hospitalization rate was 3.9 0/00, the relation male/female was 1.9/1 and the median age 23 months (75th percentile: 91 months). Antenatal ultrasound was performed in 36/44 patients; 18 of them were pathologic; among  these last ones, 11/18 underwent postnatal ultrasound to control findings. In the other 26 patients, the diagnosis of pathologic ultrasound was made after birth: in 15 of them before the hospitalization and in 11 during the hospitalization. We found 66 affected kidneys; 22 were bilateral. The most frequent diagnosis were: vesicoureteric reflux (n=19), obstruction (n=15) and renal dysplasia/ agenesis (n=18). Twenty one patients underwent surgical treatment and 6 underwent endoscopic treatment; 8 patients received more than one invasive treatment. Nine patients developed stage 5 chronic kidney disease: 4 are undergoing chronic dialysis, 1 was transplanted and 4 receive still medical treatment. One patient died with a pneumonia and restrictive respiratory failure because of nephromegaly. Discussion and conclusions: although hospitalization rate is low, these patients have high morbidity in the short and long term. Follow-up of patients with pathologic antenatal ultrasound has been inappropriate. Antenatal ultrasound did not find all the existing abnormalities. A timely antenatal ultrasound and an early diagnosis with a multi-disciplinary follow-up and medical or surgical treatment could prevent complications and reduce morbidity and mortality.


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