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During a 15-year period 29 patients were treated for unilateral multicystic kidney. The diagnosis was obtained from antenatal ultrasonography in 17 cases, investigation of an abdominal mass at routine palpation in 10, UTI investigation in 1 and uraemia investigation in 1. Eleven patients had associated malformations. Further investigations included ultrasonography, intravenous pyelography, micturition uretrocystography and in a few cases computed tomography and Dimercapto-succinic acid (DMSA) scan. Percutaneous pyelography was performed in 9 cases. Twenty-six children were operated on and 3 were not operated, of which 1 with severe cardiac malformations, died. The age at operation was under 6 months in 14 cases and between 6 and 12 months in 8. Four children developed hypertension preoperatively but the hypertension disappeared within 1 week postoperatively in all cases. The indication for surgery in unilateral multicystic kidney seems to be clear if the patient is symptomatic. In the asymptomatic patient, the complications of a remaining multicystic kidney like hypertension, malignancy, infection and pain suggest a surgical approach at around 6 months of age.
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PMID:Surgery in unilateral multicystic kidney. 223 49

47 children diagnosed as having obstructed or non-refluxing, non-obstructed, primary mega-ureters were followed up by questionnaire. 2 patients had developed renal failure over 20 years, the remainder were free of urinary tract infection or hypertension. 21 of these patients were followed up with clearance and differential renal function studies. All but 4 kidneys associated with operated mega-ureters at long term follow-up had good function.
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PMID:Twenty-year follow-up of primary mega-ureter. 231 39

Ultrasonography and intravenous pyelography (IVP) were compared for their diagnostic value in 65 patients (29 women, 36 men; mean age 57 [19-85] years) thought to have disease of the kidneys or urinary tract (microhaematuria in 16, macrohaematuria in 5, urinary tract infection in 11, suspicion of renovascular hypertension in 6, suspected tumour in 5, suspected nephrolithiasis in 15, and flank pain of uncertain cause in 7). Ultrasound established an abnormal condition in 29, in five of which IVP gave false positive results, false-negative results in three. The false-negative results were an indirect sign of renal artery stenosis in one patient and in one patient each of duplex ureter and cystic ureteritis. Mild hydronephrosis (n = 3), stone in a kidney or the renal calyx system (n = 2) and tumour of the right kidney (n = 1), diagnosed by ultrasound, were not seen by IVP. Concordant results were thus obtained in 70% of cases. Ultrasound examination of the urinary tract gives such reliable results that in many cases an additional IVP is unnecessary.
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PMID:[A comparison of sonography and intravenous pyelography in diseases of the kidneys and urinary organs]. 240 30

Chronic pyelonephritis (c.p.) is by definition an infectious tubulo-interstitial nephritis. It has to be differentiated from other etiologic forms of tubulo-interstitial nephritis. Therefore strict morphological criteria are needed for diagnosis. The characteristic lesion is a large cortico-medullary scar overlying a dilated chronically inflammed calyx. The macroscopic aspect and the histologic survey picture are more important than histologic details. A diagnosis on renal biopsies is therefore not warranted. Vesico-renal reflux and papillary morphology play an important pathogenetic role. Beside the more common focal scar a diffuse form of scarring can be observed. A limited number of conditions only have to be considered in differential diagnosis. The Ask-Upmark kidney seems to be a special form of c.p. related to urinary tract infection and reflux in early infancy. Pelvi-calyceal lithiasis without superimposed infection causes a picture very similar to a pyelonephritic scar. A reliable differentiation between c.p. and analgesic nephropathy may cause problems in endstage kidneys with sloughed off papillae. Various mechanisms of renal damage such as bacterial infection, immunological mediated inflammation, leakage of urinary constituents into the interstitium especially Tamm-Horsfall-protein and ischemia have to be considered. Despite the frequency of urinary tract infections chronic progressive pyelonephritis is rare. Predisposing factors are needed for progression of the disease. These include congenital or acquired urinary tract obstruction, vesico-renal reflux and papillary damage with intrarenal obstruction to the urinary flow. Other important factors are focal and segmental glomerulosclerosis and hypertension.
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PMID:[Chronic pyelonephritis and its differential diagnosis. A disease changing with time]. 248 12

The quality of prenatal care offered in health centers (HC) and in the hospital (H) have been compared. Two samples were evaluated. One consisted of 476 pregnant women seen in HC and another of 213 who were seen in H. Five out of the 22 selected markers did not show differences in both levels (date of delivery; weight gain in g/week; measurement of uterine weight and height; and hypertension detection). Ten markers were better fulfilled in H than in HC (obstetrical formula; gynecological examination, fetal heart beats and edema examination; detection of diabetes, urinary tract infection and anemia). By contrast, there were seven markers that were better fulfilled in HC (serological tests for syphilis and hepatitis B; treatment of urinary tract infection and anemia; and compliance with follow up). The better fulfillment of the markers in H might be due to the recent inclusion of prenatal care programs in HC. The fact that in the first level of care the controls are earlier and more frequent shows that this level facilitates the access of pregnant women to services and their follow up.
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PMID:[Comparative study of the quality of prenatal care at health centers and hospitals]. 251 96

Autosomal dominant polycystic kidney disease is the third cause of end-stage chronic renal failure (CRF) requiring dialysis and transplantation. Over a 5-year period we collected 21 cases of that disease. The patients' mean age at the time of diagnosis was 48 years and the sex ratio 1.1. Pain was the most frequent signal symptom, being present in 43 p. 100 of the patients. Varying degrees of renal impairment were found in 61 p. 100 of the cases, and arterial hypertension in 38 p. 100. The diagnosis, suspected on clinical grounds, was confirmed by ultrasonography in 95 p. 100 of the patients. Beside CRF and hypertension, the main complications were microscopic haematuria (38 p. 100) and urinary tract infection (24 p. 100). In two patients the disease was associated with hepatic polycystosis. Treatment was symptomatic for CRF (4 patients were put on periodical haemodialysis) and for the other complications. On the basis of this series, we discuss the profile and prognosis of polycystic kidney disease in our environment, and notably its effects on renal function, and we underline the usefulness of familial investigations and the need for genetic counselling.
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PMID:[Dominant renal polycystic disease]. 252 23

Treatment results of 74 secondary megaureters in 48 children (25 males and 23 females with one segmental and 73 total megaureters) are presented. The left side prevailed over the right one (ratio 1.4:1.0); the lesion was bilateral in 54%. Forty-two children (88%) were treated surgically. Eleven megaureters (15%) were modelled. and 2 megaureters had to be reoperated. The follow-up period ranged between 7 months and 9.5 years. Urinary infection was reduced from 80 to 54%, chronical renal failure was reduced from 65 to 54%, and the occurrence of arterial hypertension remained unchanged. Excellent results were achieved in 27%, they were satisfactory in 60% and poor in 13% of the megaureters.
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PMID:Secondary megaureters in children: results of treatment. 259 29

From 1969 to 1987, 35 pregnancies occurred in 31 women with renal transplant. Four of them were still pregnant when this study was concluded. There was one ectopic pregnancy. All patients received azathioprine and prednisone. In the majority of patients the glomerular filtration rate increased in a way similar to normal pregnant women. In five cases there was a progressive loss in renal function. In four of them this was attributed to preexistent renal damage. No toxemia occurred. Anemia developed during 11 pregnancies and blood transfusion was required for five women. Four patients had urinary tract infection which was easily controlled with antibiotics. One patient had severe arterial hypertension, secondary to chronic rejection. One patient developed jaundice reverted with reduction in azathioprine doses. One woman died of septicemia secondary to fetal death, during the 6th month of pregnancy. Twenty children were born with no abnormalities, although many of them were underweighted. Two thirds of pregnancies were delivered by cesarean section. No harm to the pelvic allograft occurred in vaginal deliveries. There have been 4 abortions (2 of them were induced with no medical indication). Four pregnancies (26 to 39 gestational weeks) ended in stillborn babies: the mothers had impaired renal function associated with hypertension and proteinuria. One newborn died of pulmonary infection two days after delivery. Another was born with microcephaly and polydactilia and survived 6 years. No breast feeding was allowed.
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PMID:[Pregnancy in patients with renal transplantation]. 262 4

A report is given of pregnancy in a tetraplegic patient. The main complications that patients who are suffering from tetraplegia have in pregnancy are urinary tract infection, anaemia, and complications of bed rest, as well as premature delivery and autonomic hyperreflexia. Autonomic hyperreflexia is provoked by stimuli such as distension of the bladder or of the rectum or stimulation of the cervix. In this syndrome bradycardia, arterial hypertension and headaches are associated. The major risk is of intra-ventricular haemorrhage in labour. The care of the pregnant tetraplegic patient requires the cooperation of the obstetrician, the anaesthetist and the nursing staff, as well as of the patient.
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PMID:[Tetraplegia and pregnancy]. 266 45

Urinary tract infections (UTIs) can be difficult to diagnose positively in the pediatric patient. The patient with such an infection, however, is at risk for subsequent morbidity such as recurrence, renal damage and hypertension. Accurate diagnosis in the very young child may require multiple urine specimens involving repeating bag specimens, catheterization, or suprapubic aspiration. Septic children and those with pyelonephritis must be hospitalized. Children younger than 6 years old need follow-up with radiographic studies to rule out reflux and congenital anomalies. The clinician plays a significant role in detecting possible UTIs, and providing patient education and support.
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PMID:Urinary tract infections in the pediatric patient. 266 95


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