Doğan Çağla Serpil, Torun Bayram Meral
Division of Pediatric Nephrology, Department of Pediatrics, Şanlıurfa Children's Hospital, Şanlıurfa, Turkey.
Turk J Pediatr. 2013 Nov-Dec;55(6):612-5.
The aim of this study was to evaluate associated urological anomalies and renal outcome in children with unilateral renal agenesis (URA). Medical records of 51 cases of URA followed at Şanlıurfa Children 's Hospital between January 2009 and December 2012 were reviewed retrospectively. In all patients, diagnosis was made by abdominal ultrasound (US) and confirmed by a radionuclide scan. The children were between 3 months and 17 years of age (median age: 5 years). There were 31 males (60.8%) and 20 females (39.2%). In 33 patients (67.3%), the left kidney was absent. Urological anomalies were found in 12/51 patients (23.5%), including ureterovesical junction obstruction in 4 (7.8%), bladder dysfunction in 2 (3.9%), and vesicoureteral reflux (VUR), ureteropelvic junction obstruction, ureterovesical and ureteropelvic junction obstruction, duplicated collecting system plus grade IV VUR, ectopic kidney plus grade V VUR, and ectopic kidney in 1 patient (2%) each. Chronic renal insufficiency (CRI) developed in 5/51 patients (9.8%) (stage III in 3 patients and stage IV in 2), 4 of whom had additional urological anomaly; in the remaining 1 patient, a 17-year-old female, imaging studies were normal except for a small and hyperechogenic solitary kidney determined on US. A total of 3 patients (5.8%) developed hypertension, and all except one had an associated urological anomaly. Proteinuria was seen in 2 patients (3.8%) with stage IV CRI, one of whom was also hypertensive. In conclusion, urological anomalies usually accompany URA and should be followed closely to decrease the risk of renal failure.
本研究的目的是评估单侧肾缺如(URA)患儿的相关泌尿系统异常及肾脏预后。回顾性分析了2009年1月至2012年12月在尚勒乌尔法儿童医院随访的51例URA患儿的病历。所有患者均通过腹部超声(US)诊断,并经放射性核素扫描证实。患儿年龄在3个月至17岁之间(中位年龄:5岁)。其中男性31例(60.8%),女性20例(39.2%)。33例患者(67.3%)左侧肾脏缺如。51例患者中有12例(23.5%)发现泌尿系统异常,包括输尿管膀胱连接部梗阻4例(7.8%)、膀胱功能障碍2例(3.9%)、膀胱输尿管反流(VUR)、肾盂输尿管连接部梗阻、输尿管膀胱和肾盂输尿管连接部梗阻、重复集合系统合并IV级VUR、异位肾合并V级VUR各1例(2%)。51例患者中有5例(9.8%)发生慢性肾功能不全(CRI)(3例为III期,2例为IV期),其中4例伴有其他泌尿系统异常;其余1例为17岁女性,除超声检查发现一个小的高回声孤立肾外,影像学检查均正常。共有3例患者(5.8%)发生高血压,除1例患者外均伴有泌尿系统异常。2例IV期CRI患者出现蛋白尿,其中1例也患有高血压。总之,泌尿系统异常通常伴随URA,应密切随访以降低肾衰竭风险。