Long-term Outcome of Children with Ureteropelvic Junction Obstruction: Thirty-one years’ Experience at a Tertiary Teaching Hospital in South Africa.
Journal of Pediatric Nephrology,
Vol. 7 No. 2 (2019),
31 August 2019
,
Page 1-13
https://doi.org/10.22037/jpn.v7i2.24923
Abstract
Background and Aim: Being the most common pathologic cause of hydronephrosis in children, we characterized and evaluated the long-term outcome of Ureteropelvic junction obstruction (UPJO) at a tertiary hospital in South Africa
Methods: Children confirmed to have UPJO between 1985 and 2016 were characterized based on demographic and baseline clinical data. Long term outcomes were need for surgical intervention, loss to follow up rates, anthropometric measures, renal outcomes (Glomerular Filtration Rate and Blood pressure).
Results: Of 107 children, 74.8% were male, 47% had hydronephrosis identified antenatally, 47.7% had the left kidney unilaterally affected, 31.8% had an additional urogenital anomaly, 19.6% presented with an abdominal mass, and 37.4% had a urinary tract infection. On enrolment, 54.2% and 30.8% had normal systolic and diastolic BP, 59.8% had normal BMI for age and 72% had normal length/height for age. The median follow-up time was 35(9.0 - 191.0) months, 65% had surgery with a median time to surgery of 2 (0 - 6.8) months. Children lost to follow-up had a higher proportion of extrinsic causes of UPJO (12.0% vs. 0%, P=0.041) and other urogenital anomalies (38.7% vs. 15.6%, P=0.019). There was no significant effect of time or surgical intervention on mean BMI and height for age, blood pressure percentile and eGFR for age.
Conclusion: In our setting, UPJO has an early presentation, with an early time to surgery. Long-term outcome is favorable, but loss to follow-up presents a significant drawback that needs to be addressed.
Keywords: Ureter; Hypertension; Congenital anomalies of kidney and urinary tract; CAKUT; Urological Diseases; Hydronephrosis.
- Pelvi-ureteric Junction Obstruction
- Hydronephrosis
- Renal anomalies.
How to Cite
References
Aksu N, Yavaşcan O, Kangin M, Kara OD, Aydin Y, Erdogan H, et al. Postnatal management of infants with antenatally detected hydronephrosis [Internet]. Pediatr Nephrol. 2005 Sep;20(9):1253–9. [cited 2019 Sep 10] Available from: http://link.springer.com/10.1007/s00467-005-1989-3
Nguyen HT, Benson CB, Bromley B, Campbell JB, Chow J, Coleman B, et al. Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system) [Internet]. J Pediatr Urol. 2014 Dec;10(6):982–98. [cited 2019 Sep 10] Available from: http://www.ncbi.nlm.nih.gov/pubmed/25435247
Koff S, Mutabagani K (Gillenwater J, Grayhack J, Howards S, Mitchell M, editors). Adult and Pediatric Urology. 4th ed. Philadelphia: Lippincott Williams and Wilkins; 2002. 2129 pp.
Vaos G. Pelvi-ureteric junction obstruction. Res Signpost. 2012;37661(2):125–38.
Sheu JC, Koh CC, Chang PY, Wang NL, Tsai JD, Tsai TC. Ureteropelvic junction obstruction in children: 10 years’ experience in one institution [Internet]. Pediatr Surg Int. 2006 Jun;22(6):519–23. [cited 2016 Aug 30] Available from: http://link.springer.com/10.1007/s00383-006-1698-4
Cohen B, Goldman SM, Kopilnick M, Khurana AV, Salik JO. Ureteropelvic junction obstruction: its occurrence in 3 members of a single family [Internet]. J Urol. 1978 Sep;120(3):361–4. [cited 2016 Aug 30] Available from: http://www.ncbi.nlm.nih.gov/pubmed/682259
Hosgor M, Karaca I, Ulukus C, Ozer E, Ozkara E, Sam B, et al. Structural changes of smooth muscle in congenital ureteropelvic junction obstruction. J Pediatr Surg. 2005 Oct;40(10):1632–6.
Kini H, Sridevi HB, Suresh PK, Guni LP, Bhat S, Kini JR. Spectrum of Lesions Affecting the Renal Pelvis and Pelviureteric Junction: A 13-Year Retrospective Analysis [Internet]. J Clin Diagn Res. 2016 Feb;10(2):EC01–04. [cited 2019 Sep 11] Available from: http://www.ncbi.nlm.nih.gov/pubmed/27042468
Wang JH. Ureteropelvic junction obstruction by aberrant lower pole artery. Urol Sci. 2013;24(1):18–20.
Weitz M, Tschumi S, Bassler D. Surgery versus non-surgical management for unilateral ureteric-pelvic junction obstruction in children. In: Weitz M, editor. Cochrane Database of Systematic Reviews [Internet]Chichester, UK: John Wiley & Sons, Ltd; 2013.[ [cited 2019 Mar 24]], Available from http://doi.wiley.com/10.1002/14651858.CD010716 https://doi.org/10.1002/14651858.CD010716.
Rodriguez MM. Congenital Anomalies of the Kidney and the Urinary Tract (CAKUT) [Internet]. Fetal Pediatr Pathol. 2014 Oct-Dec;33(5-6):293–320. [cited 2019 Sep 10] Available from: http://www.ncbi.nlm.nih.gov/pubmed/25313840
Sanna-Cherchi S, Westland R, Ghiggeri GM, Gharavi AG. Genetic basis of human congenital anomalies of the kidney and urinary tract [Internet]. J Clin Invest. 2018 Jan;128(1):4–15. [cited 2019 Sep 10] Available from: http://www.ncbi.nlm.nih.gov/pubmed/29293093
Capone VP, Morello W, Taroni F, Montini G. Genetics of Congenital Anomalies of the Kidney and Urinary Tract: The Current State of Play [Internet]. Int J Mol Sci. 2017 Apr;18(4):E796. [cited 2019 Sep 10] Available from: http://www.ncbi.nlm.nih.gov/pubmed/28398236
Sinha A, Bagga A, Krishna A, Bajpai M, Srinivas M, Uppal R, et al. Revised guidelines on management of antenatal hydronephrosis [Internet]. Indian J Nephrol. 2013 Mar;23(2):83–97. [cited 2016 Sep 1] Available from: http://www.ncbi.nlm.nih.gov/pubmed/23716913
Herndon CDA. Antenatal hydronephrosis: differential diagnosis, evaluation, and treatment options. Sci worldJ J. 2006;6:2345–65.
Pramod S, Ramji AN. Clinical profile and outcome of pelvi-ureteric junction obstruction (PUJO) in children presenting above 1 year. Int Surg J [Internet]. 2018 Aug 25 [cited 2019 Sep 11];5(9):3066–71. Available from: https://www.ijsurgery.com/index.php/isj/article/view/3177/2305
Demirel BB, Balci TA, Tasdemir B, Koc ZP. Comparison of DTPA and MAG3 renal scintigraphies in terms of differential renal function based on DMSA renal scintigraphy. Pak J Med Sci. 2012;28(5):795–9.
Chiou YY, Chiu NT, Wang ST, Cheng HL, Tang MJ. Factors associated with the outcomes of children with unilateral ureteropelvic junction obstruction [Internet]. J Urol. 2004 Jan;171(1):397–402. [cited 2018 Oct 20] Available from: https://www.sciencedirect.com/science/article/pii/S0022534705627656
Jain V, Agarwala S, Bhatnagar V, Gupta AK, Kumar R, Bal CS. Long term outcome of management of antenatally diagnosed pelvi-ureteric junction obstruction [Internet]. Indian J Pediatr. 2012 Jun;79(6):769–73. [cited 2018 Oct 20] Available from: http://link.springer.com/10.1007/s12098-011-0546-2
Karnak I, Woo LL, Shah SN, Sirajuddin A, Ross JH. Results of a practical protocol for management of prenatally detected hydronephrosis due to ureteropelvic junction obstruction [Internet]. Pediatr Surg Int. 2009 Jan;25(1):61–7. [cited 2019 Sep 12] Available from: http://www.ncbi.nlm.nih.gov/pubmed/19043723
Aydogdu B, Tireli G, Demirali O, Guvenc U, Besik C, Sander S, et al. Therapeutic approaches and long-term follow-up for prenatal hydronephrosis [Internet]. Pak J Med Sci. 2016 May-Jun;32(3):667–71. [cited 2018 Oct 20] Available from: http://www.ncbi.nlm.nih.gov/pubmed/27375711
Nguyen HT, Herndon CD, Cooper C, Gatti J, Kirsch A, Kokorowski P, et al. The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis [Internet]. J Pediatr Urol. 2010 Jun;6(3):212–31. [cited 2019 Sep 13] Available from: https://linkinghub.elsevier.com/retrieve/pii/S1477513110002482
De Onis M, Onyango A, Borghi E, Siyam A, Pinol A; Department of Nutrition for Health and Development WHO. WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. Vol. 95. Acta Paediatr. 2006;95:1-107
Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, et al. 2000 CDC growth charts for the United States: Methods and development. Nationale Center for Health Statistics. Vol. 11, Vital and Health Statistics. 2002. 1–190 p.
Schwartz GJ, Work DF. Measurement and estimation of GFR in children and adolescents [Internet]. Clin J Am Soc Nephrol. 2009 Nov;4(11):1832–43. [cited 2019 Sep 11] Available from: http://www.ncbi.nlm.nih.gov/pubmed/19820136
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics [Internet]. 2004 Aug [cited 2019 Sep 11];114(2 Suppl 4th Report):555–76. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15286277
Dunn OJ. Multiple Comparisons Using Rank Sums. Technometrics. 1964 Aug;6(3):241–52.
Bowlin P, Gatti J. Pediatric Ureteropelvic Junction Obstruction: Background, Anatomy, Pathophysiology [Internet]. [cited 2018 Jun 21]. Available from: https://emedicine.medscape.com/article/1016988-overview
Dabra A, Gupta R, Singh J, Kochhar S. Prenatal Diagnosis of Familial Ureteropelvic Junction Obstruction: A Case Report and Review of the Literature. J Diagn Med Sonogr. 2003;19(5):316–9.
Jenkins D, Caubit X, Dimovski A, Matevska N, Lye CM, Cabuk F, et al. Analysis of TSHZ2 and TSHZ3 genes in congenital pelvi-ureteric junction obstruction [Internet]. Nephrol Dial Transplant. 2010 Jan;25(1):54–60. [cited 2018 Jun 19] Available from: https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfp453
Pastore V, Aceto G, Niglio F, Basile A, Cocomazzi R, Faticato MG, et al. Clinical characteristics and management of children with ureteropelvic junction obstruction and severe vesicoureteral reflux [Internet]. Ann Pediatr Surg. 2013;9(3):114–6. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=01287829-201307000-00005
Senguttuvan P, Jigy J. Profile and Outcome of Pelviureteric Junction Obstruction. Open Urol Nephrol J. 2014;7(1):67–70.
Atiyeh B, Husmann D, Baum M. Contralateral renal abnormalities in multicystic-dysplastic kidney disease [Internet]. J Pediatr. 1992 Jul;121(1):65–7. [cited 2019 Sep 13] Available from: http://www.ncbi.nlm.nih.gov/pubmed/1625095
Sharma N, Bajpai M, Panda SS. Pelviureteric Junction Obstruction Associated with Vesico-ureteric reflux and Vesico-ureteric Junction Obstruction : challenges and. J Prog Paediatr Urol. 2014;17(1):24-27
Mughal S, Soomro S. Pelvi-Ureteric Junction Obstruction in Children [Internet]. J Surg Pak. 2008;13(4):163–6. [cited 2018 Jun 20] Available from: https://pdfs.semanticscholar.org/41fa/30c453133d0f5e81dd52d0fc2434157ad979.pdf
Al-Mashhadi A, Nevéus T, Stenberg A, Karanikas B, Persson AE, Carlström M, et al. Surgical treatment reduces blood pressure in children with unilateral congenital hydronephrosis [Internet]. J Pediatr Urol. 2015 Apr;11(2):91.e1–6. [cited 2018 Jun 20] Available from: http://www.ncbi.nlm.nih.gov/pubmed/25819380
Kemp C, Schutte AE. The prevalence of hypertension and the relationship with body composition in Gr1 learners in the North west province. S Afr Med J. 2011;23(4):117–22.
Monyeki K, Kemper H. The risk factors for elevated blood pressure and how to address cardiovascular risk factors: a review in paediatric populations. J Hum Hypertens. 2008 Jul;22(7):450–9.
Pengo MF, Soloni P, Cecchin D, Maiolino G, Rossi GP, Calò LA. Pelvic-ureteric junction obstruction and hypertension with target organ damage: a case report and review of the literature [Internet]. Blood Press. 2013 Oct;22(5):336–9. [cited 2019 Sep 11] Available from: http://www.ncbi.nlm.nih.gov/pubmed/23527814
Salević P, Radović P, Milić N, Bogdanović R, Paripović D, Paripović A, et al. Growth in children with chronic kidney disease: 13 years follow up study [Internet]. J Nephrol. 2014 Oct;27(5):537–44. [cited 2019 Mar 24] Available from: http://link.springer.com/10.1007/s40620-014-0094-8
Salević P, Radović P, Milić N, Bogdanović R, Paripović D, Paripović A, et al. Growth in children with chronic kidney disease: 13 years follow up study [Internet]. J Nephrol. 2014 Oct;27(5):537–44. [cited 2019 Mar 24] Available from: http://link.springer.com/10.1007/s40620-014-0094-8
National Department of Health, South African Medical Research Council. South Africa Demographic and Health Survey:Key Indicator Report [Internet]. Pretoria: Statistics South Africa; 2016. 1–30 p. Available from: www.statssa.gov.za
Ocheke IE, Antwi S, Gajjar P, McCulloch MI, Nourse P. Pelvi-Ureteric Junction Obstruction at Red Cross Children’s Hospital, Cape Town: a Six Year Review. Arab J Nephrol Transplant. 2014 Jan;7(1):33–6.
Song SH, Lee SB, Park YS, Kim KS. Is antibiotic prophylaxis necessary in infants with obstructive hydronephrosis? [Internet]. J Urol. 2007 Mar;177(3):1098–101. [cited 2019 Sep 12] Available from: http://www.ncbi.nlm.nih.gov/pubmed/17296419
Islek A, Güven AG, Koyun M, Akman S, Alimoglu E. Probability of urinary tract infection in infants with ureteropelvic junction obstruction: is antibacterial prophylaxis really needed? [Internet]. Pediatr Nephrol. 2011 Oct;26(10):1837–41. [cited 2019 Sep 12] Available from: http://www.ncbi.nlm.nih.gov/pubmed/21520006
- Abstract Viewed: 466 times
- PDF Downloaded: 221 times