SOVREMENNAYA PEDIATRIYA.2016.5(77):119-124; doi10.15574/SP.2016.77.119 

Predictors anomalies of the urinary sysnem in early childhood 

Kokorkin A.

Zaporozhye State Medical University 

The pediatric surgeons are always interested in issues of predicting clinical variants of congenital malformations. The ability to predict the most likely out-come of the disease allows a child to develop the optimum tactics of treatment.

Objective: to supplement the list of predictors of spontaneous resolution and complicated clinical course of urinary tract defect in infancy.

Materials and methods: the observed and treated 40 children aged 3–12 months. In 20 children defect resolved spontaneously, while 20 children were observed during its complications. We studied the maternal history, obstetric pathology, especially the fetus and newborn screening results. We used rank correlation analysis (Spirmen) between a plurality of indicators, and two variants of the disease outcomes: spontaneous resolution and complicated course of the disease. When predicting the outcome of the disease using regression analysis.

The results of research and discussion: on the formation of complicated blemish significant influence somatic pathology of the mother and obstetric history data: factors of recurrent pyelonephritis, and number of previous births. Predictor'natal formation of complicated urinary tract defect is the degree of dilation of the urinary tract in 2–3 trimester. Predictor dilatation is inversely proportional correlation relationship with water scarcity factor (R=-0.620) and the degree of thinning of the renal parenchyma (R=-0.536) and the floor unborn child (R=-0.707). Predictor severe defect of the urinary tract of the newborn is a clinical variant of the disease debut. Option of complicated defect characterized by a sudden and striking clinical debut persistent pyelonephritis with severe hyperthermia and pain (R=0.756; p=0.001; OR=0.224). The start of the disease is inversely proportional to depend on the degree of severity of the defect. The earlier the disease manifested itself, the more it is accompanied by a bright debut, the more likely that the defect has a complicated course (R=-0.556; p=0.001, OR=1.765). Complicated version of the clinical course of the disease has a distinctive morphometric characteristics: prevailing bilateral lesion, the presence of dilatation of the renal pelvis more than 9 mm, 10 mm more dilatation of the ureter, renal pelvis expansion of the system of more than 13 mm and a thinning of renal parenchymal layer. In early childhood, clinical debut urinary tract blemish prone to spontaneous resolution is erased clinical pyelonephritis, in the absence of pain and hyperthermia (R=-0,512; p=0.003;OR=0,875). Such a state is combined with unilateral disease, moderate dilatation of the renal pelvis (less than 9mm), a moderate expansion of the ureter (less than 7mm), the expansion of the renal pelvis system less than 13 mm, and the absence of deformation of kidney parenchyma.

Conclusions: The use of predictors allow to predict the possible outcome of the disease and to develop optimal treatment of patients.

Keywords: predictors, anomalies, children.

REFERENCES

1. Vrublevskiy SG. 2008. Prognoz i lechenie gidronefroza u detey 14.00.35 — detskaya hirurgiya. Avtoref dis d-ra med nauk. Moskva.

2. Deryugina LA. 2008. Antenatalnaya diagnostika vrozhdennyih zabolevaniy mochevyivodyaschey sistemyi i obosnovanie taktiki vedeniya detey v postnatalnom periode. Avtoref dis d-ra med nauk. Saratov: 40.

3. Lyamzin SI. 2007.Obstruktsiya pieloureteralnogo segmenta u detey rannego vozrasta (printsipyi pre- i ranney postnatalnoy diagnostiki i sovershenstvovanie hirurgicheskogo lecheniya). Avtoref dis kand med nauk. Omsk.

4. Farrugia MK, Hitchcock R, Radford A et al. 2014. British Association of Paediatric Urologists consensus statement on the management of the primary obstructive megaureter. J Pediatr Urol. 10(1): 26—33. http://dx.doi.org/10.1016/j.jpurol.2013.09.018; PMid:24206785

5. Chertin B, Pollack A, Koulikov D et al. 2006. Conservative treatment of ureteropelvic junction obstruction in children with antenatal diagnosis of hydronephrosis: lessons learned after 16 years of follow-up. Eur Urol. 49(4): 734—8. Epub 2006 Feb 17. http://dx.doi.org/10.1016/j.eururo.2006.01.046; PMid:16504374

6. Arena S, Magno C, Montalto AS et al. 2012. Long-term follow-up of neonatally diagnosed primary megaureter: rate and predictors of spontaneous resolution. Scand J Urol Nephrol. 46(3): 201—7. http://dx.doi.org/10.3109/00365599.2012.662695; PMid:22397575

7. Onen A, Jayanthi VR, Koff SA. 2002. Long-term followup of prenatally detected severe bilateral newborn hydronephrosis initially managed nonoperatively. J Urol. 168(3): 1118—20. http://dx.doi.org/10.1097/00005392-200209000-00067; http://dx.doi.org/10.1016/S0022-5347(05)64604-6

8. McLellan DL, Retik AB, Bauer SB et al. 2002. Rate and predictors of spontaneous resolution of prenatally diagnosed primary nonrefluxing megaureter. J Urol. 168(5): 2177—80. http://dx.doi.org/10.1016/S0022-5347(05)64348-0; http://dx.doi.org/10.1097/00005392-200211000-00091; PMid:12394754

9. Akhavan A, Merguerian PA, Larison C et al. 2014. Trends in the Rates of Pediatric Pyeloplasty for Ureteropelvic Junction Obstruction over 19 Years: A PHIS Database Study. Adv Urol. 2014: 142625. http://dx.doi.org/10.1155/2014/142625. Epub 2014 May 13.

10. Ulman IL, Jayanthi VR, Koff SA. 2000. The long-term followup of newborns with severe unilateral hydronephrosis initially treated nonoperatively. J Urol. 164; 3 Pt 2: 1101—5. http://dx.doi.org/10.1097/00005392-200009020-00046; http://dx.doi.org/10.1016/S0022-5347(05)67262-X