Clinical Evaluation of Renalfunction and Disease



Clinical Evaluation of Renalfunction and Disease





Early diagnosis of a renal anomaly may help to prevent complications, including those related to the kidney itself (e.g., progressive loss of renal function as a result of systemic hypertension, obstructive or reflux uropathy, or infection) and those related to other organs (e.g., cerebral hemorrhage, seizures or congestive heart failure [CHF] secondary to hypertension, ventricular arrhythmia secondary to hyperkalemia, urosepsis). In this section, clinical and laboratory features that should raise suspicion of a renal problem are reviewed and an approach to establish the correct diagnosis is presented.


Incidence of Renal and Urinary Tract Malformations

The incidence of renal and urinary tract malformations varies in different studies depending on the methodology used for detection: 0.2% to 0.6% by abdominal palpation (343,344 and 345), 7% to 9% in autopsy series (Table 42-1) (346,347), 0.1% to 1.4% by prenatal ultrasonography (US) (348,349,350,351 and 352), and 1% to 2% in prospective studies using US screening (353,354,355,356 and 357). A similar incidence (1.3%) was found using a perinatal approach that combined family history, prenatal US, physical examination, and case-oriented neonatal imaging (356). In one large series, the male-to-female ratio for hydronephrosis was 2.4:1, compared to 1.4:1 for parenchymal anomalies (358).








TABLE 42-1 INCIDENCE OF RENAL AND URINARY TRACT MALFORMATIONS IN INFANCY































































































Author No. of Subjects Selection Criteria Method of Screening Most Common Anomalies (Final Diagnosis) No. of Subjects with Anomalies (% of Total)
Sherwood 1956 12,160 Consecutive NN Palpation confirmation by IVU Ectopia (7), horseshoe/fused kidneys (5), obstruction (6), Wilms (1) 22(0.2%)
Museles 1971 12,150 Consecutive NN Palpation confirmation by IVU Ectopia (7), horseshoe (4), agenesis (3) 22(0.2%)
Brion 1984 1,200 Consecutive NN Prenatal US (2/3), physical examination, US screening for various indications Hypoplasiaiagenesis (4), obstructive uropathy (8), reflux (1) 15(1.3%)
Helm 1986 11,986 Consecutive pregnancies Prenatal US Hydronephrosis (9), VUR (3), mild dilatation (10), cystic disease (3) 33(0.3%)
Steinhart 1988 437 Healthy infants US VUR (3), obstructive uropathy (3) 6(1.4%)
Gillerot 1988 900 NN autopsies Autopsy Dysplasia/agenesis (30), polycystic kidneys (18), obstructive uropathy (11), cloacal exstrophy (4) 63(7%)
Scott 1991 1,061 NN in well-baby nursery Postnatal US, followed by appropriate workup Duplex kidney (1), solitary kidney (2), hydronephrosis
Hydronephrosis (97),		 11(1.0%)
Scott 1993 242,628 Northern Region Fetal Abnormality Survey Population survey including both prenatal US and postnatal US VUR (16), renal agenesis (33), MKD (15), dysplasia (6), PKD (11), duplex kidney (15), megaureter (10), urethral valves 451(2%)
Jelen 1993 1,021 Consecutive neonates Postnatal US Hydronephrosis (6), MKD (2), duplication (4), agenesis (2) 20(2%)
Fugelseth 1994 22,310 Consecutive pregnancies Prenatal US at 17 and 32 wk Hydronephrosis (24), MKD (10) 47(0.2%)
Gunn 1995 3,856 Consecutive pregnancies Prenatal US after 28 wk, confirmed by postnatal US at 6 d to 6 wk Transient pylectasis (216), obstructive uropathy (23), VUR (14), MKD (8), urethral valves (3) 54(1.4%)
Kim 1996 5,442 Consecutive pregnancies Prenatal US confirmed by US Hydronephrosis (37), MKD (5), PKD (2), renal agenesis (2), ectopic kidney (1), hypoplastic kidney (1) 48(0.9%)
IVU, intravenous urography; MKD, multicystic kidney dysplasia; NN, newborn infants; PKD, polycystic kidney disease; US, ultrasonography; VUR, vesicoureteral reflux.

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Jul 1, 2016 | Posted by in OBSTETRICS | Comments Off on Clinical Evaluation of Renalfunction and Disease

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