Development of pediatric hydronephrosis patients visiting the San Vicente Foundation University Hospital, Medellín, Colombia

ABSTRACT: Hydronephrosis is one of the most common congenital malformations detected on prenatal ultrasounds. Moderate and severe cases are often associated with urological abnormality. Objetive: To describe a series of pediatric patients diagnosed with hydronephrosis determining their etiology, prenatal diagnosis and frequency of chronic kidney disease (CKD). Materials and methods: A descriptive, retrospective study. Results: The records of 924 patients between the ages of 0 and 18 years were evaluated, 35.7% female and 64.3% male. In 14.4% (133) the diagnosis was prenatal. Hydronephrosis was bilateral in 198 patients (28.5%). In 18.3% (169) no associated urological abnormality was found, reaching 4.2% in CKD (7). Ureteropelvic stenosis was diagnosed in 23.3% (216) followed with 21.5% VUR (199) and posterior urethral valves in 9.4% (87), reaching 10.2% ERC (93). When the hydroneprhosis was diagnosed by urography, those patients presented 11.3% of chronic kidney disease vs. 8.4% in whom the diagnosis was made by ultrasound, when the hydronephosis diagnosed was by prenatal vs postnatal ultrasound, the percentage of CKD was 4.8% vs 10.8%, respectively. Conclusion:Early diagnosis of hydronephrosis allows the detection of urologic abnormalities susceptible of treatment. Although there are still many questions about which one is the ideal strategy of follow up; the ultrasonography, voiding cystourethrogram, urography, scintigraphy and magnetic resonance urography in selected patients are the most useful tools in order to evaluate urinary tract anomaly

Evolution of pediatric patients diagnosed with hydronephrosis at Hospital Universitario San Vicente Fundación, in Medellín, Colombia between 1960 and 2010

ABSTRACT: Hydronephrosis is one of the most common congenital malformations detected on prenatal ultrasounds. Moderate and severe cases are often associated with urological abnormalities. Objective: To describe the causes of hydronephrosis, and the frequency of its prenatal diagnosis and of chronic kidney disease (CKD) in a series of pediatric patients. Materials and methods: A descriptive, retrospective study of 924 patients under 18 years of age seen at a university hospital in Medellín, Colombia, between 1960 and 2010. Results: 64.3% were male. Diagnosis was prenatal in 133 (14.4%). Hydronephrosis was bilateral in 198 patients (28.5%). In 169 (18.3%) no associated urological abnormality was found; 7 of these (4.2%) reached CKD. Ureteropelvic stenosis was diagnosed in 216 (23.3%) followed by vesicoureteral reflux in 199 (21.5%) and posterior urethral valves in 87 (9.4%); 93 (10.2%) reached CKD. When hydronephrosis was diagnosed by urography, patients developed CKD in 11.3% vs. 8.4% in those whose diagnosis was made by ultrasound; frequency of CKD was 4.8% when diagnosis by ultrasound was prenatal, and 10.8% when it was postnatal. Conclusion: Early diagnosis of hydronephrosis allows the detection of urologic abnormalities susceptible to treatment. There is controversy about the best imaginological method for the follow-up of these patients.RESUMEN: La hidronefrosis es una de las malformaciones congénitas detectadas comúnmente en la ecografía prenatal. Los casos moderados y graves frecuentemente se asocian a anomalías de la vía urinaria. Objetivo: describir las causas de la hidronefrosis, la frecuencia de su diagnóstico prenatal y la de enfermedad renal crónica (ERC) en una serie de pacientes pediátricos. Materiales y métodos: estudio descriptivo, retrospectivo de 924 pacientes atendidos entre 1960 y 2010 en un hospital universitario de Medellín. Resultados: hubo predominio de hombres (64,3%); en el 14,4% el diagnóstico fue prenatal. En el 18,3% no se encontraron anomalías urológicas asociadas. Siete de estos (4,2%) llegaron a la ERC. La estenosis pieloureteral fue la anomalía hallada con mayor frecuencia (28,6%) seguida por el reflujo vesicoureteral (21,5%) y las valvas de la uretra posterior (9,4%); el 10,2% de los pacientes llegaron a la enfermedad renal crónica; al agrupar los pacientes de acuerdo con el método utilizado para el diagnóstico de hidronefrosis, el grupo en que se hizo por urografía excretora tuvo ERC en el 11,3%, en contraste con el 8,4% en quienes el diagnóstico se hizo por ecografía renal; por otro lado. al agrupar los pacientes con diagnóstico ecográfico de hidronefrosis prenatal o posnatal, el porcentaje de ERC fue de 4,8% frente a 10,8%, respectivamente. Conclusión: el diagnóstico temprano de la hidronefrosis permite detectar anomalías urológicas susceptibles de seguimiento o corrección quirúrgica. Todavía existe mucha controversia acerca del mejor seguimiento imaginológico para estos pacientes