Early and follow-up results in children with obstructive malformation uropathies

Centrul Național Ştiințifico-Practic de Chirurgie Pediatrică “Natalia Gheorghiu”, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Introducere. Uropatiile malformative obstructive (hidronefroza, megaureterohidronefroza obstructivă, valve de uretră posterioară etc.) rămân în continuare o serioasă problemă medico-chirurgicală prin infecțiile de tract urinar pe care le generează, prezentând recidive frecvente, acutizări, cât şi dificultăți legate de corecția chirurgicală. Prognosticul este dependent de depistarea cât mai precoce a uropatiei malformative obstructive şi corecția ei în perioada de remisie. Material şi metodă. Studiul este o cercetare retrospectivă a 163 pacienți cu uropatii malformative obstructive tratați în Centrul Național Ştiințifico-Practic de Chirurgie Pediatrică “Natalia Gheorghiu” pe o perioadă de 10 ani (2000-2010). Indicațiile terapeutice la pacienți au fost fundamentate pe criterii clinice: evidența infecției urinare repetate, alterarea funcției renale, determinarea markerilor de laborator, datelor imagistice: ecografia sistemului urinar, scintigrafia renală, urografia intravenoasă, cistouretrografia micțională etc. Rezultatele imediate şi tardive sunt condiționate de stadiul evolutiv în care s-a aplicat tratamentul chirurgical, de corectitudinea indicației şi rezolvarea chirurgicală, de tratamentele pre- şi postoperatorii, dispensarizarea adecvată.Introduction. Kidneys obstructive congenital abnormalities (hydronephrosis, obstructive megaureterohidronephrosis, posterior urethra valves, etc.) remain a serious medico-surgical problem in urinary tract infections, giving frequent relapses, acute exacerbation, and difficulties in surgical correction. The prognosis depends on early detection of kidneys obstructive congenital abnormalities and its correction during the remission. Material and methods. This research is a retrospective study of 163 patients with kidneys obstructive congenital abnormalities treated at National Scientific and Practical Center of Pediatric Surgery “Natalia Gheorghiu” in 10 years period (2000-2010). Therapeutic indications in patients were based on the following clinical criteria: observation of recurrent urinary tract infection, impairments of renal function, determining laboratory markers, data of imaging techniques: ultrasound of urinary system, renal scintigraphy, intravenous urography, cystouretrography. Immediate and late results are conditioned by the evolutionary stage in which the surgical treatment has been applied, by the adequate indications and the surgical solution, by the pre- and post-operative treatment and by the adequate follow-up

Disparities in treatment rates of paediatric end-stage renal disease across Europe: insights from the ESPN/ERA-EDTA registry.

BACKGROUND Considerable disparities exist in the provision of paediatric renal replacement therapy (RRT) across Europe. This study aims to determine whether these disparities arise from geographical differences in the occurrence of renal disease, or whether country-level access-to-care factors may be responsible. METHODS Incidence was defined as the number of new patients aged 0-14 years starting RRT per year, between 2007 and 2011, per million children (pmc), and was extracted from the ESPN/ERA-EDTA registry database for 35 European countries. Country-level indicators on macroeconomics, perinatal care and physical access to treatment were collected through an online survey and from the World Bank database. The estimated effect is presented per 1SD increase for each indicator. RESULTS The incidence of paediatric RRT in Europe was 5.4 cases pmc. Incidence decreased from Western to Eastern Europe (-1.91 pmc/1321 km, P < 0.0001), and increased from Southern to Northern Europe (0.93 pmc/838 km, P = 0.002). Regional differences in the occurrence of specific renal diseases were marginal. Higher RRT treatment rates were found in wealthier countries (2.47 pmc/€10 378 GDP per capita, P < 0.0001), among those that tend to spend more on healthcare (1.45 pmc/1.7% public health expenditure, P < 0.0001), and among countries where patients pay less out-of-pocket for healthcare (-1.29 pmc/11.7% out-of-pocket health expenditure, P < 0.0001). Country neonatal mortality was inversely related with incidence in the youngest patients (ages 0-4, -1.1 pmc/2.1 deaths per 1000 births, P = 0.10). Countries with a higher incidence had a lower average age at RRT start, which was fully explained by country GDP per capita. CONCLUSIONS Inequalities exist in the provision of paediatric RRT throughout Europe, most of which are explained by differences in country macroeconomics, which limit the provision of treatment particularly in the youngest patients. This poses a challenge for healthcare policy makers in their aim to ensure universal and equal access to high-quality healthcare services across Europe