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Urinary tract infection
Published in Samar Razaq, Difficult Cases in Primary Care, 2021
UTIs are an important differential in the list of potential diagnoses in a febrile child. A UTI should always be considered in a febrile child with no obvious focus of infection. Acutely, UTIs can cause serious bacteraemia, particularly in infants. Prior to the availability of antibiotics, UTIs were potentially fatal. Now, there is greater interest in the potential long-term consequences of UTIs and how they can be avoided. The understanding of VUR and how it may be related to kidney damage and long-term complications has shaped the management of UTIs. VUR refers to the retrograde movement of urine from the bladder towards the kidneys. The damage done to the kidney by this abnormal flow, in the form of scarring, is termed reflux nephropathy. Whereas prospective studies have failed to consistently show a strong relation between reflux nephropathy and long-term complications, retrospective studies have linked renal scarring secondary to UTIs with later development of chronic kidney disease, hypertension and pre-eclampsia. Since retrospective trials look mainly at children who are being seen in tertiary centres (hence are likely to have suffered from recurrent infections and have significant reflux nephropathy), it would be unwise to extrapolate this data to apply to children with uncomplicated febrile UTIs who make uneventful recoveries in primary care.
Disorders of the renal system
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Reflux nephropathy is one of the most common complications of the renal system for young women, and they are at particular risk in pregnancy of superimposed complications such as pre-eclampsia, hypertension, intrauterine growth restriction and a decline in the general renal function. Reflux nephropathy involves reflux of urine from the bladder to the ureters (vesicoureteric reflux: VUR) which causes the development of infection in the kidneys with progressive loss of functioning nephrons. Reflux nephropathy is characterised by moderate to severe renal damage, reduced GFR, proteinuria, recurrent urinary tract infection and concurrent hypertension. This combination of features gives rise to a poor pregnancy outcome. There can be a sudden escalation of blood pressure with superimposed pre-eclampsia and irreversible progression of renal damage during pregnancy. Severe intrauterine growth restriction may occur6.
Renal disease
Published in Catherine Nelson-Piercy, Handbook of Obstetric Medicine, 2020
Reflux nephropathy may be inherited as an autosomal dominant condition, and therefore offspring of affected mothers should be screened with a micturating cystogram, as US may miss the diagnosis. It is common to start prophylactic antibiotics if there is suspicion that the child may have reflux nephropathy.
Trends in the surgical management of vesicoureteral reflux in Finland in 2004–2014
Published in Scandinavian Journal of Urology, 2021
Liisi Ripatti, Hanna-Reeta Viljamaa, Tommi Kauko, Ville Kytö, Päivi Rautava, Jussi Sipilä, Niklas Pakkasjärvi
VUR remains a multifaceted disease and the treatment needs to be tailored to the individual patients. Operative treatment usually opts after break-through infections. The current trend seems to evolve towards less invasive treatments with bulking agent injections, and the open ureteral reimplantations are diminishing. Still, open ureteral reimplantations need to be kept in the armoury for circumstances where non-operative treatment and bulking agent injections are deemed insufficient. The optimal treatment mode for higher grade VUR with regards to future renal parenchymal disease is controversial. The main goal of treatment still remains long-term renal health, while up to 20% of children with reflux nephropathy suffer from hypertension or end-stage renal disease [29]. Thus, operative treatment is not to be neglected in the treatment of VUR.
Risk factors analysis for hyperuricemic nephropathy among CKD stages 3–4 patients: an epidemiological study of hyperuricemia in CKD stages 3–4 patients in Ningbo, China
Published in Renal Failure, 2018
Yong-Yao Wu, Xiao-Hui Qiu, Yun Ye, Chao Gao, Fuquan Wu, Guihua Xia
The CKD 3–4 patients recruited in this study were from the Nephrology department, the Beilun People's Hospital, Ningbo, Zhejiang, China (Beilun Branch of the first Affiliated Hospital of Zhejiang University) during August 2014 and July 2016. Inclusion criteria for CDK stage 3–4 patients were: (1) aged 20- to 70-year old; (2) biopsy-proven primary glomerulopathy; (3) with new-diagnosed primary glomerulopathy without any drug therapy; (4) patients at CKD stages 3 to 4 determined according to the National Kidney Foundation criteria [23]. Moreover, the patients with one of diseases such as reflux nephropathy, obesity, HIV, and other infections, malignant cancers, autoimmune diseases, drug therapies (ACE-I/ARB, steroids, immunosuppressants, and etc.), and hereditary kidney diseases were excluded from this study. Accordingly, a total of 461 CKD 3−4 patients (male = 372, 80.7%; female = 89, 19.3%) were included. Then, the clinical data including blood pressure, body mass index (BMI), eGFR [24], perimeter of abdomen and hip, history of alcoholism and smoking, water and alcohol consumption, high purine food intake amount and frequency, and exercise were recorded.
Changes of arterial pressure following relief of obstruction in adults with hydronephrosis
Published in Upsala Journal of Medical Sciences, 2018
Ammar Al-Mashhadi, Michael Häggman, Göran Läckgren, Sam Ladjevardi, Tryggve Nevéus, Arne Stenberg, A. Erik G. Persson, Mattias Carlström
In a study by Menon et al. (24) in children with hydronephrosis and less than 20% renal function in the affected unit only three out of 62 patients developed hypertension, which in two cases resolved after surgery. Furthermore, they showed that no case of hypertension occurred in this group of patients without signs of obstruction after surgery, during the long-term follow-up (up to 8 years). In our current study, we tried to investigate if there is a correlation between renal function results according to MAG3 and blood pressure changes after relief of the obstruction. Based on findings in our current study, it was clear that in spite of preserved split renal function of the hydronephrotic kidney, the arterial pressure was elevated. Moreover, there was no correlation between MAG3 split renal function and the reduction in arterial pressure after relief of the obstruction. It has, however, previously been established that children with reflux nephropathy, i.e. renal parenchymal defects associated with vesicoureteral reflux, have an increased risk for hypertension (25). What is not known is whether this risk pertains to all scintigraphic uptake defects or only those that are due to acquired renal damage (‘scarring’) as opposed to congenital hypoplasias—since these subgroups are difficult or impossible to differentiate clinically. The same ambiguities pertain to children with hydronephrosis.