The renal system
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella in Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
The backward flow of urine from the bladder into the ureters and kidneys (vesicoureteral reflux) or from the urethra into the bladder (urethrovesical reflux).Generally results from congenital abnormalities in the structure or location of the ureters or urethra. May also occur from strictures or scarring.Patients often present with urine retention and recurrent urinary tract infections that can lead to pyelonephritis.Treatment may include antibiotic therapy and possible surgical correction of the structural abnormality.
Vesicoureteral reflux
Prem Puri in Newborn Surgery, 2017
Primary vesicoureteral reflux (VUR)—the retrograde flow of urine from the bladder into the upper urinary tract—is the most common urological anomaly in children. It occurs in 1%–2% of the pediatric population and in 30%–50% of children who present with urinary tract infection (UTI).1,2 The association of VUR, UTI, and renal damage is well known. Marra et al.3 reviewed data on children with chronic renal failure who had high-grade VUR in the Italkid project, a database of Italian children with chronic renal failure, and found that those with VUR accounted for 26% of all children with chronic renal failure. Parenchymal injury in VUR occurs early, in most patients before age 3 years. Kidneys of young infants are more vulnerable to renal damage. Most renal scars are present when reflux is discovered at initial evaluation for UTI. One of the main goals of treating the child with VUR is prevention of recurring febrile UTIs and minimizing risk of renal damage and long-term renal impairment.
Dyssynergic sphincter
Jacques Corcos, David Ginsberg, Gilles Karsenty in Textbook of the Neurogenic Bladder, 2015
Clinical manifestations of detrusor–sphincter dyssynergia can be described in patients without neurological disease. Symptoms are long voiding duration, hesitancy, intermittent stream, straining to void, recurrent cystitis, enuresis, frequent voiding, pain during voiding, and anal discomfort. Vesicoureteral reflux can be observed. The etiology of detrusor–sphincter dyssynergia in these non-neurological patients may be discussed. Highly frequent intermittent spasms of the urethra during voiding represents a persistent transitional phase in the development of the cerebral control of voiding.28 Psychogenic causes and history of sexual abuses or rigid education may be searched. In these cases, failure of relaxation of external (striated muscle) urethral sphincter during detrusor contraction results in a micturitional disorder, and perineal EMG demonstrates no evidence of denervation with increased activity during attempts to void.
The relevance of practical laboratory markers in predicting high-grade vesicoureteral reflux and renal scarring
Published in Hospital Practice, 2023
Fatma Yazılıtaş, Evrim Kargın Çakıcı, Ayse Secil Eksioglu, Tülin Güngör, Evra Çelikkaya, Deniz Karakaya, Çiğdem Üner, Mehmet Bülbül
Vesicoureteral reflux (VUR), is one of the most common congenital urinary tract abnormalities, known as retrograde urine flows from the bladder up to one or both ureters and the collecting duct systems of the kidney. It is also a risk factor for recurrent UTIs, and it is associated with serious consequences such as acquired renal scarring, hypertension, and renal failure, especially for infants [1,2]. The higher grade of VUR is the greatest risk for recurrent febrile UTI and renal scarring [3]. Recently, it has been reported that low-grade VUR may not cause kidney damage [3–5]. It is important to detect the presence of high-grade VUR to preserve kidney function by minimizing the risk of UTIs in children [1–3]. The gold standard imaging method for the diagnosis of VUR is voiding cystourethrography (VCUG) which offers accurate anatomic detail and grading of VUR. Unfortunately, this method is an invasive and expensive procedure with complications such as pain, and risk of infection, and exposure to radiation [3,5,6]. There is no study examining potential accurate, noninvasive biomarkers for the ability to discriminate high-grade VUR from low-grade VUR in children. Due to the invasive and discomfort nature of VCUG described above, researchers have investigated procalcitonin, C-reactive protein (CRP), WBC as noninvasive and widely used serum biomarkers to predict VUR [5,7,8].
Comparing the role of renal ultrasound vs MAG3 renal scans for evaluation of neurogenic bladder after spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2023
Ryan Solinsky, Susan V. Garstang, Todd A. Linsenmeyer
This retrospective chart review of patients with SCI included consecutive individuals with neurogenic bladder who were being seen for annual urologic evaluation at our single-site academic medical center in the Northeastern United States from 1997 to 1999. This date range was selected as a unique time period when the standard of care included both MAG3 renal scans and renal ultrasound, performed together as part of a single evaluation. All ages and sexes, individuals with both upper and lower motor neuron bladders, and individuals using any methods of urinary drainage were included. At the time of the retrospective review, all individuals with SCI had a MAG3 renal scan without diuretic, renal ultrasound and cystogram as part of their annual evaluation. Since vesicoureteral reflux has the potential to appear as upper tract stasis and not give the true picture of urine transport from the kidneys, individuals were excluded if they demonstrated ureteral reflux or had a history of urinary diversion procedures with ureteral reimplantation.
Transient pseudohypo-aldosteronism
Published in Paediatrics and International Child Health, 2019
Neslihan Günay, Zeynep Küçükaydın, Seda Pınarbaşı, İsmail Dursun, Ruhan Düşünsel
A 53-day-old boy was admitted with fever and vomiting for 2 days. He had gained only 500 g a month since birth. Urinalysis confirmed a UTI. Serum sodium was 114 mmol/L (135–144), potassium 6.1 mmol/L (3.6–4.8), chloride 90 mmol/L (98–106), glucose 5.2 mmol/L (3.3–5.5), blood urea nitrogen 15.7 mmol/L (2.1–16.1), creatinine 66.3 μmol/L (15.0–37.1), bicarbonate 13 mmol/L (19–24) and urine sodium 26 mmol/L. Laboratory findings were compatible with hypo-aldosteronism and acute kidney injury. He was prescribed ampicillin and gentamicin, intravenous fluids and sodium bicarbonate. Klebsiella pneumonia (>106 colony-forming units/mL) was confirmed from the urine culture. Serum aldosterone and renin levels were 1253.2 ng/dL (3.7–43.2) and 179.4 pmol/L (<0.85), respectively. Ultrasound demonstrated bilateral grade 2 pelvicaliceal ectasia and ureteral dilation. Voiding cysto-ureterography showed bilateral grade 5 vesicoureteral reflux (VUR). It was treated by endoscopic correction with a subureteric injection of deflux, which is a viscous gel consisting of dextranomer microspheres and stabilised non-animal hyaluronic acid. Following these treatment strategies, his clinical condition and laboratory abnormalities returned to normal.