ESPN 50th Annual Meeting

ESPN 2017


 
CONGENITAL ANOMALIES OF THE KIDNEY AND URINARY TRACT (CAKUT) - PRE AND POSTNATAL DIAGNOSIS
CRISTINA FERRERAS 3 Marta Isabel Pinheiro 3 RIBEIRO CASTRO 2 ARMANDO REIS 2 CéLIA MADALENA 1

1- DEPARTMENT OF PEDIATRICS. CENTRO HOSPITALAR DE PóVOA DE VARZIM/VILA DO CONDE, PORTO-PORTUGAL
2- DEPARTMENT OF UROLOGY. CENTRO MATERNO-INFANTIL DO NORTE, PORTO-PORTUGAL
3- DEPARTMENT OF PEDIATRICS. CENTRO HOSPITALAR DE S. JOãO, PORTO-PORTUGAL
 
Introduction:

 Congenital anomalies of the kidney and urinary tract (CAKUT) constitute 20 to 30% of all malformations identified in the prenatal period, with the overall rate of  0,3 to 1,6 per 1000 newborns. CAKUT are the most common cause of chronic kidney disease and end-stage renal disease in the pediatric population. The goal of prenatal screening  is to identify  pathologic conditions that would require postnatal therapy in order to prevent or delay these complications.

This study aims to determine the incidence rate of CAKUT in newborn and their clinical and imagiologic outcomes.

Material and methods:

 Retrospective study of medical reports of infants born at Centro Hospitalar Póvoa de Varzim/Vila do Conde, Portugal from 2001 to 2016. Hydronephrosis was defined an anteroposterior diameter of the renal pelvis (APD)  ≥ 5 mm and has been classified in mild (5–9 mm), moderate (≥10–14 mm) or severe (≥15 mm). Size and structure of the kidney, dilatation of calices or ureters, and bladder morphology were also considered.

Results:

 In accordance with the hospitals CAKUT´s protocol, 885 children were studied. The incidence was 4,8%, of which 70% were male. Hydronephrosis was diagnosed by prenatal ultrasound in 96% (49% bilateral). In 37% there was no postnatal ultrasound hydronephrosis confirmation. The postnatal diagnosis included: transient hydronephrosis (43%), ureteropelvic junction (5%), vesicoureteral reflux (3.3%), duplex collecting system (3.2%), renal agenesis (1.8%), megaureter (1.1%) and multicystic displastic kidney (0.6%). Surgery was performed in 3.2% of patients. The mean follow up duration was 10 months (1 month-16 years). 

Conclusions:

 Correct identification and adequate follow up of patients at risk is a challenge. Although most of the hydronephrosis detected in the prenatal period do not correspond to significant nephro-urological pathology, early ultrasound diagnosis is important in the detection of severe malformations and prevention of complications.