Long Term Follow-Up Of Patients With Nonrefluxing Hydronephrosis

 

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Abstract

Backgound The aim of this study is to examine the long-term prognosis of children with ureteropelvic junction obstruction-like hydronephrosis (UPJO-like HN).

Patients and Methods The files of children with hydronephrosis (HN) were analyzed retrospectively. Patients with vesicoureteral reflux (VUR) and other genitourinary anomalies were excluded. The final status of the HN, the need for surgery, and urinary tract infection (UTI) frequency were evaluated.

Results The study included 219 patients with 302 renal units (RU) with HN. Surgery rate was higher in RUs with larger kidney size and parenchymal thinning (p:<0.001 for both). Hydronephrosis resolved in 113 (40.2%) RUs, improved in 66 (23.3%), unchanged in 100 (35.5%) and worsened in 4 (1.4%). The frequency of recovery and improvement was found to be less in RUs with severe HN, large kidney size, and thin parenchyma. The UTI frequency was higher in severe HN group (12.2% vs 30.6% p:<0.001).

Conclusions Children with mild HN had an excellent prognosis. Although the majority of the patients with high-grade HN had also a good prognosis, it seems important to closely follow up patients with severe HN, increased kidney size, and accompanying parenchymal thinning. Clinicians should be aware of the increased frequency of UTIs in children with severe HN.

Zusammenfassung

Hintergrund Das Ziel dieser Studie ist es, die Langzeitprognose von Kindern mit obstruktiver Hydronephrose des Ureter-Becken-Übergangs (UPJO-like HN) zu untersuchen.

Patienten und Methoden Die Akten von Kindern mit Hydronephrose (HN) wurden retrospektiv analysiert. Patienten mit vesikoureteralem Reflux (VUR) und anderen urogenitalen Anomalien wurden ausgeschlossen. Der endgültige Status des HN, die Notwendigkeit einer Operation und die Häufigkeit von Harnwegsinfektionen (HWI) wurden bewertet.

Ergebnisse Die Studie umfasste 219 Patienten mit 302 Niereneinheiten (RU) mit HN. Die Operationsrate war in RUs mit größerer Nierengröße und Parenchymverdünnung höher (p: <0,001 für beide). Die Hydronephrose verschwand in 113 (40,2%) RUs, besserte sich in 66 (23,3%), blieb in 100 (35,5%) unverändert und verschlechterte sich in 4 (1,4%). Es wurde festgestellt, dass die Häufigkeit der Erholung und Verbesserung bei RUs mit schwerem HN, großer Nierengröße und dünnem Parenchym geringer war. Die HWI-Häufigkeit war in der Gruppe mit schwerem HN höher (12,2% vs. 30,6%, p: <0,001).

Schlussfolgerungen Kinder mit leichter HN hatten eine ausgezeichnete Prognose. Obwohl die Mehrheit der Patienten mit hochgradigem HN ebenfalls eine gute Prognose hatte, scheint es wichtig, Patienten mit schwerem HN, vergrößerter Nierengröße und begleitender Parenchymverdünnung engmaschig zu überwachen. Ärzte sollten sich der erhöhten Häufigkeit von Harnwegsinfekten bei Kindern mit schwerer HN bewusst sein.

Publication History

Article published online:
21 November 2023

© 2023. Thieme. All rights reserved.

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