1
|
|
2
|
|
3
|
Talati AN, Webster CM, Vora NL. Prenatal genetic considerations of congenital anomalies of the kidney and urinary tract (CAKUT). Prenat Diagn 2019; 39:679-692. [PMID: 31343747 DOI: 10.1002/pd.5536] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/16/2019] [Accepted: 07/20/2019] [Indexed: 12/20/2022]
Abstract
Congenital anomalies of the kidney and urinary tract (CAKUT) constitute 20% of all congenital malformations occurring in one in 500 live births. Worldwide, CAKUT are responsible for 40% to 50% of pediatric and 7% of adult end-stage renal disease. Pathogenic variants in genes causing CAKUT include monogenic diseases such as polycystic kidney disease and ciliopathies, as well as syndromes that include isolated kidney disease in conjunction with other abnormalities. Prenatal diagnosis most often occurs using ultrasonography; however, further genetic diagnosis may be made using a variety of testing strategies. Family history and pathologic examination can also provide information to improve the ability to make a prenatal diagnosis of CAKUT. Here, we provide a comprehensive overview of genetic considerations in the prenatal diagnosis of CAKUT disorders. Specifically, we discuss monogenic causes of CAKUT, associated ultrasound characteristics, and considerations for genetic diagnosis, antenatal care, and postnatal care.
Collapse
Affiliation(s)
- Asha N Talati
- Department of Obstetrics and Gynecology, DRAFT, Division of Maternal Fetal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Carolyn M Webster
- Department of Obstetrics and Gynecology, DRAFT, Division of Maternal Fetal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Neeta L Vora
- Department of Obstetrics and Gynecology, DRAFT, Division of Maternal Fetal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
4
|
Sharony R, Engel O, Litz-Philipsborn S, Sukenik-Halevy R, Biron-Shental T, Evans MI. The impact of third-trimester genetic counseling. Arch Gynecol Obstet 2018; 297:659-665. [PMID: 29306968 DOI: 10.1007/s00404-017-4638-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/19/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the impact of genetic counseling (GC) during the third trimester by analyzing changes in pregnancy management and the correlation with postnatal findings. METHODS This was a retrospective study. Pregnancy course and neonatal follow-up were analyzed according to the reason for referral and implementation of recommendations. RESULTS The records of neonates born to 181 women were retrieved. Fifty-two women (group 1-29%) qualified for pregnancy termination under Israeli guidelines and laws, and 129 (group 2-71%) were not at the time they were referred. By another division: 104 women (group 3-57%) followed the physician's diagnostic recommendations completely after counseling including amniocentesis, fetal MRI, targeted ultrasound scans, fetal echocardiography. Seventy-seven declined amniocentesis (group 4-43%). Additional abnormalities were detected postpartum in all groups without statistically difference: 3/52 (10%) in group 1, 9/129 (7%) in group 2, 6/104 (6%) in group 3, and 6/77 (8%) in group 4). CONCLUSION GC in the third trimester of pregnancy provided the couple with a sharper more focused picture and assisted them to perceive the significance of new, significant fetal findings which attest to the value of the GC.
Collapse
Affiliation(s)
- Reuven Sharony
- The Genetics Institute, Meir Medical Center, Kfar Saba, Israel. .,Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Offra Engel
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
| | | | - Rivka Sukenik-Halevy
- The Genetics Institute, Meir Medical Center, Kfar Saba, Israel.,Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mark I Evans
- Department of Obstetrics and Gynecology, Fetal Medicine Foundation of America, Comprehensive Genetics PLLC, Mt. Sinai School of Medicine, New York, USA
| |
Collapse
|
5
|
Outcomes of prenatally diagnosed solitary functioning kidney during early life. J Perinatol 2017; 37:1325-1329. [PMID: 29072675 DOI: 10.1038/jp.2017.143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 06/11/2017] [Accepted: 06/14/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To evaluate outcomes of congenital solitary functioning kidney (SFK) in early childhood. STUDY DESIGN A retrospective study of 32 children diagnosed in utero with SFK owing to unilateral renal agenesis or multicystic dysplastic kidney and followed for 1 to 11.5 years. RESULTS SFK length was in the compensatory hypertrophy range in 45% of fetal sonographic evaluations from mid-pregnancy, and in 85% on postnatal follow-up. Glomerular filtration rate was below normal range in 44.4%, 12.5% and 0% at <1 year, age 1 to 3 years and thereafter, respectively. Hyperfiltration was detected in 18.5% and 82.6% at <1 year and >3 years, respectively. Hypertension was documented in 35% at age 1 to 3 years but in none at an older age. Proteinuria was absent in all children. CONCLUSION Congenital SFK is apparently associated with little or no renal damage in infancy or childhood. Compensatory enlargement of the functioning kidney begins in utero and might serve as a prognostic indicator for normal renal function after birth.
Collapse
|
6
|
Hamdaoui N, Dabadie A, Lesieur E, Quarello E, Kheiri M, Hery G, Guidicelli B, Bretelle F, Gorincour G. [Ultrasound of the fetal urinary system during the first trimester of pregnancy]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2017; 45:373-380. [PMID: 28552751 DOI: 10.1016/j.gofs.2017.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/02/2017] [Indexed: 12/27/2022]
Abstract
The detection of abnormalities of the fetal urinary system in the first trimester of pregnancy is constantly improving, namely owing to the improved resolution of the image, the use of the endovaginal approach and thanks to sonographers' constant training. The pathological aspects, usually detected in the second trimester of pregnancy, can be suspected early in the first trimester and range from kidneys' cavity dilation to bilateral renal agenesis, polycystic kidney disease, multi-cystic dysplasia and bladder megavessia or bladder exstrophy. A poly-malformative syndrome is to be found out. The detection of an abnormality of the urinary tract requires a close ultrasound check. Very often, the pathological aspects tend to disappear spontaneously. In particular, the non-visualization of the bladder requires repeated examinations during the same session or even a little later in the pregnancy. We will carry out a review of the literature by pointing out the usual and unusual aspects of the fetal urinary system visible in the first trimester and we will as well propose an algorithm describing how to deal with abnormalities of the urinary tract that can be found out at first trimester ultrasound.
Collapse
Affiliation(s)
- N Hamdaoui
- Centre de diagnostic prénatal, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France.
| | - A Dabadie
- Service d'imagerie pédiatrique et prénatale, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
| | - E Lesieur
- Centre de diagnostic prénatal, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
| | - E Quarello
- Département d'échographies obstétricales, fondation-hôpital Saint-Joseph, 26, boulevard de Louvain, 13008 Marseille, France; Institut de médecine de la reproduction, 6, rue Rocca, 13008 Marseille, France
| | - M Kheiri
- Service d'imagerie pédiatrique et prénatale, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
| | - G Hery
- Centre de diagnostic prénatal, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France; Service de chirurgie pédiatrique, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
| | - B Guidicelli
- Centre de diagnostic prénatal, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
| | - F Bretelle
- Centre de diagnostic prénatal, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
| | - G Gorincour
- Centre de diagnostic prénatal, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France; Service d'imagerie pédiatrique et prénatale, hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
| |
Collapse
|
7
|
Khan MN, Walsh WF. Bladder agenesis, ectopic ureters and a multicystic dysplastic horseshoe kidney in one twin newborn with normal amniotic fluid index in utero. BMJ Case Rep 2016; 2016:bcr-2016-216518. [PMID: 27932430 DOI: 10.1136/bcr-2016-216518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A monochorionic-diamniotic twin baby presented with intrauterine growth restriction and anuria. The baby was found to have bladder agenesis, a pelvic dysplastic horseshoe kidney, vertebral anomalies, a ventricular septal defect and facial dysmorphisms. It was surprising to find no abnormalities in amniotic fluid indices prenatally, suggesting the possibility of urine output that declined as the pregnancy proceeded. Some degree of twin-to-twin transfusion of amniotic fluid was also possible, which could have rescued the oligohydramnios known to be associated with kidney and urinary tract abnormalities. It was also notable that there was no abnormality in respiratory function, especially since further investigations revealed close to no kidney function. The intrauterine growth restriction (IUGR) along with the multiple anomalies found made the baby unsuitable for dialysis and transplant, and the decision of transition to palliative care was made.
Collapse
|
8
|
Schultza K, Todab LY. Genetic Basis of Ureterocele. Curr Genomics 2016; 17:62-9. [PMID: 27013924 PMCID: PMC4780476 DOI: 10.2174/1389202916666151014222815] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 05/16/2015] [Accepted: 06/23/2015] [Indexed: 11/23/2022] Open
Abstract
Congenital anomalies of the kidney and urinary tract (CAKUT) form a group of heterogeneous disorders that affect the kidneys, ureters and bladder, with frequent asynchronous presentations and multiple CAKUT associations in the same individual. Urinary tract formation is a complex process, dependent of the interaction of multiple genes and their sub-product. The same genic alterations can lead to different molecular expressions and different morphological anomalies. The ureterocele is a cystic dilation of the distal intramural ureter, resulting in obstruction of urine flow, dilation of the ureter and renal pelvis and loss of renal function. Two key steps in the urinary tract ontogenesis may be related to ureterocele development: formation and migration of the ureteric bud and its incorporation in the bladder. This review aims to describe the morphological, cellular and biochemical steps, as well as the genes involved in the occurrence of this anomaly.
Collapse
Affiliation(s)
- Karin Schultza
- Department of Urology, Hospital Pequeno Principe, Curitiba, Parana, Brazil
| | - Lia Yoneka Todab
- Department of Pediatric Surgery, Universidade Estadual de Maringa, Hospital Universitário de Maringa, Maringa, Parana, Brazil
| |
Collapse
|
9
|
Le syndrome de Beckwith-Wiedemann : que faut-il rechercher en anténatal ? À propos d’une série de 14 cas. ACTA ACUST UNITED AC 2015; 43:705-11. [DOI: 10.1016/j.gyobfe.2015.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Indexed: 12/23/2022]
|
10
|
Jiang H, Li L, Yang H, Bai Y, Jiang H, Li Y. Pax2 may play a role in kidney development by regulating the expression of TBX1. Mol Biol Rep 2014; 41:7491-8. [PMID: 25106525 DOI: 10.1007/s11033-014-3639-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 07/21/2014] [Indexed: 11/24/2022]
Abstract
Renal anomaly is commonly found among patients with loss of TBX1 gene, encoding an important transcriptional factor implicated in numerous developmental processes. Pax2 is a member of the "paired-box" (PAX) family of homeotic genes that orchestrates the patterns of gene expression in specific cells during nephrogenesis. In this study, we hypothesized that Pax2 might activate expression of TBX1, a member of T-box family that closely involving in kidney development. Immunohistochemical and immunofluorescence staining was performed to detect TBX1 expression in E16.5 embryonic rat kidney, while luciferase assay, electrophoretic mobility shift assay (EMSA), and chromatin immunoprecipitation (ChIP) assay were used to confirm the interaction between the Pax2 protein and TBX1 genes. TBX1 was expressed in the cytoplasm of renal tubular epithelial cells in the cortex of E16.5 fetal rat kidney. Inspection of the 5'-flanking sequence of the TBX1 gene identified a putative Pax2 recognition motif (TBX1-577). Luciferase assay and EMSA confirmed this novel promoter region of TBX1 that directly interacted with Pax2, and a site mutation could abolish the transcriptional activation of the TBX1 promoter by Pax2. ChIP assay of the Pax2-TBX1 promoter complex from human kidney epithelial cells further confirmed that endogenous Pax2 interacted with TBX1 promoter region. Thus, Pax2 directly regulates TBX1 expression in vivo. These findings suggest that Pax2 may regulate the TBX1 expression through specific binding to the TBX1 promoter, which may shed light on the potential mechanism of Pax2 and TBX1 in nephrogenesis and renal malformations.
Collapse
Affiliation(s)
- Hongkun Jiang
- Department of Pediatrics, First Affiliated Hospital of China Medical University, Shenyang, 110001, China,
| | | | | | | | | | | |
Collapse
|
11
|
Dias T, Sairam S, Kumarasiri S. Ultrasound diagnosis of fetal renal abnormalities. Best Pract Res Clin Obstet Gynaecol 2014; 28:403-15. [PMID: 24524801 DOI: 10.1016/j.bpobgyn.2014.01.009] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 01/06/2014] [Accepted: 01/20/2014] [Indexed: 12/14/2022]
Abstract
Development of the urogenital system in humans is a complex process; consequently, renal anomalies are among the most common congenital anomalies. The fetal urinary tract can be visualised ultrasonically from 11 weeks onwards, allowing recognition of megacystis at 11-14 weeks, which warrants comprehensive risk assessment of possible underlying chromosomal aneuploidy or obstructive uropathy. A mid-trimester anomaly scan enables detection of most renal anomalies with higher sensitivity. Bilateral renal agenesis can be confirmed ultrasonically, with empty renal fossae and absent bladder filling, along with severe oligohydramnios or anhydramnios. Dysplastic kidneys are recognised as they appear large, hyperechoic, and with or without cystic spaces, which occurs within the renal cortex. Presence of dilated ureters without obvious dilatation of the collecting system needs careful examination of the upper urinary tract to exclude duplex kidney system. Sonographically, it is also possible to differentiate between infantile type and adult type of polycystic kidney diseases, which are usually single gene disorders. Upper urinary tract dilatation is one of the most common abnormalities diagnosed prenatally. It is usually caused by transient urine flow impairment at the level of the pelvi-ureteric junction and vesico-ureteric junction, which improves with time in most cases. Fetal lower urinary tract obstruction is mainly caused by posterior urethral valves and urethral atresia. Thick bladder walls and a dilated posterior urethra (keyhole sign) are suggestive of posterior urethral valves. Prenatal ultrasounds cannot be used confidently to assess renal function. Liquor volume and echogenicity of renal parenchyma, however, can be used as a guide to indirectly assess the underlying renal reserve. Renal tract anomalies may be isolated but can also be associated with other congenital anomalies. Therefore, a thorough examination of the other systems is mandatory to exclude possible genetic disorders.
Collapse
Affiliation(s)
- Tiran Dias
- Department of Obstetrics and Gynecology, District General Hospital, Ampara, Sri Lanka.
| | - Shanthi Sairam
- Fetal Medicine and Fetal Cardiology, Mediscan, Chennai, India
| | - Shanya Kumarasiri
- Department of Obstetrics and Gynecology, District General Hospital, Ampara, Sri Lanka
| |
Collapse
|
12
|
Rasouly HM, Lu W. Lower urinary tract development and disease. WILEY INTERDISCIPLINARY REVIEWS. SYSTEMS BIOLOGY AND MEDICINE 2013; 5:307-42. [PMID: 23408557 PMCID: PMC3627353 DOI: 10.1002/wsbm.1212] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Congenital anomalies of the lower urinary tract (CALUT) are a family of birth defects of the ureter, the bladder, and the urethra. CALUT includes ureteral anomaliesc such as congenital abnormalities of the ureteropelvic junction (UPJ) and ureterovesical junction (UVJ), and birth defects of the bladder and the urethra such as bladder-exstrophy-epispadias complex (BEEC), prune belly syndrome (PBS), and posterior urethral valves (PUVs). CALUT is one of the most common birth defects and is often associated with antenatal hydronephrosis, vesicoureteral reflux (VUR), urinary tract obstruction, urinary tract infections (UTI), chronic kidney disease, and renal failure in children. Here, we discuss the current genetic and molecular knowledge about lower urinary tract development and genetic basis of CALUT in both human and mouse models. We provide an overview of the developmental processes leading to the formation of the ureter, the bladder, and the urethra, and different genes and signaling pathways controlling these developmental processes. Human genetic disorders that affect the ureter, the bladder and the urethra and associated gene mutations are also presented. As we are entering the postgenomic era of personalized medicine, information in this article may provide useful interpretation for the genetic and genomic test results collected from patients with lower urinary tract birth defects. With evidence-based interpretations, clinicians may provide more effective personalized therapies to patients and genetic counseling for their families.
Collapse
Affiliation(s)
- Hila Milo Rasouly
- Renal Section, Department of Medicine, Boston University Medical Center, Boston, MA 02118, USA
| | - Weining Lu
- Renal Section, Department of Medicine, Boston University Medical Center, Boston, MA 02118, USA
| |
Collapse
|
13
|
Gupta T, Kapoor K, Sharma A, Huria A. The Frequencies of the Urinary Anomalies which were Detected in a Foetal Autopsy Study. J Clin Diagn Res 2013; 6:1615-9. [PMID: 23373012 DOI: 10.7860/jcdr/2012/4736.2622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 09/19/2012] [Indexed: 11/24/2022]
Abstract
AIM The detection of foetal urinary abnormalities in the antenatal period will help in an adequate post natal management and it will also have a bearing on the decision of the termination of the pregnancy. The purpose of the present study was to detect urinary anomalies in the antenatal period by doing autopsies of the aborted foetuses. SETTINGS AND DESIGN A cross-sectional study. METHODS AND MATERIAL A total of 226 aborted foetuses were autopsied. The urinary anomalies which were related to the renal parenchyma, the pelvi-ureteral system and the urinary bladder were recorded. The associated anomalies of the other organ systems were also noted. The incidences of the different urinary anomalies among the aborted foetuses were calculated. The gestational ages at which the various anomalies were detected were also studied. RESULTS Twenty nine of the 226 fetuses were detected to have 34 urinary anomalies. Renal agenesis was the single most common anomaly. Overall, the anomalies which were related to the renal parenchyma accounted for 67.65 % of all the urinary anomalies, while the anomalies of the pelvi-ureteral system and the bladder constituted 20.59% of the detected urinary anomalies. The anomalies of the renal parenchyma (renal agenesis and horse-shoe and polycystic kidneys) were more frequently seen in the foetuses with a shorter gestational age as compared to the gestational ages of the foetuses which showed pelvi-ureteral anomalies. The cumulative incidence of the foetuses with urinary anomalies by 30 weeks of gestation was 12.83%. CONCLUSIONS A significant proportion of the aborted foetuses was detected to have urinary anomalies. An early antenatal detection of these and associated anomalies has significance, as this may help in an early postnatal diagnosis and management. The degree and the extent of the detected anomalies could also help in the decision making regarding the therapeutic abortions and the future pregnancies.
Collapse
Affiliation(s)
- Tulika Gupta
- Assistant Professor, Department of Anatomy, Post Graduate Institute of Medical Education & Research , Chandigarh, India
| | | | | | | |
Collapse
|
14
|
|
15
|
Ryckewaert-D'Halluin A, Le Bouar G, Odent S, Milon J, D'Hervé D, Lucas J, Rouget F, Loget P, Poulain P, Le Gall E, Taque S. Diagnosis of fetal urinary tract malformations: prenatal management and postnatal outcome. Prenat Diagn 2011; 31:1013-20. [DOI: 10.1002/pd.2824] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 06/06/2011] [Accepted: 06/06/2011] [Indexed: 11/07/2022]
|
16
|
Approche de la dysmorphologie fœtale in utero. ACTA ACUST UNITED AC 2010; 38:677-85. [DOI: 10.1016/j.gyobfe.2010.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 06/07/2010] [Indexed: 11/20/2022]
|
17
|
Avni FE, Hall M. Renal cystic diseases in children: new concepts. Pediatr Radiol 2010; 40:939-46. [PMID: 20432012 DOI: 10.1007/s00247-010-1599-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 01/31/2010] [Indexed: 12/19/2022]
Abstract
This review highlights the changes that have occurred in the general approach to cystic renal diseases in children. For instance, genetic mutations at the level of the primary cilia are considered as the origin of many renal cystic diseases. Furthermore, these diseases are now included in the spectrum of the hepato-renal fibrocystic diseases. Imaging plays an important role as it helps to detect and characterize many of the cystic diseases based on a detailed sonographic analysis. The diagnosis can be achieved during fetal life or after birth. Hyperechoic kidneys and/or renal cysts are the main sonographic signs leading to such diagnosis. US is able to differentiate between recessive and dominant polycystic kidney diseases, hepatocyte nuclear factor 1 Beta mutation, glomerulocystic kidneys and nephronophtisis. MR imaging can, in selected cases, provide additional information including the progressive associated hepatic changes.
Collapse
Affiliation(s)
- Fred E Avni
- Departments of Medical Imaging and Pediatric Nephrology, University Clinics of Brussels-Erasme Hospital, 808 Route de Lennik, 1070 Brussels, Belgium.
| | | |
Collapse
|
18
|
Abstract
Perinatal renal tract disease is the main cause of end-stage renal failure in children. The diagnosis also includes many disorders of lesser severity, which may cause morbidity, such as hypertension, in later life. There remain uncertainties in the accuracy of some fetal diagnoses, and the life-time outcomes of children born with renal tract disease, who survive the neonatal period, are not known. There is a need for prospective trials to establish the efficacy, if any, with regard to protection of long-term kidney function of existing 'therapies', such as prenatal surgical decompression and postnatal drugs, which might slow the progression of renal failure. Specific drugs, which may block the growth of renal cysts, are being tested in humans. Advances in genetics are uncovering specific mutations in some children with renal tract malformations, providing parent and carers with explanations for the occurrence of such diseases.
Collapse
|