Clinical Spectrum of Congenital Anomalies of Kidney and Urinary Tract in Children

OBJECTIVES

To evaluate the clinical spectrum and patterns of clinical presentation in congenital anomalies of kidney and urinary tract.

METHODS

We enrolled 307 consecutively presenting children with congenital anomalies of kidney and urinary tract at the pediatric nephrology clinic. Patients were evaluated clinically, with serum biochemistry, appropriate imaging and radionuclide scans.

RESULTS

The most common anomaly was primary vesicoureteric reflux (VUR) (87, 27.3%), followed by pelviureteral junction obstruction (PUJO) (62,20.1%), multicystic dysplastic kidney (51 16.6%), non-obstructive hydronephrosis (32, 10.4%) and posterior urethral valves (PUV) (23, 7.4%). 247 (80.4%) anomalies had been identified during the antenatal period. Another 33 (10.7%) were diagnosed during evaluation of urinary tract infection, and 21 (6.8%) during evaluation for hypertension at presentation. Obstructive anomalies presented earlier than non-obstructive (7 (3, 22.5) vs 10 (4, 24) mo: (P=0.01)). The median (IQR) ages of presentation for children with PUV (n=23), VUR (n=87) and PUJO (n=62) were 4 (2, 14) mo, 10 (5, 27) mo, and 7 (3, 22.5) mo, respectively. Nine (2.9%) children had extrarenal manifestations.

CONCLUSIONS

The median age at clinical presentation for various subgroups of anomalies indicates delayed referral. We emphasize the need for prompt referral in order to initiate appropriate therapeutic strategies in children with congenital anomalies of kidney and urinary tract.

Chromoblastomycosis

A 70-year-old male agriculturist from a rural area presented with a history of a painless verrucous lesion over the medial aspect of the left leg for 1 year following abrasion by a branch of a coconut tree. KOH preparation of the skin biopsy showed evidence of fungal elements. Cladophilalospora sp. was isolated in culture. The case was diagnosed as chromoblastomycosis. As there was no response to itraconazole, complete surgical resection of the lesion was done. At follow-up after 1 year there was clinical as well as mycological cure.

Case report. Disseminated cutaneous cryptococcosis in an immunocompetent host

A 50-year-old Indian housewife presented with multiple cutaneous lesions over the upper back, thigh and both the extremities, which first appeared 5 months previously. The diagnosis of disseminated cutaneous cryptococcosis was made on the basis of the demonstration and isolation of Cryptococcus neoformans from the aspirated pus and skin biopsy. A serological test for HIV antibodies was negative. The patient responded to itraconazole treatment.