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Solitary Functioning Kidney in High Anorectal Malformation.
Kanishka Das1, Srinivas Raju Rajkiran1
1Department of Paediatric Surgery, St. John's Medical College Hospital, St. John's National Academy of Health Sciences, Bengaluru, Karnataka, India.
Journal of Indian Association of Pediatric Surgeons
|April 18, 2017
Summary
Children with single kidneys and high anorectal malformation require careful monitoring. Early detection of urinary tract issues is crucial for preserving kidney function and preventing long-term complications.
Area of Science:
- Pediatric Nephrology
- Pediatric Urology
- Congenital Anomalies
Background:
- Solitary functioning renal units in high anorectal malformation (HARM) can present with complex urinary tract anomalies.
- These anomalies may lead to compromised renal function and hyperfiltration injury.
Purpose of the Study:
- To analyze the clinical course, management strategies, and outcomes for children with HARM and a solitary functioning renal unit.
- To highlight the importance of meticulous investigation and surveillance for renal preservation.
Main Methods:
- A retrospective cohort study of 17 children with HARM and a solitary functioning renal unit managed between 2000 and 2015.
- Individualized investigations and management based on specific urinary tract issues were employed.
- Clinical details, management interventions, and patient outcomes were analyzed.
Main Results:
- 17 (32%) of 53 HARM cases had a solitary functioning renal unit; 59% had additional urinary tract anomalies.
- Four patients presented with uremia, and nearly half experienced recurrent urinary infections, including epididymo-orchitis.
- At a mean follow-up of 70 months, 82% of patients preserved their solitary renoureteric unit; three await renal replacement therapy.
Conclusions:
- Meticulous investigation and surveillance are essential for preserving solitary functioning renal units in children with HARM.
- Associated rectourinary fistulas, vesicoureteral reflux, and infections significantly impact management and necessitate tailored surgical approaches.