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[Kidney transplantation in children with complex urogenital malformations-what should be considered?]
Marios Marcou1,2, Hendrik Apel3,4, Bernd Wullich3,4
1Urologische und Kinderurologische Klinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstr. 12, 91054, Erlangen, Deutschland. marios.marcou@uk-erlangen.de.
Insights
Pediatric kidney transplantation for congenital anomalies of the kidneys and urinary tract (CAKUT) requires thorough evaluation and management of lower urinary tract dysfunction (LUTD) before and after the procedure.
Area of Science:
- Pediatric nephrology
- Urology
- Transplantation surgery
Context:
- Congenital anomalies of the kidneys and urinary tract (CAKUT) are a leading cause of end-stage renal disease (ESRD) in children.
- Lower urinary tract dysfunction (LUTD) affects approximately one third of children with CAKUT.
Purpose:
- To outline key considerations for kidney transplantation in pediatric patients with complex urogenital malformations.
- To review current literature on the evaluation, preparation, perioperative management, and follow-up of these patients.
Summary:
- Comprehensive diagnostics, including voiding cystourethrography and urodynamic studies, are crucial before transplantation.
- Symptomatic vesicoureterorenal reflux and LUTD must be treated prior to kidney transplantation.
- Lifelong follow-up with regular bladder reevaluations and endoscopic examinations is necessary post-transplantation, especially after bladder augmentation or urinary diversion.
Impact:
- Ensures optimal outcomes for children with CAKUT undergoing renal transplantation.
- Highlights the importance of specialized centers for managing complex pediatric urogenital malformations and ESRD.
Background:
Congenital anomalies of the kidneys and urinary tract (CAKUT) are the most common cause of end-stage renal disease (ESRD) in children. Approximately one third of children with CAKUT have lower urinary tract dysfunction (LUTD).
Aim:
This article highlights the important aspects that need to be considered in kidney transplantation of children with complex urogenital malformations.
Materials And Methods:
The paper reviews the existing literature regarding the evaluation, preparation, perioperative management, and follow-up of children with complex urogenital malformations and ESRD undergoing renal transplantation.
Results:
Comprehensive diagnostics are required before any pediatric kidney transplantation. If LUTD is suspected, voiding cystourethrography and a urodynamic examination should be performed. Treatment of symptomatic vesicoureterorenal reflux and LUTD is mandatory prior to pediatric kidney transplantation. Following successful kidney transplantation of children with congenital urogenital malformations, lifelong follow-up is required. Regular reevaluations of the bladder by means of urodynamic examinations are necessary. In patients following bladder augmentation with intestinal segments or urinary diversions in childhood, regular endoscopic examinations of the urinary tract are recommended to rule out secondary malignancy.
Conclusion:
Treatment of children with complex urogenital malformations should be carried out in centers with appropriate expertise.
