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Renal function in idiopathic hydronephrosis in children. Follow-up after conservative and surgical treatment
Insights
Unilateral idiopathic hydronephrosis in children over one year old typically shows normal kidney function. However, urinary tract infections can impair function, necessitating prompt treatment and careful monitoring, rather than immediate surgery.
Area of Science:
- Pediatric Nephrology
- Urology
Background:
- Unilateral idiopathic hydronephrosis is a common condition in children.
- Assessing renal function and the impact of infections is crucial for management.
Purpose of the Study:
- To evaluate glomerular filtration rate (GFR), separate GFR (SGFR), and renal concentrating capacity in children with unilateral idiopathic hydronephrosis.
- To determine the influence of urinary tract infections (UTIs) and treatment (surgical vs. conservative) on renal function over time.
Main Methods:
- Prospective study of 64 children (age 1-15) with unilateral idiopathic hydronephrosis.
- Measurements included total GFR, SGFR (using 51Cr-EDTA clearance and renography), and renal concentrating capacity.
- Follow-up averaged 4.4 years, with analysis of treatment outcomes.
Main Results:
- Initial total GFR and SGFR were normal or near-normal in all patients.
- Total GFR remained stable, but SGFR declined in a small number of both conservatively and surgically treated children.
- Renal concentrating capacity was initially lower in children with UTIs, but improved significantly at follow-up.
Conclusions:
- Parenchymal function in unilateral idiopathic hydronephrosis is generally preserved in children over one year old.
- Urinary tract infections pose a risk for functional deterioration and require aggressive management.
- Pelvic obstruction is infrequent, suggesting surgery is often not the primary treatment necessity.
Abstract:
In 64 children (age 1-15, mean 7.3 years) with unilateral idiopathic hydronephrosis, measurements were made of glomerular filtration rate (GFR), separate glomerular filtration rate (SGFR, measured as 51Cr-EDTA clearance combined with renography) and renal concentrating capacity. Onset symptoms were urinary tract infection in 34 children and abdominal pain in 25, while 5 were asymptomatic. Surgery was performed soon after the first investigation in 34 children and during the follow-up period in 14, and 16 children received only conservative treatment. The mean follow-up time was 4.4 years. At the time of diagnosis the total GFR and the SGFR of the affected kidney were normal or almost normal in all the children (respective means 108 +/- 16 and 50 +/- 12 ml min-1 X 1.73 m2(-1)). The total GFR remained normal at follow-up, but SGFR became subnormal in two conservatively and two surgically treated children. The concentrating capacity was initially lower in the children with, than in those without urinary tract infection. The former values had increased significantly at follow-up examination. The study indicates that the parenchymal function in unilateral idiopathic hydronephrosis in children more than 1 year old usually is normal, but may deteriorate due to urinary tract infection. Such infection should be carefully searched for and treated. Since very few of these children seem to have pelvic obstruction, surgery seldom is primarily necessary.