| ObjectiveTo summarize the clinical characteristics of children with congenital anomalies of the kidney and urinary tract(CAKUT).To analyze and discuss the application value of renal dynamic imaging in the evaluating renal function in children with CAKUT.MethodsA retrospective analysis of the children diagnosed with CAKUT admitted to Wuhan Children’s Hospital from January 2018 to April 2019,and all of them underwent radionuclide renal dynamic imaging.The glomerular filtration rate(GFR)was measured by Gates method,and the images and related parameters were analyzed.Inclusion criteria included: CAKUT diagnosed by imaging examination;relatively complete clinical data;age 0-12 years old.The exclusion criteria were: relatively incomplete clinical data;kidney and urinary tract abnormalities caused by acquired factors;combined with other diseases affecting renal function or severe damage to another organ;serious image artifact interference and poor image quality.In addition,healthy children with matching gender and age,and normal imaging and laboratory examination results were selected as control group.Results1.A total of 186 children with CKAUT were included in this study,with an average age of 3.13±3.03 years(age range 0-12 years).There were 132 males(71.0%,132/186)and 54 females(29.0%,54/186).The ratio of male to female was2.4:1.Among 186 patients,there were 97 cases of left deformity,63 cases of right deformity and 26 cases of bilateral deformity.Therefore,212 affected kidneys and160 healthy kidneys were included.On the basis of embryological classification,CAKUT patients were divided into two groups according to the type of kidney: renal parenchymal dysplasia group(89 cases,including 56 cases of renal dysplasia and 33 cases of polycystic dysplasia),and collecting system abnormality group(123 cases,including 74 cases of ureteropelvic junction obstruction,27 cases of double ureteropelvic malformation,13 cases of congenital megaureter,13 cases of congenital megaureter and 9 cases of ureterocele.2.CAKUT has various clinical manifestations and no specific symptoms or signs.The most common clinical manifestations of two types of CAKUT in this group are urinary tract infection(UIT),followed by incontinence or dripping.Twelve cases in this group of cases have progressed to CKD,including 1 CKD stage Ⅰ,5 CKD Ⅱ,4CKD Ⅲ,1 CKD Ⅳ and 1 CKD Ⅴ.Eleven cases in the renal parenchymal dysplasia group progressed to CKD,while only 1 case in the collective system abnormality group progressed to CKD.3.The results of dynamic renal imaging in CAKUT group were analyzed: 70.3%(149/212)of the cases showed that the renal perfusion was decreased,among which55.7%(83/149)was renal parenchymal development abnormality,44.3%(66/149)was abnormal collection system(P<0.05).The results of dynamic renal imaging were also different between the two groups(P<0.05).The abnormal renal parenchymal dysplasia group mainly showed abnormal functional phase,which showed the peak time extension(82.0%),the excretion phase was mostly normal(78.7%),while the functional phase of the collection system abnormal group was mostly normal(66.7%),mainly manifested as abnormal excretion,70.7% had a half excretion time.4.There was no significant difference in serum creatinine(SCR)and blood urea nitrogen(BUN)between CAKUT groups and the control group(P=0.157,0.986).The total GFR of each CAKUT group was lower than that of the control group(P<0.001).5.In this group of cases,the positive rate of radionuclide renal dynamic imaging was higher than that of serum renal function tests,which were 75.0% and 20.8%(χ~2=5.389,P=0.020).There was no statistically significant correlation between total GFR and serum renal function indexes in each group(all P>0.05).6.There were differences in renal function among different types of CAKUT: in the renal parenchymal dysplasia group,the GFR of the affected kidney was significantly decreased,the GFR of the contralateral kidney was increased compensably,and the bilateral total GFR was still decreased.The patients with abnormal collecting system mainly showed a slight decrease of GFR in the affected kidney,while the contralateral and total GFR were basically normal.7.When the GFR of the affected side is more than or equal to 40 ml/min,there was no significant correlation between the GFR of both sides(r=0.090,P=0.677);when the GFR of the affected side was less than 40 ml / min,there was a negative correlation between the GFR of the affected side and the contralateral side,with the correlation coefficient r=-0.402,P<0.001.Binary logistic regression analysis showed that renal GFR(OR=1.040,95%CI: 1.015～1.065,P=0.001)and age(OR=1.164,95%CI: 1.034～1.310,P=0.012)were risk factors for contralateral renal decompensation.8.In this group,131 cases were treated conservatively,accounting for 70.4%(131/186),55 cases were treated surgically,accounting for 29.6%(55/186).Among them,36 patients underwent pelvicureteroplasty due to ureteropelvic junction obstruction,34 patients underwent open disjunctive pyeloplasty,and 2 patients underwent retroperitoneal laparoscopic dismembered pyeloplasty,9 patients underwent ureteral replantation due to congenital megaureter,7 cases underwent repeated nephrectomy due to heavy ureteropelvic catheter,and 3 cases underwent nephrectomy due to renal insufficiency Surgery.The proportion of surgical treatment in the group with abnormal collecting system was higher than that in the group with abnormal renal parenchyma,which were 50% and 6.1% respectively(P<0.05).The results of renal dynamic imaging showed that the GFR of the operation group was lower than that of the non operation group,and the average GFR of the two groups were 21.4 ± 20.2 ml / min and 31.5 ± 17.6 ml / min,respectively(P<0.05).The proportion of abnormal renogram in operation group was higher than that in non operation group(76.4% vs 42.0%,P < 0.05).ConclusionRadionuclide renal dynamic imaging can more comprehensively evaluate the renal function status of children with CAKUT.It can not only understand the uptake and excretion function of the affected kidney,but also evaluate the compensation or involvement of the contralateral kidney.The positive rate of diagnosis is higher than that of clinical commonly used serological renal function indicators.It has important value for guiding clinical treatment decision and prognosis evaluation. |
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