Hydronephrosis in pediatric kidney transplant: clinical relevance to graft outcome.

Abstract

OBJECTIVE:

To evaluate our pediatric renal transplant patient population at the Children's Hospital of Pittsburgh to better understand the clinical significance of hydronephrosis.

MATERIALS AND METHODS:

We retrospectively reviewed records of patients who had received a renal transplant in 1998-2008. Exclusion criteria included multi-organ transplants and allograft failure within 3-months. We determined the incidence of hydronephrosis and compared serum creatinine, incidence of pyelonephritis, rejection and vesicoureteral reflux between the hydronephrotic and non-hydronephrotic cohorts. Data were analyzed using descriptive statistics, Student's t-test and Pearson Chi-Square test.

RESULTS:

51 patients (35 male, 68.6%) were identified. The mean age at time of transplant was 8.7 ± 5.9 years and the mean follow-up period was 45.2 ± 45.4 months. Common causes of renal failure included posterior urethral valves, renal dysplasia, reflux and prune belly syndrome. Twenty-five (49%) patients developed hydronephrosis. This was associated with worsening renal function (p = 0.008). Hydronephrosis was also associated with pyelonephritis (p = 0.03) and male gender (p = 0.004). Age at transplant may be a predictor of pyelonephritis: median age of 10 patients with pyelonephritis was 4.6 years (range 0.6-19.9 years). Hydronephrotic cohort had increased rate of reflux and rejection; as not all patients underwent voiding cystourethrogram and/or allograft biopsy, this result was not significant.

CONCLUSIONS:

Pediatric renal graft hydronephrosis was correlated with worsening renal function and increased incidence of pyelonephritis. More aggressive preoperative and postoperative urological testing and management should help preserve renal function.

• Authors: Lei Chu, Bruce L Jacobs, Zeyad Schwen, Francis X Schneck
• Journal: Journal of pediatric urology (J Pediatr Urol) Vol. 9 Issue 2 Pg. 217-22 (Apr 2013) ISSN: 1873-4898 [Electronic] England
• PMID: 22503359 (Publication Type: Journal Article)
• Copyright: Copyright © 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Topics

• Adolescent
• Age Distribution
• Child
• Child, Preschool
• Female
• Follow-Up Studies
• Graft Rejection (epidemiology)
• Humans
• Hydronephrosis (epidemiology)
• Incidence
• Kidney Transplantation (adverse effects, statistics & numerical data)
• Male
• Postoperative Complications (epidemiology)
• Prevalence
• Pyelonephritis (epidemiology)
• Retrospective Studies
• Transplantation, Homologous
• Vesico-Ureteral Reflux (epidemiology)