Results of renal transplantation in boys treated for posterior urethral valves.

The results of renal transplantation in boys treated for posterior urethral valves were evaluated and compared with a matched control group. Patient and graft survival was equal in both groups, although serum creatinine levels were slightly higher in the posterior urethral valves group. Postoperative complications, such as urinary tract infections, occurred more frequently in the posterior urethral valves group. Urodynamic evaluation was performed before transplantation in 11 of 20 patients. Adequate treatment of bladder dysfunction, such as poor compliance and/or hyperreflexia, is essential in diminishing the risks of secondary graft damage due to severe bladder dysfunction.

Urogenital tract abnormalities associated with esophageal atresia and tracheoesophageal fistula.

The medical records were reviewed of 127 consecutive patients with esophageal atresia alone and with tracheoesophageal fistula. Systematical genitourinary tract examination in 112 patients showed anomalies in 24 (21.4 per cent). A survey of the literature on this subject is given. Of 8 patients with the VATER association renal involvement was found in 6. The results of urinary tract imaging by excretory urography and ultrasonography are compared to each other. Prompt and appropriate genitourinary tract examination by physical examination, urinalysis, serum creatinine levels and ultrasonography or excretory urography is recommended as a standard in all children with esophageal atresia, with further investigations ordered if indicated by the results of the studies.

Failure to detect fetal obstructive uropathy by second trimester ultrasound.

The prenatal diagnosis, management and outcome of an hereditary obstructive uropathy is presented. Serial ultrasonic assessment of the fetal urinary tract was carried out from the early second trimester onward. Slight bilateral hydronephrosis as a first sign of obstructive uropathy was only established as late as 30 weeks of gestation. On the basis of weekly ultrasound scans, a conservative approach was adopted. In view of fetal maturity, labour was induced at 36 weeks resulting in the vaginal delivery of a male infant with moderate bilateral hydronephrosis. Neonatally, anuria developed due to bilateral obstruction of the ureters as a result of increasing bladder wall hypertrophy due to urethral valves. A bilateral uretero-cutaneostomy was carried out. The infant so far develops normally, and renal function is normal for age. Women at risk for fetal obstructive uropathy should have ultrasonic monitoring throughout pregnancy.

Development of renal carcinoma in a patient with polycystic kidneys undergoing chronic haemodialysis.

A 67-year-old woman died after 4 years of treatment by haemodialysis. End-stage renal failure was caused by polycystic kidney disease. Malignancy was suspected in the last 6 months of treatment because of impressive weight loss and a suspect liver-scan. Macroscopic haematuria in the first period of treatment was noted only once. Necropsy revealed renal carcinoma of the right polycystic kidney and tumour metastases in various organs. The problem of development of renal carcinoma in polycystic kidney disease in the light of the increased incidence of malignancy during chronic renal failure is discussed.