Paravesical cystic retroperitoneal lymphangioma presenting as recurrent vesicoureteral reflux.
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Child, Preschool↗
Biomedical subjects
H N Noe
Publications and source records attributed to H N Noe.
Urinary N-acetyl-beta-glucosaminidase as a screening technique for vesicoureteral reflux.
OBJECTIVE: To determine if urinary N-acetyl-beta-glucosaminidase (NAG) assays could be applied as a screening test for early detection of vesicoureteral reflux. METHODS: Two hundred eighty-eight urine samples from children undergoing voiding cystourethrography (VCU) for a variety of urologic problems were assayed for N-acetyl-beta-glucosaminidase using spectrophotofluorimeter techniques. Sample creatinine levels were also determined using an auto analyzer. The urinary NAG to creatinine ratio for each patient was then compared to their VCU results, which were interpreted independently of the assay values and graded according to the International Reflux Classification system. The NAG to creatinine ratios were then classified according to their grade of reflux, and the mean NAG levels, plus one standard deviation, were calculated for each as well as for the nonrefluxing controls. Statistical analysis was done with P values obtained by Student's t-test. RESULTS: A total of two hundred thirty-two specimens were evaluable with ninety (38.8%) samples collected from refluxing patients and one hundred forty-two (61.2%) samples from nonrefluxers. The NAG levels standardized to urine creatinine revealed a mean value among refluxers of 15.514 mumol/g creatinine. This compared with a mean value of 14.611 mumol/g creatinine in the nonrefluxing group, with the difference being insignificant. When the mean NAG levels were compared for each grade of reflux to the nonrefluxing controls, only grade V had a significant elevation (44.561 mumol/g creatinine) above the nonrefluxers (P = 0.0001). CONCLUSIONS: With the exception of grade V vesicoureteral reflux, urinary NAG levels do not reliably detect the presence of reflux and therefore cannot be accurately applied as a screening test for detection of this common urologic problem.
Acetylglucosaminidase↗
The importance of urinary tract infection in the evaluation of the incontinent child.
Diurnal incontinence secondary to dysfunctional voiding is a problem that is commonly encountered by the pediatric urologist. We have observed that reflux is more common in these children and hypothesized that urinary tract infection would influence the rate of reflux as well as the rate of significant urinary tract abnormalities, such as renal scarring. We prospectively evaluated 308 incontinent children with a voiding cystourethrogram and upper tract studies. Of these patients 162 (53%) had had previous culture proved urinary tract infection, while 146 (47%) had no history of infection. A total of 90 patients (29%) had an abnormal voiding cystourethrogram, which demonstrated reflux in all but 1. Among the patients with a history of urinary tract infection reflux was found in 34% compared to 23.3% in those with no history of urinary tract infection (p = 0.82). Five patients had significant cortical scarring, of whom 4 had grade III or greater reflux along with urinary tract infection. We conclude that urinary tract infection is not helpful in determining which patients with dysfunctional voiding will exhibit vesicoureteral reflux but it is important in detecting significant upper tract abnormalities, such as renal scarring. We discuss appropriate evaluation in children who present with incontinence secondary to dysfunctional voiding with or without urinary tract infections.
Adolescent↗
Fat containing renal mass in childhood: a case report of teratoid Wilms tumor.
Renal masses in childhood rarely contain adipose tissue as a major component. We report a case of teratoid Wilms tumor, an atypical variant of nephroblastoma, in which bilateral renal masses were found on computerized tomography to have a high fat content. Previously reported cases have had clinical characteristics in common with our case. However, our patient died of metastatic disease, which to our knowledge has not been previously described.
Adipose Tissue↗
The long-term results of prospective sibling reflux screening.
A prospective study was begun more than 10 years ago to identify the incidence of vesicoureteral reflux in the siblings of patients with reflux. A total of 354 siblings of 275 index patients was screened with a voiding cystourethrogram for the presence of reflux. Of the siblings tested 119 (34%) were found to have reflux, including 75% who were asymptomatic. Reflux was present in a significant percentage of younger siblings. No correlation with index patient reflux grade, sex or established renal damage could be related to the likelihood of sibling reflux. A slightly higher rate of reflux was found in the female siblings of female index patients, which is a variation from the initial study. The incidence of renal damage was significantly reduced in the siblings with reflux compared to the index patients, which was also true in the youngest patients, who are believed to be the most susceptible to reflux-mediated renal damage. Sibling reflux screening can be justified due to a high percentage of siblings found to have reflux without symptoms and a significant decrease in renal damage compared to the index patients. Aggressive screening in young children (less than 5 years old) is still advisable, although this recommendation has been modified for older children. Additional information will be needed before the genetic transmission of reflux can be clarified.
Child, Preschool↗
The transmission of vesicoureteral reflux from parent to child.
Vesicoureteral reflux is now recognized to be hereditary and familial. The incidence of reflux in siblings has proved to be significant but less is known about the incidence of reflux in the offspring of known reflux patients. In an ongoing prospective series of reflux screening we identified 23 patients of childbearing age with a known history of reflux and screened their 36 offspring with an awake voiding cystourethrogram. Of these 36 offspring 24 (66%) exhibited vesicoureteral reflux. The literature was also reviewed to determine the incidence of parent/child reflux from reported cases. This review revealed a 65% rate of reflux in the offspring of known patients. Our preliminary results coupled with those in the literature signify a need to screen the offspring of known reflux patients and suggest a rethinking of the genetic transmission for this trait. While vesicoureteral reflux could still be a multifactorial genetic trait with a major gene, consideration must also be given to an autosomal dominant inheritance pattern.
Child↗
Re: Adrenal hemorrhage in the newborn with evidence of bleeding in utero.
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Adrenal Gland Diseases↗
Is it practical to screen for familial vesicoureteral reflux within a private pediatric practice?
A prospective study was established within a private pediatric practice to identify the incidence and severity of vesicoureteral reflux in the siblings of patients known to have reflux. Twenty-four siblings of 18 children with reflux were studied. Eleven of these siblings were found to have reflux for an incidence of 46%. The risk of reflux in siblings of known children with reflux is thus significant and, at least in this study, compares with the risk of reflux after urinary tract infection. The outcome of the sibling group is discussed, along with our thoughts on the possible modes of inheritance of this disorder.
Age Factors↗
Late urologic complication of an abdominal gunshot wound.
An unusual late complication of an abdominal gunshot wound is presented. It consisted of an acute hydronephrosis of the left kidney by a BB-type bullet that migrated into the ureter of a 11-year-old boy 1 month after he was injured in the left flank, causing its complete obstruction. A percutaneous nephrostomy was performed and, with the help of a basket-type catheter, the bullet was removed. To our knowledge this is the first case reported of this rare complication treated by this technique.
Abdominal Injuries↗
Conservative management of renal carbuncles in children.
Renal carbuncles have traditionally been treated with surgical drainage and appropriate antibiotic therapy. Recently, 2 pediatric patients with well-documented renal carbuncles were treated with antibiotic therapy alone. Close follow-up documented complete resolution in both cases. Late studies showed no evidence of renal scarring or functional compromise.
Adolescent↗
Uric acid excretion in children with urolithiasis.
Urinary uric acid excretion was assessed in 38 children to determine whether hyperuricuria was a risk factor in children with urolithiasis. Uric acid excretion (measured per deciliter glomerular filtration rate), and fractional excretion of uric acid were similar in 27 children with hypercalciuria and calcium oxalate urinary stones, in six children with idiopathic calcium oxalate urolithiasis, and in five with uric acid urolithiasis, of whom four were white boys and one was an Asian girl. One boy with a urate stone had cystinosis. Serum uric acid concentrations exceeded 6.0 mg/dl (360 mumol/L) in two children with hypercalciuria and in two patients with idiopathic calcium oxalate urolithiasis. None of the children with calcium urolithiasis had excessive urinary excretion of uric acid. In children with hypercalciuria, uric acid excretion did not change significantly when dietary sodium was increased from 1.0 to 5.0 gm/1.73 m2. We conclude that excessive urinary uric acid excretion is seldom an additional risk factor in children with calcium urolithiasis and that dietary sodium chloride does not have a strong influence on urinary excretion of uric acid in children with hypercalciuria.
Adolescent↗
Nodular renal blastema in the multicystic kidney.
Of 60 surgically removed multicystic, dysplastic kidneys examined for the presence of nodular renal blastema only 1 (2 per cent) had blastematous elements. Of the 60 patients 35 were from the authors' personal series and they were examined in clinical detail. The results of this study and those in the literature are discussed in relation to the over-all management of the asymptomatic multicystic, dysplastic kidney.
Child↗
The relationship of sibling reflux to index patient dysfunctional voiding.
The rate of sibling reflux in index patients with and without dysfunctional voiding symptoms was compared. Of the siblings of index patients with reflux and dysfunctional voiding 20 per cent demonstrated reflux compared to 38 per cent of siblings of those without symptom of bladder dysfunction. The difference is significant and suggests an interaction of genetic and environmental factors. These factors are discussed. There remains a need to screen siblings of patients with reflux regardless of symptoms of either the index patient or the sibling.
Child↗
Re: Urological complications of sickle cell disease in a pediatric population.
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Anemia, Sickle Cell↗
Treatment of complications of cyclophosphamide cystitis.
Since 1976, 23 patients with cyclophosphamide-induced cystitis were treated. These patients presented with a variety of urinary problems, including incontinence, hematuria and vesicoureteral reflux. Vesicoureteral reflux was found in 9 patients, hydronephrosis in 4 and a contracted fibrotic bladder in 3. Of the 23 patients 18 had undergone a combination of radiation and cyclophosphamide therapy. Based on this experience a general outline is developed for evaluation and treatment of patients with cyclophosphamide-induced cystitis and its potentially severe complications.
Cyclophosphamide↗
Diagnostic imaging in children with urinary tract infection.
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Child↗
Progression of mild ureteropelvic junction obstruction in infancy.
Mild and clinically silent ureteropelvic junction obstruction was observed to progress in severity in 2 infants. Diuretic renography was useful in serial evaluation and documentation of progression. The possible mechanism for such progression of obstruction is proposed. Although mild obstruction in the older child and adult can be followed successfully without surgery, it appears that close follow-up of mild obstruction during the first year of life is necessary to detect and assure treatment of progressive obstruction at an optimum age.
Diuresis↗
Management of obstruction and resultant complications in transplant kidney by endoscopic and percutaneous techniques.
Management of obstructive complications in a renal transplant patient are most efficiently performed using endoscopic and percutaneous techniques where possible. A case of such obstruction managed by placement of an internal stent is described. An unusual complication involving the fracture of the stent was also managed percutaneously.
Adolescent↗