ESPN 53rd Annual Meeting

ESPN 2021


 
Early renal ultrasound in congenital solitary kidney may help to select patients at lower risk of associated vesico-ureteral reflux
PIERLUIGI MARZUILLO 1 ANNA DI SESSA 1 ROSSELLA FRANCESCA DE SIMONE 1 DAVIDE URSI 1 MICHELE SABATINO 1 MARIA CECILIA RUSSO 1 EMANUELE MIRAGLIA DEL GIUDICE 1 STEFANO GUARINO 1

1- DEPARTMENT OF WOMAN, CHILD AND OF GENERAL AND SPECIALIZED SURGERY, UNIVERSITà DEGLI STUDI DELLA CAMPANIA “LUIGI VANVITELLI”, VIA LUIGI DE CRECCHIO 2, 80138, NAPLES, ITALY
 
Introduction:

The identification of vesico-ureteral reflux (VUR) in children with congenital solitary functioning kidney (CSFK) identifies patients at risk of kidney injury but exposes to radiations and pain. VUR may be associated with renal dysplasia and reduced renal length (RL). Our hypothesis was that RL>2 standard deviation score (SDS) in the first months of life (renal hyperplasia) could identify patients with CSFK with lower probability of presenting VUR. We also hypothesized that the utility of RL in selecting patients with lower risk of VUR is limited to the first months of life because -later- the compensatory renal growth of CSFK could not allow to distinguish patients with renal hyperplasia from those with renal hypertrophy. We aimed testing our hypotheses.

Material and methods:

We retrospectively selected 207 CSFK patients with prenatal diagnosis of CSFK and having undergone renal ultrasound (RUS) both at 0-3 and 10-13 months of life, renal scintigraphy and cystourethrography/cystoscintigraphy. We compared the cumulative proportion of RL>2SDS by Kaplan-Meier analysis and evaluated the odds to present VUR of patients with RL>2SDS both at first and second RUS.

Results:

RL>2SDS at first RUS was shown by 3.3% of patients with VUR and 22.0% of patients without VUR (p=0.02). At the second RUS, RL>2SDS was presented by 53.3% of patients with VUR and 52.5% of patients without VUR (p=0.93). The cumulative proportion of RL>2SDS at 3months of life was higher in patients without than in those with VUR (p=0.02). This difference however, disappeared at 11 and 13 months of age (p=0.17 and p=0.54, respectively). A RL>2SDS within 3 months predicted absence of VUR (OR=0.12;95%CI,0.02-0.92;p=0.005) while a RL>2SDS at 12 months of life presented an OR for VUR of 0.96 (95%CI,0.45-2.1;p=0.93).

Conclusions:

A RUS made early in life (within 3months) identifies a population of CSFK patients at lower risk of presenting an associated VUR.