The case of kidney rupture caused by posteriori urethral valve and diagnosed in neonatal period – many years of the patient observation
Klinika Pediatrii, Nefrologii i Alergologii Dziecięcej Wojskowego Instytutu Medycznego w Warszawie. Kierownik Kliniki: prof. dr hab. n. med. Anna Jung Correspondence to: Klinika Pediatrii, Nefrologii i Alergologii Dziecięcej CSK MON WIM, ul. Szaserów 128, 00-909 Warszawa, tel.: 022 681 72 36 Source of financing: Department own sources
PEDIATR MED RODZ Vol 4 Numer 3, p. 200-204
Urinary tract defects are one of the most common congenital anomalies. As a result of progress in the medical imaging methods and chirurgical procedures with development of endoscopic facilities, early diagnosis and fast management is possible. Therefore we can avoid many complications caused by congenital defects. Congenital hydronephrosis may be due to a variety of causes: an obstruction in ureteropelvic junction, ureterostenosis, kidney duplication, vesicoureteral reflux, posterior urethral valve, prune belly syndrome. Posterior urethral valve is the most common reason for abnormal bladder emptying and occurs in approximately 1 in 5000 live male births. The clinical presentation of posterior urethral valve is variable. As a result of występumechanical obstruction, we can observe bladder hypertrophy, detrusor sphincter dysfunction, vesical diverticula, distension and elongation of the ureters, kidney dysplasia. The mild obstructive syndrome, like voiding disorder or nocturnal enuresis, is caused by “mini valve” type of posterior urethral valve that is characterized by limited functional impairment and upper urinary tract changes. In severely cases pulmonary hypoplasia and oligohydramnios may exhibit as a result of intrauterine renal dysfunction, therefore high perinatal mortality is observed. We describe the case of kidney rupture of the patient with posterior urethral valve, who was diagnosed in neonatal period and underwent chirurgical intervention. During following 17 years, the patient has been under regular control in Department of Pediatrics, Nephrology and Allergology in Military Medical Institute. Blood test and urinary test were constantly controlled and did not revealed any abnormalities, however imaging methods showed smaller injured kidney. Actually injured kidney present irregular echogenicity in ultrasonography, as well as irregular perfusion and accumulation of radiotracer within renal parenchyma, however with the function proportional to its mass in renoscyntygraphy. At the early childhood the boy suffered from nocturnal enuresis but after pharmacological treatment a gradual improvement was observed. Actually the boy is 17 years old and arterial hypertension has been recently diagnosed. Infant’s kidney with the lack of correlation between its mass and child’s weight and with weak protective structure is extremely exposed to injury factors. Depending on the degree of kidney’s injury conservatively or rarely chirurgical treatment is administrated.
Keywords: kidney injuries, posterior urethral valve, urinary tract defects, imaging methods, hydronephrosis