Exacerbation of Congenital Hydronephrosis as the First Presentation of COVID-19 Infection in Children: A Case Series

Background:Congenital hydronephrosis is one of the most common abnormalities of the upper urinary tract, which can be exacerbated by a variety of intrinsic or extrinsic triggers. The urinary tract system is one of the major organs complicated by COVID-19 infection. Case presentations:Here we report five patients with an established diagnosis of congenital hydronephrosis, who presented with acute abdominal pain and fever and an abrupt increase in the anteroposterior pelvic diameter (APD). Patients had a previous stable course and were under regular follow-up with serial ultra-sonographic studies. They underwent surgery or supportive treatment due to the later exacerbation of hydronephrosis. Based on the clinical and imaging findings, no plausible etiologies for these exacerbation episodes, including infection, nephrolithiasis or abdominal masses, could be postulated. The common aspect in all these patients was the evidence of a COVID-19 infection. Conclusions:Infection with COVID-19 in children with antenatal hydronephrosis may exacerbate the degree of hydronephrosis and renal APD in ultrasonography, which itself may be mediated by the increase in inflammatory mediators.

STAGES OF BIOFILMS FORMATION BY THE LEADING PATHOGENS IN CHILDREN WITH PYELONEPHRITIS ON CONGENITAL HYDRONEPHROSIS BACKGROUND DEPENDING ON CHILD’S AGE

The aim: to study the stages of primary and secondary biofilms formation by the leading pathogens in children with pyelonephritis on congenital hydronephrosis background depending on child’s age. Materials and methods. Venflons, catheters, urine were used as material for microbiological study. Identification of microorganisms was provided with MICRO-LA-TESTÒID kits. Isolates were tested for ability to form biofilms in Petri dishes with d=40 mm. The morphological structure of the biofilms was studied by scanning electron microscopy. Results: The study of structural and functional features of biofilms formation by leading pathogens of in children with pyelonephritis on congenital hydronephrosis background depending on child’s age revealed a number of features and patterns. In addition to the classical stages of biofilms formation as 3D structure there was found a dissemination of planktonic cells with the release of bacteria or loss of single fragments that spread throughout the body and attach to the substrate with the formation of a new or secondary biofilm. In children under 3 years it was shown that the cocci attachment to the substrate appeared faster than in gram-negative rods and had appearance of separate structures. The longest stage of primary biofilms formation in young children was the co-aggregation. Detecting an ability to colonize with the formation of a secondary biofilm in isolates established that the longest stage was re-adsorption and the shortest was re-aggregation, which lasted 2 hours in all detected pathogens. In middle-aged children, the duration of adhesion stage was reduced by 1-2 hours compared with it in young children. Conclusions. Scientific data about the stages of biofilms formation by microorganisms, causative agents of pyelonephritis in children was updated. Adhesion stage of isolates from elder children with pyelonephritis on background of congenital hydronephrosis underwent faster in the formation of secondary biofilms than in primary, and it formed the possibility for chronic process and the development of recurrences. The duration of each stage in biofilms formation by causative agents of pyelonephritis in children with congenital hydronephrosis depended on the age of the child and the properties of microorganisms

Dynamics of renal parenchymal thickness in hydronephrosis patients before and after surgery

Aim of study. To reveal changes in renal parenchymal thickness in hydronephrosis patients before and after surgery depending on the patient’s age. Materials and methods. Archived medical histories of 350 patients after surgery for congenital hydronephrosis within 1990-2020 were studied. The age of patients at the moment of surgery varied from one month to 18 years. The dynamics of change in the parenchymal layer thickness of the impaired kidney was evaluated based on ultrasound protocols of kidney scanning before and after the surgery. Results. The maximum decrease in renal parenchyma before surgery was noted in the group of patients aged 15-18 years: 46.00% and 59.68% on the poles and in the lower third, respectively. The minimum decrease was registered in patients aged 0-3 months: 24.43% on the poles and 49.06% in the middle third of the kidney. The best renal parenchyma restoration after surgery was registered in group 1: 94.04% on the poles and 87.74% in the middle third. Low percentages of parenchymal regeneration were observed in the 7th age group: 69.11% and 61.52%, respectively. The values of loss and restoration of parenchyma in each age group were statistically reliable at p≤0.001. Conclusion. Patients operated at the age before 3 months were observed to have the minimum decrease in the thickness of the renal parenchymal layer before surgery with maximum values associated with restoration of renal parenchyma after surgical correction. The probability of complete equivalence of parenchymal thickness of the operated kidney to the healthy one reliably declines with increasing age at the moment of operation.

INCIDENCE OF URINARY TRACT INFECTION AFTER CYSTOGRAPHY

ABSTRACT Objective: Cystography an invasive procedure with potential complications such as urinary infection (UI). There are few studies about the incidence of complications associated with this procedure. The purpose of this study is to evaluate the incidence of post-cystography urinary infection (UI.). Methods: Retrospective study with a review of clinical records of patients under 15 years of age, followed in this hospital, who underwent cystography (radiologic or indirect radionuclide) between 2009 and 2018. Post-cystography UI was defined when it occurred until seven days after the procedure. Descriptive and nonparametric statistics were applied to assess possible predictive factors related with post-cystography UI. Results: In the study period, 531 cystograms were undertaken (55% indirect radionuclide and 45% radiologic). The mean age at the procedure was 11.5 months; 62% were boys. Every patient had a previous negative urine culture; 50% were under antibiotic prophylaxis at the time of the procedure. The most common indication for the procedure was the post-natal study of congenital hydronephrosis/other nephrological malformation (53%), followed by the study of febrile UI (31%). Vesicoureteral reflux (VUR) was diagnosed in 40% of procedures. Post-cystography UI occurred in 23 cases (incidence of 4.3%). The most frequent microorganism was E. coli (52%). The presence of VUR was significantly associated with the occurrence of post-cystography IU. Conclusions: The incidence of post-cystography UI was low in our sample. The presence of VUR was significantly associated with the occurrence of post-cystography UI. The authors highlight the importance of an adequate catheterization technique and the need for clinical surveillance after the procedure.

The Rating System of Urodynamics Upper Urinary Tract in Children under Three Years Old with Congenital Hydronephrosis

Background. One of the main reasons for the incorrect differentiation of obstructive and non-obstructive disorders of the upper urinary tract (UUT) is age-related morphofunctional immaturity of the kidney and its structures in children of the first three years of life. Aims to investigate to determine the peculiarities of urodynamic disorders of the UUT in infants with congenital hydronephrosis using diuretic pyeloehography (DРG) method. Methods. There were studied DPG data of 55 patients aged 336 months with unilateral hydronephrosis of IIII grades SFU, which were divided into groups in accordance with the variant of violation of the urodynamics of the UUT (obstructive, obstructive-hypertensive and disadaptive). The variants established according to the parameters of the DPG (transient coefficient PUJ (Kpus), the coefficients of postfurosemide adaptation (Ka) and the efficiency of emptying (Ko) pelvis). The obtained data are compared with the conclusions of morphometric studies of the operated 20 children with ureteropelvic junction obstruction (UPJO). Results. The obstructive-hypertensive variant was determined in 18 patients, obstructive in 20, and disadaptive in 17. The severity of pelvic dysfunction (according to Ka and Ko) did not correlated to the grade of UPJO (according Kpus) in most cases. Intergroup and intragroup variability in the values of the DРG coefficients is confirmed by the results of PUJ and pelvis morphometry. The correlation between hystological modification in the pelvis and DPG parameters was revealed. Obtained data allowed to introduce a new indicator urodynamic indicator of quantitative assessment of functional insufficiency of the UUT. And the score gradation of each DРG coefficient (from 0 to 4 points) in accordance with deviation from the reference values was developed. The total indicator functional insufficiency is expressed by the sum of points (SP) for each coefficient (Ka, Ko, Kpus). When SP is less than 3 points light, 46 moderate, 79 expressed and 1012 severe grade of violation of urodynamics. The severity of dysfunctions of the UUT in 88% of children (n = 15) with a disadaptive variant corresponded to light degree, in 75% of patients (n = 14) with an obstructive-hypertensive variant expressed (50%) and severe (25%) grades. Moderate degree of dysfunction revealed in 65% of patients (n = 13) with an obstructive variant. Conclusion. The severity of urodynamic dysfunction of the UUT in this age group can be determined by the score gradation of the DPG parameters which reflects the functionality of the pelvis/PUJ and the grade of their violation adaptive reactions in response to diuretic.