Morphological spectrum of congenital anomalies of kidney and urinary tract in hospitalized pediatric population: a single-center prospective observational study

BackgroundThe range of congenital anomalies affecting the kidneys and urinary tract (CAKUT) is wide, extending from asymptomatic ectopic kidneys to severe bilateral kidney agenesis.ObjectiveTo unveil the spectrum of morphological anomalies in the kidneys and urinary tract among patients hospitalized in the pediatric nephrology unit.MethodsThis is a cross-sectional study. Over 2 years, patients admitted to the pediatric nephrology unit and found to have CAKUT underwent comprehensive evaluation, including lab tests, imaging, and radionuclide scans for morphological characterization of the CAKUT subtype.ResultsAmong the 650 patients admitted to the pediatric nephrology unit, 116 cases were identified as CAKUT, yielding a prevalence rate of 17.8% among patients hospitalized in the pediatric nephrology unit. Among these, 67 of 116 (57.7%) were male, with the majority (85%) aged 0 to 5 years. Abnormal ultrasonographic (USG) led to the evaluation of CAKUT in 46 of 116 (39.7%) cases, followed by recurrent fevers (19.8%), and urinary dribbling (12%). Anemia and renal dysfunction were the main laboratory abnormalities in 90/116 (77.5%) and 40/116 (34.5%) respectively). CAKUT cases were categorized as non-obstructive in 78/116 (68.1%) and obstructive in 37/116 (31.9%) based on USG findings. Primary vesicoureteric reflux (VUR) in 25/116 (21.6%) and ureteropelvic junction obstruction in 18/116 (15.6%) were the most common non-obstructive and obstructive anomalies respectively. Among VUR cases, grade II and grade III VUR accounted for 09/25(36%) and 7/25 (28%) respectively, associated with hypertension in 18/25 (72%) and renal scarring in 04/25 (16%). Ureteropelvic junction obstruction was present in 18/116 (15.5%), typically mild in 14/18 (61%) on ultrasonography. Posterior urethral valves accounted for 16/116 (13.7%) of cases, presenting with renal dysfunction in 13/16 (81%) and hydronephrosis in 12/16 (75%).ConclusionThis study provides valuable insights into the clinical patterns and morphological diversity of CAKUT. These findings underscore the importance of early diagnosis and multidisciplinary management for optimizing outcomes.