CLINICAL SPECTRUM AND BIOCHEMICAL PROFILE OF CONGENITAL ABNORMALITIES OF KIDNEY AND URINARY TRACT IN NEONATES IN A TERTIARY CARE HOSPITAL - AN OBERVATIONAL STUDY

Congenital anomalies of kidney and urinary tract (C.A.K.U.T.) encompasses various Developmental abnormalities of the kidney as well as upper (mesenchymal derived glomeruli and tubules) and lower urinary tracts (ureteric bud derivatives: collecting ducts, renal pelvis and ureter). It represents 15% of all prenatally detected anomalies.It is an important cause of chronic kidney disease in children accounting for approximately 30% cases.

      C.A.K.U.T. includes a spectrum of conditions such as renal agenesis, dysplasia, hypoplasia, hydronephrosis, posterior urethral valves (PUV),and vesicoureteric reflux (VUR) and duplex kidney systems. These anomalies may either occur in isolation or as part of various syndromic disorders. Their clinical significance ranges from asymptomatic cases to life-threatening renal failure. They are frequently detected using antenatal ultrasound. A genetic basis has been linked to the occurrence of these abnormalities . C.A.K.U.T. affects around 3–6 per 1,000 live births. There is a slight male preponderance. The most common anomaly picked up prenatally is hydronephrosis, commonly secondary to ureteropelvic junction obstruction or vesicoureteric reflex (Nicolaou et al., 2015).

 In majority of cases, C.A.K.U.T. is non-syndromic i.e occurs isolated; however, syndromic presentations are also prevalent and may encompass cardiac, auditory or skeletal  abnormalities. A strong familial predilection has been recognized, backing the role of inherited and de novo genetic mutations (Weber et al., 2011).

 Impact on Health System

 Failure of early detection, prompt antenatal counselling regarding disease course, management, prognosis and recurrence in subsequent pregnancies can increase the disease burden. Children affected with any of the various renal abnormalities in the spectrum often require frequent hospital visits for follow up or admissions due to subsequent urinary tract infections causing poor quality of life. They are in need of long term follow up along with multidisciplinary care. Renal replacement therapy would be inadvertent in conditions on the severe end of the spectrum having immense impact on the personal, social and psychological wellbeing of the child. The economic as well as emotional burden on healthcare systems and families is substantial. Hence, attempts toward early detection, personalized management, and genetic counselling take public health precedence.

AIM:

To estimate the prevelance of spectrum of congenital abnormalities of the kidney and urinary tract

OBJECTIVES:

1.To determine the spectrum of CAKUT among neonates born at our hospital 

2.To estimate the prevelance of CAKUT amongst neonates born at our hospital

3.To determine the clinico biochemical profile of neonates with CAKUT

STUDY TYPE : Observational study

STUDY PLACE : Dhanalakshmi Srinivasan Medical College and Hospital, PERAMBALUR, TAMIL NADU , INDIA

STUDY POPULATION :Neonates born between August 01, 2023 and December 01 ,2024

STUDY DURATION :18 months

INCLUSION CRITERIA:

•  All alive neonates born between AUGUST 01 2023 and DECEMBER 01 2024 having

congenital anomalies of the kidney and urinary system 

•  Consenting patients

EXCLUSION CRITERIA

•  Neonates delivered at outside hospital and referred here for further management

 • Mothers not consenting to enroll their neonates

METHODOLOGY:

 All neonates delivered at our hospital (Dhanalakshmi Srinivasan medical college and Hospital) with antenatally diagnosed kidney anomalies are considered for this study. Informed consent was obtained from the parents of all participants included in the study.

The relevant history was taken, clinical examination was done, and findings were noted in a predesigned proforma. Length/height and weight were compared with the Indian Academy of Pediatrics reference charts

•  Blood pressure was recorded using a noninvasive blood pressure monitor. A systolic/diastolic/mean arterial pressure of more than or equal to the 95th percentile for sex, post menstrual age, and height for at least three readings was considered as hypertension

•  Blood samples were collected by sterile puncture of a peripheral vein at 48 hours of life.

•  The estimated glomerular filtration rate (eGFR) was calculated by the Modified Schwartz

equation: GFR (mL/min/1.73 m2) = (0.41 × length in cm)/creatinine in mg/dL 

•  Ultrasound abdomen  was done after 48 hours of life and before 48 hours of life in case of lower urinary tract obstruction.

GESTATIONAL AGE AMONG THE STUDY SUBJECTS

 Majority of neonates enrolled in this study were of term  47 (92.2%) gestation while the remaining 4  (7.8%)  were preterm neonates.

SEX DISTRIBUTION OF NEONATES

A majority of 73.1 % of the neonates were males while the remaing 26.9 % were females in this study

BIRTH WEIGHT AMONG STUDY POPULATION

This study found no neonates below 1.5 kg (very low birth weight) and above 4 kg (macrosomia). Of the 51 neonates enrolled in this study 94.1% fell in the normal weightrange while the remaining were low birth weight neonates i.e between 1.5 to 2.5 kg 

FIRST PASSED URINE AMONG THE STUDY SUBJECTS

All babies except for 1 passed urine within 48 hours of life .the remainder one baby passed urine at 56 hours of life attributable to poor milk secretion from mother 

ANTENATAL SCAN AMONG THE STUDY SUBJECTS

Left renal pelviectasia 47% was the most common finding antenatally followed by b/l renal pelviectasia 23.5%. It was found that 7.8 % of neonates had a normal antenatal USG finding.

MATERNAL COMORBIDITIES

This study shows 18 mothers (35.2 %) without any comorbidities while a majority of 64.7 % suffered comorbidities. Of this a majority had gestational hypertension with 21 mother falling in this category (41.1 %) while GDM was found in 12 mother ( 23% ).

SINGLE UMBILICAL ARTERY AMONG THE STUDY SUBJECTS

This study shows 3.9% of neonates having single umbilical artery with an underlying USG finding of ectopic kidney in both the cases. Remaining 92.2 % cases had no external anomaly

SYSTOLIC BLOOD PRESSURE AMONG THE STUDY SUBJECTS

None of the neonates had any elevation in blood pressure recorded within 24 hours of birth . standard normograms were used for this comparision.

SERUM UREA AMONG THE STUDY SUBJECTS 

Serum urea values were found to be normal in all the neonates with 52.9% having urea in the range 10 – 15. The minority of 2 % fell the range more than 21 

SERUM CREATININE AMONG THE STUDY SUBJECTS

All of the neonates had normal creatinine values and there was no evidence suggestive of either acute renal injury 

POST-NATAL USG AMONG THE STUDY SUBJECT