Experience of managing neonates and breastfed in-fants with grade IV bilateral hydronephrosis
- Authors: Nikolaev S.N.1,2, Sergeeva S.V.1, Menovshchikova L.B.1,2, Levitskaya M.V.2, Shumikhin V.S.1,2, Erokhina N.O.2, Burkin A.G.3
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Affiliations:
- Russian National Research Medical University named after N.I. Pirogov
- Children's City Clinical Hospital named after N.F. Filatov
- Children’s City Clinical Hospital named after Z.A. Bashlyaeva
- Issue: Vol 38, No 4 (2021)
- Pages: 150-158
- Section: Clinical case
- URL: https://journals.rcsi.science/PMJ/article/view/64364
- DOI: https://doi.org/10.17816/pmj384150-158
- ID: 64364
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Abstract
To analyze the clinical cases of four patients with grade IV bilateral hydronephrosis. Ultrasound examination of the urinary system was used as the main examination method. During the first stage of surgical treatment, all children underwent preliminary urinary diversion; a month later, the results were assessed. The result of the preliminary urinary diversion was the implementation of the Heines-Andersen-Kucher reconstructive operation. According to the control ultrasound performed a month after the nephrostomy, pelvis on the nephrostomy was reduced in all cases, parenchyma thickness increased by an average of 4.5 times, improvement in intragranular blood flow was noted. Evaluation of the effectiveness of pyeloplasty was carried out according to three criteria: restoration of urodynamics, restoration of kidney function and the presence of infectious complications. The parenchyma of the operated kidney grew by an average of 3 times, the pelvis decreased by an average of 3.5 times. Restoration of intrarenal blood flow to the cortical layer, inclusive, was noted in 5 of 8 renal units. Before pyeloplasty, there were marked changes in the renal parenchyma and a decrease in its function by an average of 34 ± 14 %; a year after reconstructive surgery, the changes became moderate, there was an improvement in renal function, a decrease in function by 25 ± 10 %. In our opinion, the starting method for providing urgent surgical care to neonates and breastfed infants with grade IV GN is preliminary urinary diversion, which allows us to determine the functional reserve of the renal parenchyma, delay reconstructive surgery, thereby giving time for the restoration of renal function and avoiding organ-carrying surgery.
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##article.viewOnOriginalSite##About the authors
S. N. Nikolaev
Russian National Research Medical University named after N.I. Pirogov; Children's City Clinical Hospital named after N.F. Filatov
Email: ss181219@mail.ru
MD, PhD, pediatric surgeon of Highest Qualification Category, Head of Center of Urology and Reproductive Health, Professor of Department of Pediatric Surgery
Russian Federation, MoscowS. V. Sergeeva
Russian National Research Medical University named after N.I. Pirogov
Author for correspondence.
Email: ss181219@mail.ru
ORCID iD: 0000-0003-1602-988X
pediatric surgeon, postgraduate student, Department of Pediatric Surgery
Russian Federation, MoscowL. B. Menovshchikova
Russian National Research Medical University named after N.I. Pirogov; Children's City Clinical Hospital named after N.F. Filatov
Email: ss181219@mail.ru
MD, PhD, pediatric surgeon of Highest Qualification Category, pediatric urologist-andrologist, Professor of Department of Pediatric Surgery
Russian Federation, MoscowM. V. Levitskaya
Children's City Clinical Hospital named after N.F. Filatov
Email: ss181219@mail.ru
Candidate of Medical Sciences, pediatric surgeon of Highest Qualification Category, Neonatal and Preterm Infants Unit
Russian Federation, MoscowV. S. Shumikhin
Russian National Research Medical University named after N.I. Pirogov; Children's City Clinical Hospital named after N.F. Filatov
Email: ss181219@mail.ru
Candidate of Medical Sciences, pediatric surgeon of Highest Qualification Category, Head of Neonatal and Preterm Infants Unit, Associate Professor of Department of Pediatric Surgery
Russian Federation, MoscowN. O. Erokhina
Children's City Clinical Hospital named after N.F. Filatov
Email: ss181219@mail.ru
pediatric surgeon, Neonatal and Preterm Infants Unit
Russian Federation, MoscowA. G. Burkin
Children’s City Clinical Hospital named after Z.A. Bashlyaeva
Email: ss181219@mail.ru
Candidate of Medical Sciences, pediatric urologist-andrologist, Head of Pediatric Urology-Andrology and Planned Surgery Unit
Russian Federation, MoscowReferences
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