Advertisement

Baseline Renal Volumes in Children Born With Cloacal Anomalies

      Objective

      To better understand why children born with cloacal anomalies are at a high risk of renal insufficiency, this study aims to determine baseline renal volume in children with cloacal anomalies compared to controls. We hypothesized children with cloacal anomalies would be born with less renal volume.

      Methods

      An IRB approved database of children with cloacal anomalies was reviewed. Controls were female patients with 2-vessel umbilical cord or preauricular tags who underwent screening renal ultrasound. Children were included if they had a renal ultrasound in the first 3 months of life. Cloacal exstrophy, horseshoe and cross-fused ectopic kidneys were excluded. Total and individual kidney volumes were compared between the 2 groups.

      Results

      The study cohort consisted of 109 patients, 46 (42.2%) cloaca patients and 63 (57.8%) controls. In unadjusted analyses, average total renal volume for cloaca and control patients was 22.4 cm3 vs 25.5 cm3 respectively (P = .1006), and there was no significant difference when adjusting for age (P = .3915). The estimated difference in renal unit volume between cloaca patients without solitary kidneys and controls was −1.6 cm3 (95%C.I.: −3.6, 0.4; P = .1201), and there was no significant difference when adjusting for age (P = .4725). The age-adjusted difference in renal unit volume between cloaca patients with solitary kidney and controls was 1.8 cm3 (95%CI: −1.1, 4.8; P = .2148).

      Conclusions

      Children with cloacal anomalies have similar baseline renal volumes as children without cloacal anomalies. Therefore, the increased risk of renal insufficiency in this patient population appears to be due to renal injury postnatally.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hendren WH
        Urological aspects of cloacal malformations.
        J Urol. 1988; 140: 1207-1213
        • Hendren WH
        Cloaca, the most severe degree of imperforate anus: experience with 195 cases.
        Ann Surg. 1998; 228: 331-346
        • Warne SA
        • Wilcox DT
        • Ledermann SE
        • Ransley PG
        Renal outcome in patients with cloaca.
        J Urol. 2002; 167 (discussion 2551): 2548-2551
        • Caldwell BT
        • Wilcox DT
        Long-term urological outcomes in cloacal anomalies.
        Semin Pediatr Surg. 2016; 25: 108-111
        • Rink RC
        • Herndon CD
        • Cain MP
        • et al.
        Upper and lower urinary tract outcome after surgical repair of cloacal malformations: a three-decade experience.
        BJU Int. 2005; 96: 131-134
        • Braga LH
        • Lorenzo AJ
        • Dave S
        • Del-Valle MH
        • Khoury AE
        • Pippi-Salle JL
        Long-term renal function and continence status in patients with cloacal malformation.
        Can Urol Assoc J. 2007; 1: 371-376
        • Abitbol CL
        • Seeherunvong W
        • Galarza MG
        • et al.
        Neonatal kidney size and function in preterm infants: what is a true estimate of glomerular filtration rate?.
        J Pediatr. 2014; 164 (e1022): 1026-1031
        • Bourke WG
        • Clarke TA
        • Mathews TG
        • O'Halpin D
        • Donoghue VB
        Isolated single umbilical artery–the case for routine renal screening.
        Arch Dis Child. 1993; 68: 600-601
        • Kohelet D
        • Arbel E
        A prospective search for urinary tract abnormalities in infants with isolated preauricular tags.
        Pediatrics. 2000; 105: E61
        • Hricak H
        • Lieto RP
        Sonographic determination of renal volume.
        Radiology. 1983; 148: 311-312
        • Hodson CJ
        • Drewe JA
        • Karn MN
        • King A
        Renal size in normal children: a radiographic study during life.
        Arch Dis Child. 1962; 37: 616-622
        • Rosenbaum DM
        • Korngold E
        • Teele RL
        Sonographic assessment of renal length in normal children.
        AJR Am J Roentgenol. 1984; 142: 467-469