The impact of perinatal urinoma formation on renal function: our experience and review of the literature

Introduction: A urinoma is a fluid mass consisting of extravasated urine in the perirenal space. Its impact on renal function was analysed. Methods: All cases of prenatal and neonatal urinoma reported in the literature were analysed as well as two cases recently observed in our department. Results: A review of all prenatally diagnosed urinomas revealed 25 cases, for a total of 30 renal units. The cause of obstruction was: lower urinary tract (LUT) obstruction in 16 cases (62.5%), upper urinary tract (UUT) obstruction in seven cases (29.5%) and unknown in two cases (8%). A preserved renal function was found in only 30% of all cases. Furthermore, prognosis for renal function was better in posterior urethral valve (PUV) patients than in uretero‐pelvic junction obstruction (UPJO) patients. In addition, we analysed 35 published cases of urinoma with a neonatal onset, without prenatal diagnosis, and secondary to LUT obstruction in 27 cases (77%), UUT obstruction in seven cases (20%), while the underlying cause was unknown in one cases (3%). A preserved renal function was observed in 84% of cases with UUT obstruction and in 80% of cases presenting a LUT obstruction. Conclusions: Prognosis concerning renal function seems to be mainly related to two factors: age at presentation and underlying diagnosis. Decompression of the urinary tract by urine extravasation produces the best results in terms of preservation of the renal function in LUT obstruction (75% in prenatal and 84% in postnatal cases); UUT obstruction however is associated with a good prognosis in the neonatal period (80% of preserved renal function) but with a severe impairment (only 20% of preserved renal function) in prenatally detected cases.     

Neurofibromatosis involving the lower urinary tract in children A report of three cases and a review of the literature

Three children with neurofibromatosis involving the lower urinary tract are reported and their clinical, radiological and pathological findings are described. Lower urinary tract involvement in neurofibromatosis has previously been reported in 17 children, 12 of whom had other stigmata of von Recklinghausens disease. Lower urinary tract involvement may be asymptomatic and can be found incidentally. Every case with neurofibromatosis presenting with what may appear to be even only insignificant urinary symptoms should be thoroughly investigated urologically. Symptoms are usually related to urinary tract obstruction or neurogenic bladder dysfunction due to the involvement of the nerves supplying the bladder. Urinary diversion is the treatment of choice as surgical removal of the extensive tumour is seldom feasible. Following treatment the prognosis for survival appears to be good.     

Interkinetic nuclear migration in the mouse embryonic ureteric epithelium: Possible implication for congenital anomalies of the kidney and urinary tract

Interkinetic nuclear migration (INM) is a phenomenon in which progenitor cell nuclei migrate along the apico‐basal axis of the pseudostratified epithelium, which is characterized by the presence of apical primary cilia, in synchrony with the cell cycle in a manner of apical mitosis. INM is suggested to regulate not only stem/progenitor cell proliferation/differentiation but also organ size and shape. INM has been reported in epithelia of both ectoderm and endoderm origin. We examined whether INM exists in the mesoderm‐derived ureteric epithelium. At embryonic day (E) 11.5, E12.5 and E13.5, C57BL/6J mouse dams were injected with 5‐bromo‐2’‐deoxyuridine (BrdU) and embryos were killed 1, 2, 4, 6, 8, 10 and 12 h later. We immunostained transverse sections of the ureter for BrdU, and measured the position of BrdU (+) nuclei in the ureteric epithelia along the apico‐basal axis at each time point. We analyzed the distribution patterns of BrdU (+) nuclei in histograms using the multidimensional scaling. Changes in the nucleus distribution patterns suggested nucleus movement characteristic of INM in the ureteric epithelia, and the mode of INM varied throughout the ureter development. While apical primary cilia are related with INM by providing a centrosome for the apical mitosis, congenital anomalies of the kidney and urinary tract (CAKUT) include syndromes linked to primary ciliary dysfunction affecting epithelial tubular organs such as kidney, ureter, and brain. The present study showed that INM exists in the ureteric epithelium and suggests that INM may be related with the CAKUT etiology via primary ciliary protein function.     

Communicating hunger and satiation in the first 2 years of life: a systematic review

Responsive feeding has been identified as important in preventing overconsumption by infants. However, this is predicated on an assumption that parents recognise and respond to infant feeding cues. Despite this, relatively little is understood about how infants engage parental feeding responses. Therefore, the aim of this systematic review was to identify what is known about infant communication of hunger and satiation and what issues impact on the expression and perception of these states. A search of Medline, CINAHL, Web of Science, PsycINFO, Science Direct and Maternal and Infant care produced 27 papers. Eligibility criteria included peer reviewed qualitative and/or quantitative publications on feeding behaviours, hunger, and satiation/satiety cues of typically developing children in the first 2 years of life. Papers published between 1966 and 2013 were included in the review. The review revealed that feeding cues and behaviours are shaped by numerous issues, such as infants' physical attributes, individual psychological factors and environmental factors. Meanwhile, infant characteristics, external cues and mothers' own characteristics affect how feeding cues are perceived. The existing literature provides insights into many aspects of hunger and satiation in infancy; however, there are significant gaps in our knowledge. There is a lack of validated tools for measuring hunger and satiation, a need to understand how different infant characteristics impact on feeding behaviour and a need to extricate the respective contributions of infant and maternal characteristics to perceptions of hunger and satiation. Further research is also recommended to differentiate between feeding driven by liking and that driven by hunger.     

单中心6年先天性肾脏和尿道畸形病因构成分析

目的 分析2005至2010年复旦大学附属儿科医院先天性肾脏和尿道畸形（CAKUT）诊断情况,为CAKUT的早期诊断提供线索。方法 系统提取住院诊断为CAKUT病例的病史资料,将三聚氰胺事件结石筛查作为特殊暴露因素,与正常暴露因素下进行比较,分析CAKUT病种构成比、首次入院的病因和影像学检查。结果 6年间1 358例CAKUT患儿进入分析,在重复入院只计1次的前提下CAKUT占同期住院患儿的1.33%（1 358/102 442）。男913例,女445例,男女比例为2.05∶1;首次入院时平均年龄为（3.0±3.4）岁。①正常暴露因素下CAKUT的住院构成比2005至2010年呈缓慢增高趋势（P<0.05）, CAKUT的住院构成比特殊暴露因素较正常暴露因素下高0.67%和0.26%,2008至2009两个年度多筛查出112例达到手术干预指征的CAKUT病例,占同期正常因素暴露下达到手术干预指征CAKUT病例的24.4％［112/（227＋232）］。②CAKUT构成比排序前4位的病种分别为肾盂输尿管连接处梗阻（PUJO）、 膀胱输尿管反流(VUR)、双集合系统和输尿管膀胱连接部梗阻(UVJO),占总CAKUT病例的79.6％;③首诊通过产前B超检查发现异常406例（29.9%）,以PUJO、UVJO和输尿管膨出比例最高;48.5%（658/1 358）CAKUT患儿有泌尿系统症状和体征（腹部症状、血尿、排尿异常、尿路感染伴发热和尿路感染）;尿路感染伴发热占41%（270/658）,为CAKUT病种主要的症状, <2岁患儿是≥2岁患儿的3.2倍（206/64）;其他症状和体征均为≥2岁患儿明显多于<2岁患儿。 98.0%的CAKUT患儿进行B超检查,除VUR的B超异常检出率为68.5%外,其他CAKUT病种的B超异常检出率均>94.0%;根据B超检查和临床表现,选择性进行了功能状态检查（DTPA、DMSA）1 203例,形态学检查（MR、CT或IVP）1 009例,反流情况（MCU）400例。结论 CAKUT构成比以PUJO、VUR、双集合系统和UVJO最为常见,泌尿系统B超筛查CAKUT的准确性较好。在人群中常规筛查可检出CAKUT,其成本效益有待进一步研究。