Selective use of voiding cystourethrography in children undergoing renal transplant evaluation.
OBJECTIVE
Voiding cystourethrography is a routine component in evaluating children awaiting renal transplantation. We examined whether this assessment is necessary in children with renal failure due to dysplasia/aplasia/hypoplasia syndrome and unknown etiology, which account for up to 25% of those with renal failure requiring renal replacement therapies.


METHODS
We performed an institutional review board approved, retrospective review of 191 children undergoing transplantation between 2002 and 2007. We reviewed clinical factors associated with positive findings on voiding cystourethrogram. We also reviewed cystography results in children with chronic kidney disease due to renal dysplasia and unknown etiology.


RESULTS
We identified 113 boys and 78 girls who underwent renal transplantation during the study period. Pre-transplant voiding cystourethrography was documented in 108 children (57%). Predictors of positive pre-transplant results included history of hydronephrosis, urinary tract infections and renal failure due to urological causes. No pre-transplant cystogram was positive in children with renal failure due to dysplasia or unknown etiology.


CONCLUSIONS
We recommend selective use of voiding cystourethrography to evaluate children awaiting renal transplantation. We continue to support performing this test in children with renal failure due to urological causes and those with a history of urinary tract infection, hydronephrosis or voiding dysfunction. In the absence of these findings children with renal failure due to renal dysplasia/aplasia/hypoplasia syndrome or unknown etiology need not undergo pre-transplant voiding cystourethrography.
Singer
Jennifer S
JS
Division of Pediatric Urology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA. jsinger@mednet.ucla.edu
Zaid
Uwais
U
Gritsch
H Albin
HA
Lerman
Steven E
SE
Churchill
Bernard M
BM
D002648:Child; D005260:Female; D006801:Humans; D007668:Kidney / Q000002:abnormalities; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D011300:Preoperative Care; D012189:Retrospective Studies; D014563:Urodynamics; D014567:Urography