title: Study of prognostic significance of antenatal ultrasonography and renin angiotensin system activation in predicting disease severity in posterior urethral valves.
abstract: OBJECTIVE
  Study on prognostic significance of antenatal ultrasonography and renin angiotensin system activation in predicting disease severity in posterior urethral valves.
  
  
  METHODS
  Antenatally diagnosed hydronephrosis patients were included. Postnatally, they were divided into two groups, posterior urethral valve (PUV) and non-PUV. The studied parameters were: Gestational age at detection, surgical intervention, ultrasound findings, cord blood and follow up plasma renin activity (PRA) values, vesico-ureteric reflux (VUR), renal scars, and glomerular filtration rate (GFR).
  
  
  RESULTS
  A total of 25 patients were included, 10 PUV and 15 non-PUV. All infants with PUV underwent primary valve incision. GFR was less than 60 ml/min/1.73 m(2) body surface area in 4 patients at last follow-up. Keyhole sign, oligoamnios, absent bladder cycling, and cortical cysts were not consistent findings on antenatal ultrasound in PUV. Cord blood PRA was significantly higher (P < 0.0001) in PUV compared to non-PUV patients. Gestational age at detection of hydronephrosis, cortical cysts, bladder wall thickness, and amniotic fluid index were not significantly correlated with GFR while PRA could differentiate between poor and better prognosis cases with PUV.
  
  
  CONCLUSIONS
  Ultrasound was neither uniformly useful in diagnosing PUV antenatally, nor differentiating it from cases with non-PUV hydronephrosis. In congenital hydronephrosis, cord blood PRA was significantly higher in cases with PUV compared to non-PUV cases and fell significantly after valve ablation. Cord blood PRA could distinguish between poor and better prognosis cases with PUV.
authors.affiliation: Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Divya
authors.initials: D
authors.lastname: Bhadoo
authors.affiliation: Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: M
authors.initials: M
authors.lastname: Bajpai
authors.affiliation: Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ali
authors.initials: A
authors.lastname: Abid
authors.affiliation: Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Gayan
authors.initials: G
authors.lastname: Sukanya
authors.affiliation: Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Agarwala
authors.affiliation: Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: M
authors.initials: M
authors.lastname: Srinivas
authors.affiliation: Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Deepika
authors.initials: D
authors.lastname: Deka
authors.affiliation: Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Nutan
authors.initials: N
authors.lastname: Agarwal
authors.affiliation: Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Agarwal
authors.affiliation: Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kumar
keywords: Amniotic fluid index; antenatal ultrasonography; congenital hydronephrosis; plasma renin activity; posterior urethral valves
references.citation: J Urol. 2005 Feb;173(2):592-4
references.pmid: 15643266
references.citation: J Urol. 1999 Sep;162(3 Pt 1):849-53
references.pmid: 10458394
references.citation: J Indian Assoc Pediatr Surg. 2013 Apr;18(2):74-8
references.pmid: 23798811
references.citation: Pediatr Surg Int. 2001;17(1):11-5
references.pmid: 11294258
references.citation: Ultrasound Obstet Gynecol. 2009 Oct;34(4):419-23
references.pmid: 19642115
references.citation: Urology. 2002 Aug;60(2):335-8; discussion 338
references.pmid: 12137837
references.citation: J Urol. 1994 Aug;152(2 Pt 2):698-701
references.pmid: 8021998
references.citation: J Urol. 1992 Jul;148(1):125-6
references.pmid: 1613851
references.citation: J Indian Assoc Pediatr Surg. 2014 Jul;19(3):133-7
references.pmid: 25197189
references.citation: Br J Urol. 1988 Jul;62(1):59-62
references.pmid: 3408870
references.citation: Eur J Pediatr Surg. 1999 Oct;9(5):307-11
references.pmid: 10584190
references.citation: J Hum Hypertens. 1998 Aug;12(8):497-504
references.pmid: 9759982
references.citation: J Indian Assoc Pediatr Surg. 2013 Oct;18(4):143-6
references.pmid: 24347867
references.citation: BJU Int. 2003 May;91(7):687-90
references.pmid: 12699486