58
Causes of Hydronephrosis in Pyelonephritic Children
p a t i e n t s . The p r o g n o s i s for h e i g h t , g r o w t h a n d
development of all segments of the limb is based on serial
examination and intervention begun early in life4. Early
surgical t r e a t m e n t and prosthetic rehabilitation yield
excellent results, not only for the short term but also for
the long term s.
A s h o k K u m a r 1, Jayant K. G h o s h , Pragya Pant,
S. Basu and B.D. Bhatia
Division of Neonatology, ~Department of Pediatrics
Institute of Medical Sciences, Banaras Hindu University,
Varanasi- 221 005, India.
Causes of Hydronephrosis in Pyelonephritic Children
Sir,
Urinary tract infection (UTI) is one of the most c o m m o n
bacterial infectious diseases a m o n g children. Since 1960,
the use of radiological imaging has been accepted in child
with UTI. 1However, the choice of radiological imaging in
children is controversial. Urinary tract ultrasonography is
s o m e t i m e s p r e f o r m e d for initial u p p e r u r i n a r y tract
imaging because of the absence of radiation. Radiologists
m a y r e p o r t v a r i o u s d e g r e e s of dilation of collecting
system and recommended further investigation to detect
a b n o r m a l i t i e s such as vesicoureteral reflux (VUR) or
u r e t e r o p l e v i c junction obstruction (UPJO). VUR was
r e p o r t e d in 30%-50% of the children with UTI 2, a n d
dilatation of collecting system was reported in about 27%-
28% of children with UTI. 3q
Based on the data collected from September 1996 to
April 2003, all symptomatic febrile UTI patients referred
to D e p a r t m e n t of Pediatric N e p h r o l o g y of A m i r k o l a
Children Hospital (north of Iran) were enroled in this
study, and causes of urinary tract dilation were evaluated.
UTI was c o n f i r m e d with positive urine culture in the
samples. Any patient with dilation of collecting system
(by ultrasonography) was selected. Then, VCUG (voiding
cystourethrography) was done, and if the patients do not
have VUR, [VP ( I n t r a v e n o u s p y e l o g r a p h y ) or DTPA
(Diethylenetriamine pentaacetate) imaging was
conducted. Statistical analysis was performed using SPSS
version 10 and student t-test was used to compare the P-
TABLE1. Cause of Dilation of Collecting System in Children with UTI According to Age and Sex Groups
Causes Sex VUR UPJO
Age groups (years)
M F M F
Less than 2 12 5 3 1 3
3-5 3 3 2 2
6-15 7 10 2 3
22 18 7 6
VUR: Vesicoureteral reflux; UPJO: Urerteroplevic junction obstruction, UVJO: Ureterovesical junction, M: males, F: females
1058
REFERENCES
1. Achterman C, Kalamchi A. Congenital absence of the fibula. J
Bone Joint Surg (Br) 1979; 61 (B): 133-137.
2. Amstutz HC. Natural history and treatment of congenital
absence of the fibula, l Bone Joint Surg (Am) 1972; 54 (A): 1349.
3. Coventry MB, Johnson EW. Congenital absence of the fibula.
J Bone Joint Surg (Am) 1952; 34 (A): 941-955.
4. Sharr~rd WJW. Major Congenital Malformations of the Limbs.
In PediatricOrthopedics and Fractures. ya edn. Oxford; Blackwell
Scientific Publications, 1993; 1 : 234-242.
5. Bohne WHO, Root L. Hypoplasia of the fibula. Clin Orthop
1977; 125: 107-112.
values, which is less than 0.05 and considered significant.
346 patients were admited in the hospital with diagnosis
of UTI. 70 (20%) subjects h a d d i l a t i o n of UTI b y
ultrasound. 40 (57%) patients were male, younger than
the female patients (45 months vs 63 months). 29 (41%)
subjects had 6-12-years-old that were more than other
age-groups. A m o n g the a g e - g r o u p b e l o w 2 years, the
numbers of males outnumbered the females (Table 1). 37
(53%) patients had bilateral involvement and 27 (73%) of
them were males. 40 (57%) and 13 (19%) patients had
VUR and UPJO respectively (p<0.05) (Table 1). 26 (65%)
with VUR had bilateral involvement and 22 (55%) of them
w e r e male. VUR w a s the m o s t c o m m o n c a u s e of
hydronehrosis in the patients with pyelonephritis in both
sexes and all age groups, but renal stone was a second
cause of hydronephrosis in males above 6 yr (Table 1).
Ultrasonography is a non-invasive and non-ionizing
radiation form of imaging which could detect dilation of
collecting system. F o r e s m a n et al reported dilation of
k i d n e y in 52 (28%) patients with UTI. 3 Some a u t h o r s
showed the frequency of VUR had no difference between
patients with or without dilatation (39% vs 32%). 5 Also,
the sensitivity and specificity of ultrasound for detection
of VUR were 40% and 76% respectively; positive a n d
negative predictive value of ultrasound for VUR were
32% and 82% respectively?"5Dipietro found ultrasound is
not reliable for detection of VUR in children aged 5 yr or
older? In this study, 20% of patients with UTI had dilation
UVJO Stone Uretrocel Total
M F M F M F
1 25
2 1 1 2 16
5 2 29
5 1 6 3 2 70
Indian Journal of Pediatrics, Volume 72--December, 2005
59
Neonatal Listeriosis
of collating system. Mean age in males was Mss than that
of females, and 41% of patients were between 6-15 yr old.
Urinary tract abnormalities are higher in y o u n g males,
a n d this s t u d y s h o w s m o r e y o u n g e r b o y s w i t h
h y d r o n e p h r o s i s t h a n girls. So, d e l a y in d i a g n o s i s
(especially in males) may cause irreversible renal damage.
The most c o m m o n cause of dilation of collecting
system in this s t u d y was VUR (57%) and than UPJO
(19%). S a u n d e r s et al s t u d i e d 74 c h i l d r e n w i t h 91
h y d r o n e p h r o t i c kidneys e v a l u a t e d with isotope scan
(mercaptoacetyl tryglycin). Obstructive hydronephrosis in
22 k i d n e y s (21 with UPJO and 1 with ureterovesical
junction obstruction) and non-obstructive hydronephrosis
in the 69 kidneys were diagnosed. 7
According to this study, although VUR is the most
c o m m o n cause of d i l a t i o n c o l l e c t i n g s y s t e m , b u t
ultrasonography could not predict the VUR, and other
c a u s e s of d i l a t i o n of c o l l e c t i n g s y s t e m s h o u l d be
c o n s i d e r e d . Surgical or n o n - s u r g i c a l f o l l o w - u p can
p r e v e n t irreversible renal damage, especially in male
young children.
Hadi Sorkhi
Department of Pediatric Nephrology
Amirkola Children Hospital, Babol Medical University, Iran
Zip Code : 47317-41151
Fax : +98 1113240656
E-mail : hadisorkhiC'wpednephir.org
Neonatal Listeriosis
s~
Perinatal listerial infection is the most c o m m o n clinical
syndrome caused by Listeria monocytogenes and includes
abortion, still birth, neonatal sepsis and meningitis. Early
onset neonatal listeriosis develops within 7 days and
classically within 1 or 2 days of life. Aspiration of infected
amniotic fluid contributes to pathogenesis, although,
transplacental transmission is favored by most authors)
We report a case of early onset neonatal listeriosis in a full
term baby presenting at 58 hours of life.
A 58-hour-old male b a b y p r e s e n t e d with grunting
respiration and poor feeding. The baby was born at term
gestation to an unbooked gravida I mother by emergency
cesarean section for eclampsia and w e i g h e d 3.4 kg at
birth. The amniotic fluid was meconium stained and the
baby suffered from perinatal asphyxia. There was no
history of fever, foul smelling liquor and p r o l o n g e d
r u p t u r e of m e m b r a n e s or d r u g intake in the mother.
Examination revealed a sick baby with heart rate of 136/
min, respiratory rate of 7 0 / m i n expiratory grunts and
subcostal and intercostals retractions.
L a b o r a t o r y e v a l u a t i o n of the b a b y s h o w e d total
leucocyte count of 14,000 c e l l s / m m 3 (neutrophils 65%,
Indian Joumal of Pediatrics, Volume 72---December, 2005
REFERENCES
1. Smellie]lV[,Hodson, CJ, Edwards D, Normand IC. Llinicaland
radiological features of urinary infection in childhood. BKJ
1964; 2 : 1222.
2. SmellieJM, Normand JCS, Katz G. Children with urinary tract
infection: a comparison of those with and without
vesicoureteral reflux. Kidney Int 1981;20 : 717-722.
3. Foresman WIJ, Hulbert WC, JR Rabinowitz R. Dose urinary
tract ultrasonography at hospitalization for acute
pyelonephritis predict vescourereteral reflux?.J Urol 2001; 165
: 2232-2234.
4. Mahant S, Friedman J, Macartur C. Renal ultrasound findings
and vesicoureteralreflux in children hospitalized with urinary
tract infection. Arch Dis Child 2002;86: 419-421.
5. Davey MS, Zerin JM, ReillyC et al. Mild renal dilatation is not
predictive of vesicoureteral reflux in children. Pediatr Radiol
1997; 27 : 908-911.
6. Dipietro MA, Blane CE, Zerin MG. Vesicoureteral reflux in
older children: concordance of us and voiding
cysturethrographyic finding. Radiology 1997;205; 821-822.
7. Saunders CA, Choong KK, Lavcos G, Farlow D, Gruenewald
SM. Assessment of pediatric hydronephrosis using o output
efficiency.J Nucl Med 1997;38 (9) : 147787-147789.
lymphocytes 30%, monocytes 5%) and band cells 4 per
100 neutrophils; micro ESR was 4 mm/l'thour; C Reactive
Protein was l m g / L and chest X ray revealed bilateral
r e t i c u l o n o d u l a r opacities. C e r e b r o s p i n a l f l u i d
examination was normal and culture was sterile. Two
samples of p e r i p h e r a l v e n o u s b l o o d collected f r o m
different sites at the same time were inoculated into Brain
Heart Infusion (BHI) broth. After incubation at 37 ~ for
18 hours, Gram's stain from both BHI broths s h o w e d
gram positive bacilli. Subsequent subculture yielded
Listeria monocytogenes. The isolate was identified b y
standard methods. 2Antimicrobial susceptibility tes~ng by
Kirby Bauer method showed the isolate to be sensitive to
ampicillin, penicillin, chloramphenicol, gentamicin and
v a n c o m y c i n . The child was t r e a t e d w i t h p a r e n t e r a l
ampicillin and gentamicin for fourteen days and showed
uneventful recovery.
Few reports of neonatal listeriosis are available from
India, wherein the incidence of neonatal listeriosis was
found to be 2.2% in meconium stained babies and 0.2% in
total births) Listeria monocytogenes has been isolated from
the genital tract of 14% cases of bad obstetric history in
Mumbai 4 and 1.34% in Delhi. 5
1059