Main Physical Features, Echocardiographic and Renal Ultrasonographic Findings of Turner Syndrome in 107 Pediatric Patients

Turner syndrome (TS) is one of the most common malformation syndromes in females. A total number of 107 TS patients, diagnosed between 2000 and 2018, were evaluated for their phenotypic features, and cardiac and renal findings. The mean age of patients at admission was 10.08 ± 4.9 years (range, newborn to 18 years). Four different karyotype groups were encountered, and the most common findings in all groups were short stature, followed by cubitus valgus. Echocardiographic findings of 85 patients were available among which 63 (<i>n</i> = 63/85, 74.1%) were found to be normal. The most common cardiac anomaly was left ventricular outflow tract/aortic arch pathology detected in 9 patients (<i>n</i> = 9/22, 40.9%). Renal malformations were detected in 15 patients (<i>n</i> = 15/84, 17.9%) by renal ultrasonography, and horseshoe kidney was the most common renal malformation, followed by left multicystic dysplastic kidney. There was no significant difference in the frequency of renal malformation and cardiac anomalies among the 4different karyotype groups (χ² exact test, <i>p</i> &#x3e; 0.05). Compared with the literature, the frequency of renal anomalies was detected at a lower rate. Karyotype analysis should be carried out in all female patients with short stature, even if there are no associated phenotypic findings suggestive of TS. Since cardiac anomalies are frequently seen in TS patients and they represent a common cause of mortality, echocardiography should be carried out as soon as the definite diagnosis is established. Renal anomalies may be less frequent than cardiac anomalies; however, evaluation of TS patients with renal ultrasonography should be done at the time of diagnosis. Although renal ultrasonography can be used as the initial renal screening in TS patients, it may underestimate the frequency of renal malformation; hence, further management may be required.

Preliminary study on the application of renal ultrasonography radiomics in the classification of glomerulopathy

Background The aim of this study was to investigate the potential use of renal ultrasonography radiomics features in the histologic classification of glomerulopathy. Methods A total of 623 renal ultrasound images from 46 membranous nephropathy (MN) and 22 IgA nephropathy patients were collected. The cases and images were divided into a training group (51 cases with 470 images) and a test group (17 cases with 153 images). A total of 180 dimensional features were designed and extracted from the renal parenchyma in the ultrasound images. Least absolute shrinkage and selection operator (LASSO) logistic regression was then applied to these normalized radiomics features to select the features with the highest correlations. Four machine learning classifiers, including logistic regression, a support vector machine (SVM), a random forest, and a K-nearest neighbour classifier, were deployed for the classification of MN and IgA nephropathy. Subsequently, the results were assessed according to accuracy and receiver operating characteristic (ROC) curves. Results Patients with MN were older than patients with IgA nephropathy. MN primarily manifested in patients as nephrotic syndrome, whereas IgA nephropathy presented mainly as nephritic syndrome. Analysis of the classification performance of the four classifiers for IgA nephropathy and MN revealed that the random forest achieved the highest area under the ROC curve (AUC) (0.7639) and the highest specificity (0.8750). However, logistic regression attained the highest accuracy (0.7647) and the highest sensitivity (0.8889). Conclusions Quantitative radiomics imaging features extracted from digital renal ultrasound are fully capable of distinguishing IgA nephropathy from MN. Radiomics analysis, a non-invasive method, is helpful for histological classification of glomerulopathy.

Preoperative clinical and renal ultrasonography variables associated with improved systolic and diastolic blood pressure reduction after renal artery stenting

IntroductionResponse to stent-assisted angioplasty (PTA) in hypertensive patients with atherosclerotic renal artery stenosis (ARAS) is unpredictable. Therefore, the present study aimed to search for preoperative clinical and renal ultrasonography variables associated with systolic (SBP) and diastolic blood pressure (DBP) reduction.Material and methodsPreoperative clinical assessment and renal ultrasonography were performed in 202 patients who underwent PTA for ARAS (2003–2018). Patients were categorized as responders if decrease of SBP of at least 20mmHg or DBP of 5mmHg was achieved. Logistic regression models, with percentage shares, were evaluated by basic decision characteristics for ultrasonographic and clinical variables.ResultsLogistic regression analysis showed that preoperative SBP ≥145mmHg (OR,20.0 [95%CI 8.67–46.2], p<0.001), (2) baseline DBP >82 mmHg (OR,3.46 [95%CI 1.61–7.42], p=0.001), (3) prior myocardial infarction (OR,3.14 [95%CI 1.09–9.0], p=0.033), and (4) Renal-Aortic-Ratio >5.1 (OR,2.67 [95%CI 1.20-6.0], p=0.016) predicted the SBP response, with respective influence shares of 69.8%; 12.1%; 10.9%; and 7.2%. The DBP response was associated with (1) baseline SBP >145mmHg (OR,3.79 [95%CI 1.87–7.70], p<0.001), (2) baseline DBP >82mmHg (OR,6.09 [95%CI 2.88–12.9], p<0.001), (3) ARAS progression (OR,0.32 [95%CI 0.09–1.07], p=0.062), (4) contralateral kidney length>106mm (OR,0.43 [95%CI 0.22–0.86], p=0.017), and (5) bilateral PTA (OR,2.39 [95%CI 1.08–5.27], p=0.03), with respective shares of 21.8%; 35.0%; 18.2%; 13.3% and 11.8%.ConclusionsCurrent study identified clinical and ultrasonographic characteristics of patients who are likely to respond to PTA for ARAS. The RAR and contralateral kidney size may enhance prediction of response likelihood.

Incidence of urinary tract infection in neonates with significant indirect Hyperbilirubinemia of unknown etiology: case-control study

Background Indirect hyperbilirubinemia is frequently encountered during neonatal period. Although it has different causes, in some cases it can’t be explained. Previous studies have illustrated that jaundice could be a major sign of urinary tract infection (UTI) in neonates. Aim of the work We aimed to determine the association between UTI and significant unexplained neonatal indirect hyperbilirubinemia. Methods This prospective controlled study was performed on 150 neonates divided in two groups (100 as cases and 50 as controls) to investigate the incidence of UTI in neonates with significant unexplained hyperbilirubinemia. Urine sample was obtained using urine catheterization technique from neonates and full urine analysis was done and cases with pyuria had urine culture to confirm UTI. Immediate renal ultrasonography (USG) was performed for neonates with UTI. Results UTI incidence was 11% in cases while none of neonates in control group had UTI with statistical significance between cases and controls (P value < 0.05). The most common (36.4%) pathogen was Escherichia coli. Posterior urethral valve with mild hydronephrosis was diagnosed in 18.2% of UTI positive patients by renal ultrasonography. Conclusion In neonates with unexplained indirect hyperbilirubinemia, UTI should be considered as a pathological cause.

A correlation study of the effectiveness of renal scintigraphy and sonography in the detection and evaluation of renal disorders

Background: This retrospective study was undertaken to assess correlation between renal scintigraphy employing technetium Tc-99m chelated with radiopharmaceutical drug Diethylenetriamine Penta Acetic Acid (DTPA) and renal ultrasonography morphological findings. Methods: For this purpose, ninety six patients imaging data was statistically analyzed including 43 females and 53 males. All the patients were subjected to renal scintigraphy while 68 patients underwent renal ultrasonography. Renal U/S reported anatomical renal anomaly in 94.1% patients versus 85.4% detected by scintigraphy. There were 41 patients out of 68 diagnosed with hydronephrosis and 21 of them were suffering with mild hydronephrosis as suggested by U/S imaging. Results: Renal scintigraphy of 41 hydronephrotic patients validated that 19 patients having non-obstructive bilateral pelvic dilation while remaining 22 with mild to severe obstruction. Ultrasonography diagnosed 4 patients with renal obstruction. Conversely, renal scintigraphy validated 2 of them with renal obstruction on the basis of renal function. In total, 19 out 96 patients were reported with renal obstruction through scintigraphy and validated obstruction in 1 of the 3 patients who were diagnosed with abnormal postvoid residual volume through U/S. Conclusion: Renal scintigraphy is not significant in diagnosing kidney disease; rather this is a vibrant imaging tool providing supplementary data on the basis of renal function. Effectively targeted intervention regime can be achieved by correlating renal scintigraphy and renal ultrasonography results to minimize renal disease incidence.

Hematuria

Key Points The most common cause of hematuria overall is UTI. The most common cause of asymptomatic isolated microscopic hematuria is benign transient hematuria. Before further evaluation, repeating the urinalysis at least once is prudent, and asymptomatic school-aged children may be followed for 2 or more years before further work-up. Macroscopic hematuria is a common sign of glomerular or urologic disease, warranting renal ultrasonography and further evaluation as indicated.