Know More On Congenital Abnormality of Kidney and Urinary Tract- CAKUT

Why know about CAKUT?

Do you know in our country with a population of more than 1 billion, children contribute 40 % of this population. Adult hospital based study have shown the prevalence of 0.8 % of exclusive chronic kidney diseases but no recent pediatric data is available for the burden of this disease. Dr. Sonia Sharma says CAKUT ( a congenital abnormality of kidney and urinary tract) and hereditary nephropathies contribute 2/3 of all chronic renal failure in children. CAKUT include renal agenesis, multicystic dysplastic kidney, renal dysplasia, duplex, ectopic ureter and bladder abnormalities.

Recognize the hidden illness

Case 1

A 15 yr old boy from a poor family was presented in emergency with seizures. He also had pallor and blood pressure was 150/100 mmHg (Above 95th centile). Past history of recurrent urinary tract infections was present. USG showed absent left kidney and right side small kidney. His kidney function tests were also deranged (Urea/Creatinine: 198/5).  The family has explained the diagnosis of chronic kidney disease and the need for dialysis. Now the child is on regular hemo-dialysis and waiting for kidney transplant.

Case2

3-month-old infant was admitted with poor intake and vomiting off and on for 4 days and not passing urine for 1 day. He was antenately diagnosed with bilateral hydro-uretero-nephrosis and post-natal USG also showed similar findings. His kidney function tests were within the normal limit at birth and discharged without further investigations. Now at admission, he was noted to have fast breathing and irritability. Investigations suggested impaired urea and creatinine (180/ 2.5) and metabolic acidosis. USG showed similar findings. MCU suggested posterior urethral valve. The child was taken for surgery after stabilizing the KFT. He needed dialysis for the same.

Facts:

Do not ignore the underlying cause especially with recurrent urinary tract infection as CAKUT is the cause of 30% of all CKD in children. All renal and urinary tract malformations altogether present in 1:500 live born fetuses, 1:2000 births neonatal death and contribute to 15 % of all prenatally detected anomalies. Other than gene mutation and obstruction, exposure to certain intrauterine factors like low protein diet, vitamin A deficiency, high/low sodium diet, RAS blockers etc affect the normal anatomy. Timely intervention for an underlying cause can prevent chronicity but abnormality like posterior urethral valve may progress to chronic kidney disease despite corrections.

Your Child may need a follow up with a Pediatric nephrologist (age group: 0-18 years) for:

• Hypertension
• Proteinuria
• Hematuria
• Recurrent urinary tract infection, day time & night time enuresis, urgency, frequency
• Decline in GFR
• Emergency Dialysis

Imaging needed for complete evaluation if diagnosed early:

• USG
• Voiding cystourethrography
• DTPA
• DMSA

If diagnosed late with chronic kidney disease, neither of the nuclear imaging modalities are required.

Are there any treatment options?

If approached early:

• Timely correction of underlying cause
• Medicinal management for persistent hypertension, proteinuria

If approach late:

• Dialysis: Hemodialysis, Peritoneal dialysis
• Renal transplant

Early Prevention can help the doctor in preparing a preventive plan.