Abstract Ref Number = APCP1087
Monitoring of Chronic Kidney Disease due to CAKUT and Incidence of Recurrent Urinary Tract Infection
Rizki ayu Rizal,Ahmedz Widiasta,Dedi Rachmadi,Dany Hilmanto,Nanan Sekarwana
Universitas Padjajaran Medical School Department of Child Health, Universitas Padjajaran Medical School
Background : Congenital anomalies of the kidney and the urinary tract (CAKUT) can occur in 3–6 per 1000 births. It may develop into chronic kidney disease (CKD) in 34–59% , with 31% of all cases develop into end stage renal disease (ESRD). We need further strategy to maintain kidney function and to prevent recurrent urinary tract infection (UTI) or other morbidities in developing countries with limited facilities.
Case Presentation Summary : Case 1 An 8-months-old boy was admitted to an outpatient clinic with fever since 6 days before. The complaint was accompanied by difficulty of urination since 4 months ago that was frequently recurring. There was full bladder found in physical examination. Blood result showed WBC 22.500 /mm3, ureum 52 mg/dL, creatinine 2.09 mg/dL. Urinalysis was full of leukocytes and bacteria in microscopic finding. Renal ultrasound showed bilateral hydronephrosis, while voiding cystourethrogram showed signs of dilated and tortuous left ureter. Renogram examination found glomerular filtration rate (GFR) total was 24,5 mL/min. He was treated with Ceftriaxon 50mg/kg/day, paracetamol, urine catheterization and was discharged with improvement. Case 2 An 8-year-old boy came to emergency room with shortness of breath accompanied by fever and lack of urinating since 4 days before. He had history of recurrent UTI since 3 years old. Blood pressure was 120/90 mmHg. Laboratory finding showed WBC 60.300 /mm3, ureum 236 mg/dL creatinine 8.95 mg/dL, and severe metabolic acidosis from blood gas analysis. Renogram was performed with total GFR was 35.9 mL/min. Kidney ultrasound found bilateral hydronephrosis. Voiding cystourethrogram revealed christmas tree appearance from the bladder shape. He was discharged with improvement. Both patients routinely underwent check-ups in outpatient clinic for monitoring their renal function and urine catheter replacement. Currently, they have normal GFR with less incidence of recurrent UTI.
Learning Points/Discussion : Recurrent Urinary Tract Infection could be predisposed by CAKUT. Adequate management would prevent or inhibit CKD progression.
Keywords: CAKUT Chronic Kidney Disease Urinary tract infection