INTEGRATING PEDIATRIC UROLOGY AND NEPHROLOGY IN THE EARLY DETECTION OF CONGENITAL ANOMALIES OF THE KIDNEY AND URINARY TRACT (CAKUT): CLINICAL AND RADIOLOGICAL INSIGHTS – A PROSPECTIVE OBSERVATIONAL COHORT STUDY
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Abstract
Background: Congenital anomalies of the kidney and urinary tract (CAKUT) are the most common cause of chronic kidney disease (CKD) in children. Early detection requires a coordinated approach integrating pediatric nephrology, urology, and advanced radiological tools.
Objective: To evaluate the effectiveness of an integrated pediatric urology–nephrology approach in early CAKUT detection, with emphasis on clinical and radiological insights.
Methods: A prospective observational study of 120 infants (0–12 months) referred for suspected CAKUT was conducted across two tertiary centers (2020–2023). Patients underwent nephrology and urology evaluation, ultrasound (US), voiding cystourethrography (VCUG), and dimercaptosuccinic acid (DMSA) scans. Integrated care (joint evaluation within 4 weeks) was compared with standard sequential referral.
Results: Integrated care improved diagnostic accuracy (91% vs. 72%, p<0.01) and reduced time-to-surgery for obstructive lesions (2.5 vs. 4.7 months, p<0.05). Ultrasound detected hydronephrosis in 78% of cases but missed 22% of VUR cases, which VCUG identified. DMSA added value in detecting cortical scarring (21% of patients undetected on US).
Conclusion: Multidisciplinary assessment enhances early CAKUT diagnosis and improves clinical outcomes. Establishing pediatric CAKUT clinics may reduce diagnostic delays and improve parental counseling.
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Dr. Anita Haroon
MBBS, Jinnah Medical and Dental College, Karachi University; MRCP (UK), FCPS (Nephrology), FRCP (UK)
Dr. Rabbia Salahuddin Shaikh
MBBS, Liaquat University of Medical and Health Sciences; FCPS (Paediatric Surgery)
Dr. Muaz Ahmed
MBBS, Medical Officer, Pakistan Kidney and Liver Institute & Research Center (PKLI & RC), Lahore
Dr. Amber Shams
MBBS, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan; Professional Diploma in Gynaecology & Obstetrics, Royal College of Physicians of Ireland (RCPI)