Nephrology 3: Dialysis and Diversity and Equity in Kidney Health
275 - Are patients with renal anomalies at risk for Müllerian anomalies?
Saturday, April 29, 2023
3:30 PM – 6:00 PM ET
Poster Number: 275 Publication Number: 275.252
Laura Walawender, Nationwide Children's Hospital, Columbus, OH, United States; Benjamin Davies, Ohio State University College of Medicine, Columbus, OH, United States; Yueyang Frances. Fei, Nationwide Children's Hospital, Columbus, OH, United States; Brian Becknell, Ohio State University College of Medicine, Columbus, OH, United States; Daryl McLeod, Nationwide Children’s Hospital, Columbus, OH, United States
Pediatric Nephrology Fellow Nationwide Children's Hospital Columbus, Ohio, United States
Background: Patients with Müllerian anomalies have a 30-50% prevalence of congenital renal anomalies, but the prevalence of Müllerian anomalies among patients with known congenital renal anomalies is unknown. A delay in diagnosis of obstructive Müllerian anomalies can increase the risk of poor clinical outcomes including pelvic inflammatory disease, abscess, infertility, and endometriosis. Objective: The goal of this study was to describe the prevalence of Müllerian anomalies in a cohort of patients with known congenital renal anomalies. Design/Methods: A retrospective electronic medical record review was performed of patients within the Nationwide Children’s Hospital system with ICD9 or ICD10 diagnostic codes for both urologic and gynecologic anomalies. Patients with complex urogenital pathology, such as, cloaca, urogenital sinus, or bladder exstrophy were excluded. Renal anomaly diagnosis, Müllerian anomaly diagnosis, reason for pelvic evaluation, type of evaluation, and age of diagnosis of both renal and Müllerian anomalies were evaluated. Results: 136 patients were identified as having both urologic and gynecologic codes; 79 were excluded based on the exclusion criteria. Of the 57 eligible patients, 30 (53%) had a congenital solitary kidney. The majority (46/57) underwent imaging with evaluation of pelvic structures. Abdominal pain/dysmenorrhea was the most common reason for pelvic evaluation (32%), leading to the diagnosis of a Müllerian anomaly in 41 (72%) patients. Among the 38 patients with renal and Müllerian anomalies, 23 (61%) had an initial diagnosis of a renal anomaly; 7 (18%) had an initial diagnosis of Müllerian anomaly, and 8 (21%) were diagnosed with both simultaneously. 15 patients (39%) had a Müllerian obstruction, and 9 underwent urgent surgical intervention within 2 weeks of the diagnosis.
Conclusion(s): In this study, over half of the patients had a renal anomaly diagnosed before their Müllerian anomaly, which was obstructive in over one-third of instances. Given the primacy of early diagnosis for obstructive Müllerian anomalies, there is a need for a prospective study in patients with congenital renal anomalies to determine if routine pelvic ultrasound at thelarche or around the age of expected menarche could reduce the rate of obstructive Müllerian anomalies presenting acutely.
