Association of congenital renal and intestinal lesions.

TRACHEO-OESOPHAGEAL fistula and oesophageal atresia (TOF) duodenal atresia, anorectal anomaly and exomphalos are known to have a significant association with renal abnormalities. 1-4 The incidence of the association varies depending on the primary gastrointestinal condition and the reported series but is sufficiently common in all to merit consideration of the routine investigation of neonates with these conditions by way of intravenous pyelogram and micturating cystogram. Such a policy had gradually been introduced since 1977 in the Royal Belfast Hospital for Sick Children and the diagnostic yield of this policy to December 1982 is presented. METHODS The records of all neonates with primary diagnosis of tracheo-oesophageal fistula, duodenal atresia, imperforate anus or exomphalos were investigated to determine the presence or absence of renal abnormalities. In cases where the child was deceased and no renal study was performed, post mortem records were examined. The policy to investigate these children was not uniformly applied initially but has been almost total since 1980. RESULTS Eighty-three cases were examined, 31 had no radiological investigation of the urinary tract, 9 had an incomplete investigation i.e. only one of either intravenous pyelogram or micturating cystogram. Thirty-seven abnormalities were discovered in 28 patients (54.6 per cent of the cases with partial or complete radiological investigation or 65.1 per cent of the cases with full radiological investigation). Fourteen cases died before investigation: one abnormality was reported at post mortem in this group-ureteral obstruction queried as secondary to posterior urethral valves. Of the 42 T.O.F. examined eight cases not radiologically investigated developed urinary tract infections which would now be regarded as an indication for intravenous pyelogram and micturating cystogram in itself. In none of these cases was radiological investigation carried out. The reasons for these omissions could not be ascertained. The 14 cases with duodenal atresia contained eight with Down's syndrome. Six died before investigation (4 Down's syndrome). No abnormalities were revealed at post mortem. Six cases out of 25 cases of imperforate anus died before investigation. No abnormalities were revealed at post mortem. Thirteen cases had abnormalities other than an intestinal fistula to the urinary tract. The occurrence of normal and abnormal urinary tracts in the various groups is presented in Table 1.