الفهرس 
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Abstract
Congenital anomalies of kidney and urinary tract (CAKUT) are characterized by structural and functional abnormalities of kidney, collecting system, bladder and urethra. CAKUT are the most frequent form of malformation at birth, identified in 20% to 50% of all fetal congenital anomalies and represent the cause of 40–50% of pediatric ESRD worldwide. CAKUT is thought to be due to the effect of the interaction between environmental, epigenetic, and genetic factors on kidney development. Many Environmental risk factors have been recognized, including maternal diet, maternal diabetes and medication.
Aim of the study:
This study was conducted to identify possible risk factors of CAKUT and to describe different pattern of presentation and mode of diagnosis of CAKUT.
Subjects and methods:
The study was conducted on 150 children aged ≤ 5 years old with established diagnosis of CAKUT. All children ≤ 5 years of age who were visited pediatric and urology department in Minia University Hospitals during the study period were recruited. Also 150 age and sex matched controls were selected randomly from outpatient clinic of Minia University Hospitals.
Children’ mothers were interviewed and an informed written consent was taken from them after explaining the nature and purpose of the study. A structured interview questionnaire was designed and filled by the researcher and take about half hour to be completed. The questionnaire included: child medical history, socio demographic data of child parents, medical history of mother during pregnancy, maternal supplements and medication during pregnancy and environmental risk factors during pregnancy.
Results:
The most common type of CAKUT detected was UPJO and the commonest pattern of presentation was fever, while urological manifestation was only in quarter of cases. Demographic characteristics revealed no significant differences between cases and controls. However, history of consanguinity between parents was significantly higher among cases (35.3%) compared to control (18.7%). The study group also had a significantly higher rate of familial history of congenital renal anomalies than the controls (13.3% versus 4%), respectively.
Regarding maternal medical history during pregnancy it was found that gestational diabetes and infection during pregnancy were significantly different between cases and control. About quarter of CAKUT mothers reported history of medication intake during pregnancy with significant difference between study groups and fertility medication before indexed child pregnancy was a risk factor for CAKUT development.
More than half of CAKUT fathers were smokers 56% compared to 41.3% in controls and history of pesticides exposure in CAKUT was higher in cases than in controls (21.3% versus 10%), respectively and these differences were statistically significant.
Recommendations:
Collaboration between different concerned sectors for developing and strengthening registration and surveillance systems for CAKUT.
Strengthening research and studies on etiology, diagnosis and prevention of CAKUT.
Development of health education program for health professionals especially primary health care specialists, gynaecologists, obstetricians and neonatologists.
Raising public awareness about the importance of preconceptional counseling in preventing CAKUT and the dangers of superfluous use of fertility medication before pregnancy and self-medication during pregnancy is a must.
Controlling diabetes prior to and during pregnancy through counseling, weight management, diet and administration of insulin when required is an important issue to be concerned with.