Estatísticas

 array:24 [
  "pii" => "S2255553616300039"
  "issn" => "22555536"
  "doi" => "10.1016/j.jpedp.2016.03.012"
  "estado" => "S300"
  "fechaPublicacion" => "2016-05-01"
  "aid" => "365"
  "copyrightAnyo" => "2016"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "ssu"
  "cita" => "J Pediatr (Rio J). 2016;92 Supl 1:S57-63"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 1738
    "formatos" => array:3 [
      "EPUB" => 87
      "HTML" => 1102
      "PDF" => 549
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:20 [
      "pii" => "S0021755716000498"
      "issn" => "00217557"
      "doi" => "10.1016/j.jped.2016.01.006"
      "estado" => "S300"
      "fechaPublicacion" => "2016-05-01"
      "aid" => "365"
      "copyright" => "Sociedade Brasileira de Pediatria"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "ssu"
      "cita" => "J Pediatr (Rio J). 2016;92 Supl 1:S57-63"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 968
        "formatos" => array:3 [
          "EPUB" => 108
          "HTML" => 520
          "PDF" => 340
        ]
      ]
      "en" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>"
        "titulo" => "Signs and symptoms of developmental abnormalities of the genitourinary tract"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "pt"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "S57"
            "paginaFinal" => "S63"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Sinais e sintomas das anormalidades do desenvolvimento do trato geniturin&#225;rio"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Paulo Cesar Koch Nogueira, Isabel de P&#225;dua Paz"
            "autores" => array:2 [
              0 => array:2 [
                "nombre" => "Paulo Cesar Koch"
                "apellidos" => "Nogueira"
              ]
              1 => array:2 [
                "nombre" => "Isabel de P&#225;dua"
                "apellidos" => "Paz"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "pt" => array:9 [
          "pii" => "S2255553616300039"
          "doi" => "10.1016/j.jpedp.2016.03.012"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "pt"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2255553616300039?idApp=UINPBA000049"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755716000498?idApp=UINPBA000049"
      "url" => "/00217557/00000092000003S1/v2_201702240034/S0021755716000498/v2_201702240034/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S2255553616300076"
    "issn" => "22555536"
    "doi" => "10.1016/j.jpedp.2016.03.016"
    "estado" => "S300"
    "fechaPublicacion" => "2016-05-01"
    "aid" => "367"
    "copyright" => "Sociedade Brasileira de Pediatria"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "ssu"
    "cita" => "J Pediatr &#40;Rio J&#41;. 2016;92 Supl 1:S64-70"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1513
      "formatos" => array:3 [
        "EPUB" => 61
        "HTML" => 941
        "PDF" => 511
      ]
    ]
    "pt" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Artigo de revis&#227;o</span>"
      "titulo" => "Fidgety movements &#8211; tiny in appearance&#44; but huge in impact"
      "tienePdf" => "pt"
      "tieneTextoCompleto" => "pt"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "S64"
          "paginaFinal" => "S70"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Movimentos irregulares &#8211; pequenos na apar&#234;ncia&#44; por&#233;m enormes no impacto"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "pt" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figura 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1675
              "Ancho" => 2054
              "Tamanyo" => 225672
            ]
          ]
          "descripcion" => array:1 [
            "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Captura de v&#237;deo de um neonato de 14 semanas que apresenta movimentos irregulares ao longo do tempo&#44; da esquerda para a direita e de cima para baixo&#46; Foi usada uma taxa de frames de 12&#44;5<span class="elsevierStyleHsp" style=""></span>Hz que totalizou 1&#44;92 s&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Christa Einspieler, Robert Peharz, Peter B&#46; Marschik"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Christa"
              "apellidos" => "Einspieler"
            ]
            1 => array:2 [
              "nombre" => "Robert"
              "apellidos" => "Peharz"
            ]
            2 => array:2 [
              "nombre" => "Peter B&#46;"
              "apellidos" => "Marschik"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S0021755716000516"
        "doi" => "10.1016/j.jped.2015.12.003"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755716000516?idApp=UINPBA000049"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2255553616300076?idApp=UINPBA000049"
    "url" => "/22555536/00000092000003S1/v2_201703310303/S2255553616300076/v2_201703310303/pt/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S2255553616300118"
    "issn" => "22555536"
    "doi" => "10.1016/j.jpedp.2016.03.020"
    "estado" => "S300"
    "fechaPublicacion" => "2016-05-01"
    "aid" => "372"
    "copyright" => "Sociedade Brasileira de Pediatria"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "ssu"
    "cita" => "J Pediatr &#40;Rio J&#41;. 2016;92 Supl 1:S46-56"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3224
      "formatos" => array:3 [
        "EPUB" => 109
        "HTML" => 2230
        "PDF" => 885
      ]
    ]
    "pt" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Artigo de revis&#227;o</span>"
      "titulo" => "Signs and symptoms associated with digestive tract development"
      "tienePdf" => "pt"
      "tieneTextoCompleto" => "pt"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "S46"
          "paginaFinal" => "S56"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Sinais e sintomas associados com o desenvolvimento do trato digestivo"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "pt" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Mauro Batista de Morais"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "Mauro Batista"
              "apellidos" => "de Morais"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S0021755716000565"
        "doi" => "10.1016/j.jped.2016.02.008"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755716000565?idApp=UINPBA000049"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2255553616300118?idApp=UINPBA000049"
    "url" => "/22555536/00000092000003S1/v2_201703310303/S2255553616300118/v2_201703310303/pt/main.assets"
  ]
  "pt" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Artigo de revis&#227;o</span>"
    "titulo" => "Signs and symptoms of developmental abnormalities of the genitourinary tract"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "S57"
        "paginaFinal" => "S63"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Paulo Cesar Koch Nogueira, Isabel de P&#225;dua Paz"
        "autores" => array:2 [
          0 => array:4 [
            "nombre" => "Paulo Cesar Koch"
            "apellidos" => "Nogueira"
            "email" => array:1 [
              0 => "pckoch&#64;uol&#46;com&#46;br"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Isabel de P&#225;dua"
            "apellidos" => "Paz"
            "email" => array:1 [
              0 => "isabelppaz&#64;gmail&#46;com"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Departamento de Pediatria&#44; Escola Paulista de Medicina&#44; Universidade Federal de S&#227;o Paulo &#40;Unifesp&#41;&#44; S&#227;o Paulo&#44; SP&#44; Brasil"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Autor para correspond&#234;ncia&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Sinais e sintomas das anormalidades do desenvolvimento do trato geniturin&#225;rio"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Caso cl&#237;nico</span><p id="par0005" class="elsevierStylePara elsevierViewall">H&#46;O&#46;R&#46;S&#44; 12 anos e tr&#234;s meses&#44; nasceu a termo&#44; sem intercorr&#234;ncias durante o parto&#46; Recebeu alta m&#233;dica em 72<span class="elsevierStyleHsp" style=""></span>h na companhia da m&#227;e com orienta&#231;&#227;o de seguir acompanhamento com especialista&#44; pois em ultrassonografia pr&#233;&#8208;natal havia sido evidenciada hidronefrose bilateral com medida de di&#226;metro anteroposterior da pelve renal de aproximadamente 12<span class="elsevierStyleHsp" style=""></span>mm&#46; Por&#233;m&#44; ap&#243;s o nascimento&#44; os pais perderam o seguimento m&#233;dico da crian&#231;a com o nefrologista&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Compareciam &#224;s consultas com o pediatra irregularmente&#46; Aos oito anos foi encaminhado para consultas com o hematologista e endocrinologista devido &#224; baixa estatura e anemia n&#227;o responsiva ao tratamento com ferro por via oral&#59; esses especialistas n&#227;o encontraram a causa para as altera&#231;&#245;es&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Apenas aos 10 anos e 11 meses foi diagnosticado com doen&#231;a renal cr&#244;nica secund&#225;ria &#224; estenose da jun&#231;&#227;o ureteropi&#233;lica bilateral&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Ao diagn&#243;stico j&#225; apresentava sinais de nefropatia cr&#244;nica com afilamento do par&#234;nquima renal bilateral ao exame de ultrassonografia&#46; Os genitores contaram que aos dois anos a crian&#231;a j&#225; tinha controle esfincteriano diurno&#46; Mas chamava aten&#231;&#227;o por apresentar poli&#250;ria&#44; noct&#250;ria e ingerir muita &#225;gua&#46; N&#227;o tinha altera&#231;&#227;o do jato urin&#225;rio ou epis&#243;dios de infec&#231;&#227;o do trato urin&#225;rio&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Aos 11 anos e tr&#234;s meses foi submetido a procedimento cir&#250;rgico&#44; pieloplastia com implante de duplo J &#224; direita&#44; com o objetivo de prolongar o tratamento conservador e retardar o in&#237;cio da terapia de substitui&#231;&#227;o renal&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Aos 12 anos e tr&#234;s meses&#44; um ano e quatro meses ap&#243;s o diagn&#243;stico&#44; foi submetido a transplante renal preemptivo com doador vivo relacionado&#44; a m&#227;e&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Discuss&#227;o</span><p id="par0035" class="elsevierStylePara elsevierViewall">O caso descrito acima &#233; real e comum&#44; revela o preocupante problema do diagn&#243;stico tardio da DRC em crian&#231;as no Brasil&#46; A DRC &#233; definida pela exist&#234;ncia de qualquer dano renal&#44; associado a v&#225;rios graus de redu&#231;&#227;o na taxa de filtra&#231;&#227;o glomerular&#44; conforme representado na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">1</span></a> A DRC em est&#225;gio 5&#44; que necessita de terapia de substitui&#231;&#227;o renal &#40;TSR&#41; &#8211; di&#225;lise ou transplante &#8211;&#44; &#233; um problema de sa&#250;de p&#250;blica e h&#225; evid&#234;ncias de aumento crescente na incid&#234;ncia e na preval&#234;ncia dessa condi&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">2</span></a> O n&#250;mero de pessoas que recebem TSR no mundo em 2010 foi estimado em 2&#44;7 milh&#245;es de indiv&#237;duos&#44; por&#233;m tamb&#233;m calcula&#8208;se que igual n&#250;mero de pacientes com indica&#231;&#227;o de TSR n&#227;o receba tal tratamento por falta de acesso &#224; terapia&#44; principalmente por raz&#245;es econ&#244;micas&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">3</span></a> Calcula&#8208;se ainda que a propor&#231;&#227;o de pacientes com DRC em est&#225;gios 2 a 4 seja muitas vezes superior ao n&#250;mero de pacientes com DRC em est&#225;gio 5&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">4</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Felizmente a propor&#231;&#227;o de crian&#231;as com DRC &#233; muito menor do que a de adultos&#44; por&#233;m a DRC em crian&#231;as traz consequ&#234;ncias devastadoras sobre o crescimento&#44; desenvolvimento ponderoestatural e intelectual&#44; resulta em aumento na morbimortalidade dos indiv&#237;duos acometidos&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">4</span></a> A preval&#234;ncia da DRC pedi&#225;trica em nosso meio &#233; inferior &#224; reportada em pa&#237;ses desenvolvidos do Ocidente&#44; provavelmente devido &#224; falta de diagn&#243;stico dos casos&#46; Em estudo feito no Brasil foram estimados 1&#46;300 pacientes pedi&#225;tricos em tratamento dial&#237;tico no pa&#237;s em 2012&#44; resulta numa preval&#234;ncia de 20 casos por milh&#227;o de indiv&#237;duos com idade compat&#237;vel &#40;cpmic&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">5</span></a> Na Europa&#44; por exemplo&#44; registros mostram preval&#234;ncia de 65 cpmic&#46; Nos Estados Unidos&#44; esses dados sobem para 85 cpmic&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Nos pa&#237;ses desenvolvidos a principal causa de DRC na inf&#226;ncia s&#227;o doen&#231;as heredit&#225;rias&#44; com destaque para as anormalidades cong&#234;nitas dos rins e trato urin&#225;rio &#40;CAKUT&#41;&#44; que somam de 30&#37; a 60&#37; das crian&#231;as com doen&#231;a renal cr&#244;nica em TSR&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">4&#44;6</span></a> Em contraste&#44; o principal diagn&#243;stico etiol&#243;gico que foi atribu&#237;do para as crian&#231;as em di&#225;lise no Brasil foi &#8220;causa desconhecida&#8221;&#44; com 32&#37; dos casos&#44; que &#233; muito superior ao reportado nos pa&#237;ses do ocidente&#44; sugere que o diagn&#243;stico entre n&#243;s &#233; formulado de maneira incompleta&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">5</span></a> Outro aspecto que chama aten&#231;&#227;o &#233; o tempo entre o diagn&#243;stico da DRC e o in&#237;cio da TSR&#44; que no Brasil foi de 14 meses no Sudeste&#44; nove no Centro&#8208;Oeste e nenhum no Nordeste&#44; sugere um retardo no estabelecimento do diagn&#243;stico&#44; o que tamb&#233;m deprecia o progn&#243;stico final dessas crian&#231;as&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">No caso cl&#237;nico apresentado acima&#44; o paciente j&#225; apresentava ao diagn&#243;stico anemia e baixa estatura&#44; que s&#227;o sinais de doen&#231;a detectada tardiamente&#46; O diagn&#243;stico tardio merece discuss&#227;o&#44; pois&#44; assim como nesse caso&#44; muitos outros podem passar despercebidos sem diagn&#243;stico e gerar preju&#237;zos aos pacientes&#46; O diagn&#243;stico precoce da DRC &#233; uma oportunidade que compete aos pediatras generalistas&#44; e n&#227;o aos especialistas&#46; Ele possibilita terapias m&#233;dicas e indica&#231;&#227;o de procedimentos cir&#250;rgicos quando necess&#225;rios&#44; que podem retardar a progress&#227;o da DRC e a necessidade de in&#237;cio da TSR&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">O diagn&#243;stico gen&#233;tico das CAKUT &#233; desafiador e ainda n&#227;o acess&#237;vel pelo custo elevado dos exames gen&#233;ticos e pela complexidade de intera&#231;&#245;es entre os m&#250;ltiplos genes candidatos a explicar as doen&#231;as<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">7</span></a> e n&#227;o ser&#225; abordado neste manuscrito&#46; Este artigo visa a revisar os sinais e sintomas cl&#237;nicos associados &#224;s CAKUT mais prevalentes na inf&#226;ncia&#44; busca fornecer ao pediatra geral elementos para o diagn&#243;stico e tratamento precoces para melhor progn&#243;stico das crian&#231;as acometidas&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Classifica&#231;&#227;o das anormalidades cong&#234;nitas dos rins e do trato urin&#225;rio</span><p id="par0060" class="elsevierStylePara elsevierViewall">As CAKUT constituem um grupo heterog&#234;neo de patologias do desenvolvimento dos rins e do trato urin&#225;rio &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; Em estudo alem&#227;o que envolveu 30&#46;940 rec&#233;m&#8208;nascidos&#44; natimortos e abortamentos&#44; estimou&#8208;se que 7&#37; apresentavam malforma&#231;&#245;es importantes e as CAKUT foram a segunda anomalia mais frequente&#44; com preval&#234;ncia estimada de 1&#44;6&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">8</span></a> Em estudo no Brasil com 6&#46;245 necropsias perinatais e pedi&#225;tricas&#44; os autores observaram que as CAKUT estavam presentes em 2&#44;9&#37; dos casos&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">9</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Al&#233;m de seu papel como principal etiologia da DRC em crian&#231;as&#44; entende&#8208;se que as CAKUT representam importante etiologia da DRC tamb&#233;m nos adultos&#46; Estudo recente que avaliou 212&#46;930 indiv&#237;duos com DRC em idade adulta revelou que pacientes com CAKUT iniciaram TSR aos 31 anos&#44; enquanto indiv&#237;duos com outras etiologias necessitaram de TSR apenas aos 61 anos&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">10</span></a> Isso sugere que parte dos adultos com fal&#234;ncia renal &#233; portadora de CAKUT&#44; que&#44; como na inf&#226;ncia&#44; podem ser reconhecidas e tratadas precocemente&#44; o que expande a import&#226;ncia desse diagn&#243;stico&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Subs&#237;dios para o diagn&#243;stico das anormalidades cong&#234;nitas dos rins e do trato urin&#225;rio</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Malforma&#231;&#245;es associadas</span><p id="par0070" class="elsevierStylePara elsevierViewall">As CAKUT t&#234;m causas muito variadas e fatores gen&#233;ticos&#44; como anormalidades cromoss&#244;micas e muta&#231;&#245;es heredit&#225;rias nos genes que regulam o desenvolvimento do aparelho urin&#225;rio&#44; podem ser causa subjacente da malforma&#231;&#227;o&#46; Al&#233;m disso&#44; s&#227;o igualmente importantes as influ&#234;ncias ambientais sobre o desenvolvimento fetal&#46; Isso faz com que a rela&#231;&#227;o entre o gen&#243;tipo e o fen&#243;tipo nessas doen&#231;as seja complexa&#46; Como ponto de partida para se tentar caracterizar essa complexidade&#44; &#233; importante se considerar que as CAKUT podem aparecer isoladamente ou podem vir associadas a outras malforma&#231;&#245;es ou s&#237;ndromes&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Em estudo recente feito a partir de 346&#46;841 abortamentos&#44; natimortos ou rec&#233;m&#8208;nascidos vivos&#44; estimou&#8208;se que 34&#37; dos 1&#46;678 casos de CAKUT observados tinham outras malforma&#231;&#245;es n&#227;o urin&#225;rias associadas&#46; A distribui&#231;&#227;o dessas associa&#231;&#245;es est&#225; representada na <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a><a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">11</span></a> e a import&#226;ncia dessas para o pediatra geral &#233; que o encontro dessas anomalias associadas deve ser um ponto de alerta para a busca de casos de CAKUT&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Antecedentes importantes e sinais e sintomas cl&#237;nicos</span><p id="par0080" class="elsevierStylePara elsevierViewall">Antecedentes do per&#237;odo antenatal que est&#227;o associados &#224;s Cakut s&#227;o mais frequentemente o oligo&#226;mnio&#44; a prematuridade&#44; o baixo peso ao nascer e a restri&#231;&#227;o do crescimento intrauterino&#46; Estudo feito no Jap&#227;o mostrou rela&#231;&#227;o entre antecedentes perinatais e CAKUT&#44; sugeriu sinais para se indicar um <span class="elsevierStyleItalic">screening</span> das crian&#231;as&#46; Dentre todos dados estudados &#40;14&#37; dos pacientes com CAKUT nasceram prematuros&#44; 18&#37; tinham baixo peso ao nascer&#44; 79&#37; baixo ganho de peso&#44; 18&#37; asfixia&#44; 8&#37; eram oligo&#226;mnios e 12&#37; tinham icter&#237;cia&#41;&#44; foram encontrados 82&#37; com antecedentes de oligo&#226;mnio e baixo ganho de peso&#46; Isso sugere que esses dois sinais s&#227;o marcadores para selecionar indiv&#237;duos com maior risco para Cakut&#44; com especificidade de 95&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">12</span></a> Em estudo brasileiro foram avaliados antecedentes preditores de mortalidade associados a Cakut em 29&#46;653 rec&#233;m&#8208;nascidos entre 1996 a 2006&#46; Nesse estudo revelaram&#8208;se 524 casos de CAKUT&#44; que corresponderam a 17&#44;7 por 1&#46;000 nascidos vivos&#44; e os fatores de risco para mortalidade foram oligo&#226;mnio&#44; CAKUT associada a outras malforma&#231;&#245;es&#44; baixo peso ao nascer e prematuridade&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">13</span></a> Outro antecedente digno de nota &#233; a exist&#234;ncia de mais casos de Cakut na fam&#237;lia&#46; Em estudo recente revelou que 14&#37; dos 107 casos de CAKUT tinham antecedente familiar com diagn&#243;stico confirmado em ao menos um membro da fam&#237;lia&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">14</span></a> Mais um antecedente familiar foi revelado em estudo que envolveu 1994 pacientes com DRC &#40;diagn&#243;stico antes de 21 anos&#41; e 20&#46;032 controles&#46; Baixo peso ao nascer e diabetes materna pr&#233;&#8208;gestacional foram significantemente associados a risco de displasia&#47;aplasia renal&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">15</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">A literatura &#233; bastante escassa acerca da descri&#231;&#227;o de sinais e sintomas que alertam para a exist&#234;ncia de um comprometimento do sistema urin&#225;rio&#46; No caso das CAKUT a express&#227;o cl&#237;nica das malforma&#231;&#245;es pode conceitualmente ser devida a&#58; a&#41; o comprometimento alto do sistema urin&#225;rio que leva &#224; disfun&#231;&#227;o renal&#44; que &#233; evolutiva quando ocorre e pode se externar por poli&#250;ria&#44; polaci&#250;ria&#44; noct&#250;ria&#44; infec&#231;&#227;o urin&#225;ria&#44; hipertens&#227;o arterial sist&#234;mica e baixo ganho de peso<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">14&#44;16&#8211;18</span></a> ou b&#41; aos sinais de comprometimento do trato urin&#225;rio inferior com obstru&#231;&#227;o do trato urin&#225;rio&#44; como jato urin&#225;rio fraco&#44; dificuldade para iniciar a mic&#231;&#227;o&#44; bexigoma&#44; enurese n&#227;o monossintom&#225;tica&#44; urge&#47;incontin&#234;ncia urin&#225;ria&#44; disfun&#231;&#227;o do intestino e da bexiga&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">19</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">A controv&#233;rsia sobre o uso de epis&#243;dios de infec&#231;&#227;o do trato urin&#225;rio como indicador de CAKUT &#233; bastante acirrada&#44; por&#233;m parece que algumas situa&#231;&#245;es configuram maior chance de associa&#231;&#227;o com CAKUT&#46; Idade menor do que dois anos e febre alta &#40;maior do que 38&#44;3<span class="elsevierStyleHsp" style=""></span>&#176;C&#41; s&#227;o os fatores que podem predizer anormalidades urol&#243;gicas&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">20</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Finalmente outro dado cl&#237;nico que &#233; proeminente para permitir o diagn&#243;stico precoce das nefropatias cong&#234;nitas &#233; a medida da press&#227;o arterial&#46; Sabe&#8208;se que a hipertens&#227;o &#233; mais frequente nas crian&#231;as nefropatas e inversamente que o controle da press&#227;o arterial tem efeito terap&#234;utico comprovado para reduzir a progress&#227;o da DRC em crian&#231;as&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">21</span></a> Essas associa&#231;&#245;es refor&#231;am a import&#226;ncia da recomenda&#231;&#227;o de medida da press&#227;o arterial em crian&#231;as&#44; que deve ser feita em todas as consultas pedi&#225;tricas a partir dos tr&#234;s anos e nas crian&#231;as menores de tr&#234;s anos quando existir alguma das seguintes situa&#231;&#245;es&#58; a&#41; prematuridade&#44; baixo peso ao nascer ou complica&#231;&#245;es neonatais que requerem interna&#231;&#227;o em UTI neonatal&#44; b&#41; cardiopatias cong&#234;nitas&#44; c&#41; infec&#231;&#227;o urin&#225;ria&#44; hemat&#250;ria ou protein&#250;ria&#44; d&#41; doen&#231;a renal conhecida ou malforma&#231;&#245;es urol&#243;gicas&#44; e&#41; hist&#243;ria familiar de doen&#231;a renal cong&#234;nita&#44; f&#41; transplante de &#243;rg&#227;os s&#243;lidos&#44; g&#41; tumores malignos ou transplante de medula &#243;ssea&#44; h&#41; doen&#231;as sist&#234;micas associadas com hipertens&#227;o e i&#41; evid&#234;ncia de press&#227;o arterial elevada&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">22</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Altera&#231;&#245;es de ultrassonografia antenatal</span><p id="par0100" class="elsevierStylePara elsevierViewall">O uso da ultrassonografia no acompanhamento da gravidez e tamb&#233;m dos neonatos se iniciou no fim dos anos 1970&#46; Atualmente o ultrassom gestacional &#233; parte da rotina m&#233;dica na maioria dos pa&#237;ses&#44; com pelo menos dois exames em cada gesta&#231;&#227;o para acompanhamento do desenvolvimento fetal e identifica&#231;&#227;o de poss&#237;veis malforma&#231;&#245;es&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">23</span></a> A ultrassonografia gestacional melhorou substancialmente o diagn&#243;stico e progn&#243;stico das crian&#231;as com Cakut&#44; chegou a uma sensibilidade para detec&#231;&#227;o de uropatias obstrutivas entre 80&#37; e 90&#37;&#46; Em estudo europeu feito em 12 pa&#237;ses&#44; a sensibilidade para detec&#231;&#227;o de malforma&#231;&#227;o renal foi de 81&#44;2&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">23</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">A hidronefrose &#233; o achado no ultrassom mais frequentemente descrito e usado&#46; Hidronefrose antenatal &#233; a presen&#231;a de um ou ambos os rins com algum grau de dilata&#231;&#227;o do sistema pielocalicinal no feto&#46; O diagn&#243;stico &#233; feito pela ultrassonografia obst&#233;trica&#44; usa&#8208;se como par&#226;metro principalmente o di&#226;metro anteroposterior &#40;DAP&#41; da pelve renal e a presen&#231;a de caliectasia&#46; H&#225; hidronefrose quando o DAP da pelve est&#225; acima de determinados limites&#44; por&#233;m ainda n&#227;o h&#225; consenso sobre a defini&#231;&#227;o desses limites&#46; Os valores mais citados&#44; acima dos quais h&#225; maior risco de degenera&#231;&#227;o da fun&#231;&#227;o renal ou de necessidade de cirurgia&#44; s&#227;o os propostos pela Sociedade de Urologia Fetal &#40;SFU&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">24</span></a> que est&#227;o resumidos na <a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">O maior valor preditivo positivo &#40;VPP&#41; est&#225; no exame feito no terceiro trimestre da gesta&#231;&#227;o&#46; O VPP para valores de DAP &#62;7<span class="elsevierStyleHsp" style=""></span>mm no terceiro trimestre &#233; de 69&#37; <span class="elsevierStyleItalic">versus</span> 49&#37; para DAP<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>mm no segundo trimestre&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">4</span></a> A incid&#234;ncia reportada de acometimento fetal varia de 1&#37; a 5&#37; das gesta&#231;&#245;es&#44; depende dos crit&#233;rios diagn&#243;sticos&#44; &#233; mais frequente em meninos &#40;3 a 4&#47;1&#41;&#44; predominantemente unilateral e apenas 20&#37; ter&#227;o significado cl&#237;nico p&#243;s&#8208;natal&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Outro achado ultrassonogr&#225;fico de interesse para o diagn&#243;stico e progn&#243;stico das crian&#231;as com CAKUT &#233; a classifica&#231;&#227;o da hidronefrose proposta pela SFU&#44; que se baseia no grau de dilata&#231;&#227;o pielo&#8208;calicinal e leva em conta tamb&#233;m a integridade do par&#234;nquima&#46; O grau 0 representa ultrassonografia normal e os demais graus est&#227;o representados na <a class="elsevierStyleCrossRef" href="#tbl0025">tabela 5</a>&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Esse sistema de classifica&#231;&#227;o foi desenvolvido para ultrassonografia feita ap&#243;s o nascimento&#44; mas tem sido aplicado na ultrassonografia antenatal e existem evid&#234;ncias de que crian&#231;as com hidronefrose de graus 3 e 4 t&#234;m risco aumentado de necessidade de cirurgia e deteriora&#231;&#227;o da fun&#231;&#227;o renal&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">25</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Qualquer que seja a classifica&#231;&#227;o da hidronefrose&#44; o acompanhamento p&#243;s&#8208;natal de crian&#231;as com imagens de hidronefrose detectadas no per&#237;odo gestacional mostra resolu&#231;&#227;o em 50&#37; dos casos&#44; caliectasia sem fator obstrutivo incluindo pelve extrarrenal em 15&#37;&#44; estenose da jun&#231;&#227;o ureteropi&#233;lica em 11&#37;&#44; refluxo vesicoureteral em 9&#37;&#44; megaureter em 4&#37;&#44; rim multic&#237;stico displ&#225;sico em 2&#37;&#44; ureterocele em 2&#37;&#44; cisto renal em 2&#37; e v&#225;lvula de uretra posterior em 1&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">25&#8211;27</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Outros achados de imagem obtidos por meio da ultrassonografia gestacional que auxiliam no diagn&#243;stico e progn&#243;stico da crian&#231;a com CAKUT e tamb&#233;m est&#227;o associados com deteriora&#231;&#227;o da fun&#231;&#227;o renal s&#227;o&#58; a&#41; o encontro de rim &#250;nico&#44; situa&#231;&#227;o na qual at&#233; 1&#47;3 dos acometidos tem Cakut associada&#44;<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">28&#44;29</span></a> b&#41; hidronefrose associada a outras anomalias&#44; quando a probabilidade de DRC aos dois anos &#233; de 15&#37; <span class="elsevierStyleItalic">versus</span> apenas 2&#37; nas crian&#231;as com hidronefrose isolada<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">30</span></a> e c&#41; hidronefrose bilateral&#44; que por si s&#243; confere risco de deteriora&#231;&#227;o na fun&#231;&#227;o renal 9&#44;4 vezes maior do que os casos com altera&#231;&#227;o unilateral&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">31</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Al&#233;m do aspecto e do grau da hidronefrose&#44; outros achados ultrassonogr&#225;ficos devem ser valorizados&#44; como&#58; a&#41; a dilata&#231;&#227;o ureteral&#44; presente no megaureter&#59; b&#41; estenose de jun&#231;&#227;o ureterovesical&#44; v&#225;lvula de uretra posterior e ausente na estenose da jun&#231;&#227;o ureteropi&#233;lica&#59; c&#41; o tamanho renal&#44; que pode estar comprometido na hipo&#47;displasia renal ou mesmo na hidronefrose&#59; d&#41; o tamanho vesical e a espessura da parede da bexiga com ou sem forma&#231;&#227;o de trab&#233;culas&#44; altera&#231;&#245;es que podem estar presentes na bexiga de esfor&#231;o ou na bexiga hipot&#244;nica&#59; e&#41; o volume urin&#225;rio residual p&#243;s&#8208;mic&#231;&#227;o aumentado&#44; associado ao mau funcionamento vesical e f&#41; a ureterocele&#44; geralmente presente na duplicidade ureteral&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">32</span></a></p></span></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclus&#245;es</span><p id="par0140" class="elsevierStylePara elsevierViewall">No presente trabalho buscamos revisar a literatura m&#233;dica para listar os principais dados cl&#237;nicos que podem ser &#250;teis na pr&#225;tica pedi&#225;trica para identificar precocemente os pacientes portadores de CAKUT&#46; A import&#226;ncia desse diagn&#243;stico deriva do fato de serem as Cakut a causa mais comum de DRC em crian&#231;as&#46; No cen&#225;rio epidemiol&#243;gico presente&#44; caracterizado por queda da morbimortalidade secund&#225;ria &#224;s doen&#231;as infectocontagiosas&#44; as doen&#231;as cr&#244;nicas em geral e a DRC em particular ganham import&#226;ncia na pr&#225;tica cl&#237;nica e essa tend&#234;ncia deve se acentuar com o tempo&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">2</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">V&#225;rias evid&#234;ncias recentes apontam que a DRC tem suas origens na vida intrauterina e atualmente sabe&#8208;se que o n&#250;mero de nefros existentes em cada rim pode variar bastante entre indiv&#237;duos e que o menor n&#250;mero de unidades funcionais do rim representa risco aumentado de DRC e doen&#231;a cardiovascular<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">33&#44;34</span></a> Tal considera&#231;&#227;o assume contornos ainda mais importantes nas crian&#231;as portadoras de anormalidades do desenvolvimento do sistema urin&#225;rio&#44; situa&#231;&#227;o na qual a nefrog&#234;nese frequentemente &#233; perturbada&#44; resulta em menor n&#250;mero de nefros&#46; Essas constata&#231;&#245;es antecipam para a idade pedi&#225;trica o momento de maior interesse para se fazer o diagn&#243;stico precoce dos pacientes em risco para DRC&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">O momento para fazer essa busca diagn&#243;stica deve ser o mais precoce poss&#237;vel&#44; se poss&#237;vel at&#233; antes do nascimento&#46; Sabe&#8208;se que mesmo em situa&#231;&#245;es de exist&#234;ncia de servi&#231;os de seguimento bem organizados a ocorr&#234;ncia de n&#227;o ades&#227;o completa das fam&#237;lias aos procedimentos necess&#225;rios para pesquisa diagn&#243;stica &#233; um fen&#244;meno frequente&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">35</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Alguns pa&#237;ses buscam o diagn&#243;stico precoce do risco para DRC com programas compuls&#243;rios de exames de sedimento urin&#225;rio ou de imagem em determinados pontos de idade&#44;<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">36&#44;37</span></a> mas as an&#225;lises de custo&#8208;efetividade de tais programas nunca demonstraram definitivamente que essa iniciativa fosse vantajosa&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">38</span></a> Numa situa&#231;&#227;o como essa&#44; a avalia&#231;&#227;o cl&#237;nica &#233; um recurso inestim&#225;vel para triar quais os pacientes devem ser estudados com recursos laboratoriais mais detalhados&#46; Principalmente em pa&#237;ses com recursos limitados na &#225;rea de sa&#250;de&#44; tal estrat&#233;gia parece ser ainda mais acertada&#46; No Brasil&#44; com exce&#231;&#227;o da Regi&#227;o Sudeste&#44; a causa desconhecida &#233; o mais comum diagn&#243;stico da DRC avan&#231;ada em crian&#231;as&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">5</span></a> o que sugere que h&#225; uma lacuna importante a ser preenchida para melhor qualificar o diagn&#243;stico da DRC&#46; &#201; plaus&#237;vel que muitas crian&#231;as cheguem ao est&#225;gio final da evolu&#231;&#227;o da DRC sem ter tido acesso ao diagn&#243;stico de Cakut&#44; que &#233; a causa mais importante dessa doen&#231;a no mundo&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Chama aten&#231;&#227;o na presente revis&#227;o que n&#227;o existem estudos com metodologia robusta para dar respostas com base em evid&#234;ncias s&#243;lidas sobre o tema&#46; A maioria dos estudos revistos &#233; descritiva e unic&#234;ntrica e por isso os achados aqui resumidos devem ser considerados como preliminares&#46; Os sinais de alerta para o encontro de crian&#231;as portadoras de Cakut est&#227;o resumidas na <a class="elsevierStyleCrossRef" href="#tbl0030">tabela 6</a>&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">Acreditamos que&#44; mesmo com as limita&#231;&#245;es metodol&#243;gicas dos estudos revistos&#44; as sugest&#245;es apresentadas podem ajudar os pediatras a estabelecer hip&#243;teses cl&#237;nicas para o diagn&#243;stico precoce das anormalidades do desenvolvimento do trato geniturin&#225;rio valendo&#8208;se exclusivamente de dados cl&#237;nicos e de informa&#231;&#245;es do ultrassom gestacional&#44; sem metodologias caras e invasivas&#46; Como n&#227;o existem dados prospectivos para avaliar quais dos sinais e sintomas cl&#237;nicos aqui relacionados tem maior import&#226;ncia para identificar o risco&#44; acreditamos que&#44; pelo momento&#44; a ocorr&#234;ncia de qualquer um deles deveria ser indicativo para investigar as crian&#231;as quanto &#224; poss&#237;vel exist&#234;ncia de Cakut o mais precocemente&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflitos de interesse</span><p id="par0170" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:9 [
        0 => array:3 [
          "identificador" => "xres822654"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Objective"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Data sources"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Data synthesis"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusion"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec819464"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres822655"
          "titulo" => "Resumo"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Objetivo"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Fontes dos dados"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "S&#237;ntese dos dados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclus&#227;o"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec819465"
          "titulo" => "Palavras&#8208;chave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Caso cl&#237;nico"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Discuss&#227;o"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Classifica&#231;&#227;o das anormalidades cong&#234;nitas dos rins e do trato urin&#225;rio"
            ]
            1 => array:3 [
              "identificador" => "sec0020"
              "titulo" => "Subs&#237;dios para o diagn&#243;stico das anormalidades cong&#234;nitas dos rins e do trato urin&#225;rio"
              "secciones" => array:3 [
                0 => array:2 [
                  "identificador" => "sec0025"
                  "titulo" => "Malforma&#231;&#245;es associadas"
                ]
                1 => array:2 [
                  "identificador" => "sec0030"
                  "titulo" => "Antecedentes importantes e sinais e sintomas cl&#237;nicos"
                ]
                2 => array:2 [
                  "identificador" => "sec0035"
                  "titulo" => "Altera&#231;&#245;es de ultrassonografia antenatal"
                ]
              ]
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Conclus&#245;es"
        ]
        7 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Conflitos de interesse"
        ]
        8 => array:1 [
          "titulo" => "Refer&#234;ncias"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-01-15"
    "fechaAceptado" => "2016-01-15"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec819464"
          "palabras" => array:4 [
            0 => "Urinary tract malformations"
            1 => "Chronic kidney disease"
            2 => "Early diagnosis"
            3 => "Child"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras&#8208;chave"
          "identificador" => "xpalclavsec819465"
          "palabras" => array:4 [
            0 => "Malforma&#231;&#227;o do trato urin&#225;rio"
            1 => "Doen&#231;a renal cr&#244;nica"
            2 => "Diagn&#243;stico precoce"
            3 => "Crian&#231;a"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The abnormalities of the genitourinary tract development are the leading cause of chronic kidney disease &#40;CKD&#41; in children&#46; The diagnosis of this disease in Brazil is late and incomplete&#44; which results in increased morbidity and mortality in this age group&#46; Early diagnosis of this condition is the prerogative of generalist pediatricians&#44; and the aim of this study was to review the clinical signs and symptoms associated with developmental abnormalities of the genitourinary tract&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Data sources</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Based on the description of a symbolic clinical case&#44; the authors conducted a non&#8208;systematic review of medical literature&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Data synthesis</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The results suggest that the following data should be used as a warning for early diagnosis of affected children&#58; a&#41; combined urinary tract abnormalities &#40;chromosomal abnormalities&#59; sequence of malformations &#91;VACTERLand Prune&#8208;Belly&#93;&#59; and musculoskeletal&#44; digestive tract&#44; heart&#44; and nervous system malformations&#41;&#59; b&#41; previous history &#40;congenital anomalies of the kidney and urinary tract &#91;CAKUT&#93; in the family&#44; low birth weight&#44; and oligoamnios&#41;&#59; c&#41; clinical signs &#40;polyuria&#47;nocturia&#44; urinary tract infection&#44; systemic arterial hypertension&#44; failure to thrive&#44; weak urinary stream&#44; difficulty to start urination&#44; distended bladder&#44; non&#8208;monosymptomatic enuresis&#44; urinary&#47;urge incontinence&#44; and bowel and bladder dysfunction&#41;&#59; and d&#41; pre&#8208; and postnatal ultrasonographic alterations &#40;increased anteroposterior diameter of the renal pelvis&#44; mainly in the third trimester of pregnancy&#59; single kidney&#59; hydronephrosis associated with other abnormalities&#59; and hydronephrosis with parenchymal involvement in the post&#8208;neonatal assessment&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The suggestions shown here can help the pediatrician to establish clinical hypotheses for the early diagnosis of developmental abnormalities of the genitourinary tract without resorting to expensive and invasive procedures&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Data sources"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Data synthesis"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">As anormalidades do desenvolvimento do trato geniturin&#225;rio s&#227;o a principal causa de doen&#231;a renal cr&#244;nica &#40;DRC&#41; em crian&#231;as&#46; O diagn&#243;stico dessa doen&#231;a no Brasil &#233; formulado de maneira incompleta e tardia&#44; o que resulta em aumento na morbimortalidade nessa faixa et&#225;ria&#46; O diagn&#243;stico precoce dessa condi&#231;&#227;o &#233; prerrogativa dos pediatras generalistas e o objetivo deste trabalho foi revisar os sinais e sintomas cl&#237;nicos associados &#224;s anormalidades do desenvolvimento do trato geniturin&#225;rio&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Fontes dos dados</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A partir da descri&#231;&#227;o de um caso cl&#237;nico simb&#243;lico&#44; fizemos uma revis&#227;o n&#227;o sistem&#225;tica da literatura m&#233;dica&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">S&#237;ntese dos dados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Os resultados sugerem que os seguintes dados devem ser usados como alerta para o diagn&#243;stico precoce das crian&#231;as acometidas&#58; a&#41; anomalias do trato urin&#225;rio compostas &#40;anomalias cromoss&#244;micas&#44; sequ&#234;ncias de malforma&#231;&#245;es &#8211; Vacterl e Prune&#8208;Belly&#44; malforma&#231;&#245;es musculoesquel&#233;ticas&#44; do trato digestivo&#44; card&#237;acas e do sistema nervoso&#41;&#59; b&#41; antecedentes &#40;anomalias cong&#234;nitas do rim e trato urin&#225;rio &#40;CAKUT&#41; na fam&#237;lia&#44; baixo peso ao nascer e oligo&#226;mnio&#41;&#59; c&#41; sinais cl&#237;nicos &#40;polaci&#250;ria&#47;noct&#250;ria&#44; infec&#231;&#227;o urin&#225;ria&#44; hipertens&#227;o arterial sist&#234;mica&#44; baixo ganho de peso&#44; jato urin&#225;rio fraco&#44; dificuldade para iniciar a mic&#231;&#227;o&#44; bexigoma&#44; enurese n&#227;o monossintom&#225;tica&#44; urge&#47;incontin&#234;ncia urin&#225;ria&#44; disfun&#231;&#227;o do intestino e da bexiga&#41; e d&#41; altera&#231;&#245;es ultrassonogr&#225;ficas ante e p&#243;s&#8208;natais &#40;di&#226;metro anteroposterior da p&#233;lvis renal aumentado principalmente no terceiro trimestre da gesta&#231;&#227;o&#44; rim &#250;nico&#44; hidronefrose associada a outras anomalias e hidronefrose com comprometimento de par&#234;nquima na avalia&#231;&#227;o p&#243;s&#8208;neonatal&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">As sugest&#245;es apresentadas podem ajudar o pediatra a estabelecer hip&#243;teses cl&#237;nicas para o diagn&#243;stico precoce das anormalidades do desenvolvimento do trato geniturin&#225;rio sem metodologias caras e invasivas&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Fontes dos dados"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "S&#237;ntese dos dados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#227;o"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Nogueira PC&#44; Paz IP&#46; Signs and symptoms of developmental abnormalities of the genitourinary tract&#46; J Pediatr &#40;Rio J&#41;&#46; 2016&#59;92&#40;3 Suppl 1&#41;&#58;S57&#8211;63&#46;</p>"
      ]
    ]
    "multimedia" => array:10 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabela 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Est&#225;gio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Descri&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">TFG &#40;mL&#47;min&#47;1&#44;73m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dano renal com TFG normal&#47;aumentada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#62;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dano renal com TFG levemente reduzida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#8208;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dano renal com TFG moderadamente reduzida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#8208;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dano renal com TFG gravemente reduzida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#8208;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fal&#234;ncia renal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1383243.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Classifica&#231;&#227;o dos est&#225;gios da doen&#231;a renal cr&#244;nica</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabela 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">AD&#44; autoss&#244;mico dominante&#59; AR&#44; autoss&#244;mico recessivo&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Anormalidades da diferencia&#231;&#227;o renal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Displasia renal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Anormalidades da massa renal</td><td class="td" title="table-entry  " align="left" valign="top">Agenesia renal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hipoplasia renal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Anormalidades da forma e posi&#231;&#227;o</td><td class="td" title="table-entry  " align="left" valign="top">Rim supranumer&#225;rio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rim ect&#243;pico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rim em ferradura&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Anormalidades do trato urin&#225;rio superior</td><td class="td" title="table-entry  " align="left" valign="top">Duplica&#231;&#227;o da pelve e ureter&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Estenose da jun&#231;&#227;o ureteropi&#233;lica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Megaureter cong&#234;nito&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="5" align="left" valign="top">Anormalidades do trato urin&#225;rio inferior</td><td class="td" title="table-entry  " align="left" valign="top">Estenose jun&#231;&#227;o ureterovesical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">V&#225;lvula de uretra posterior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Agenesia bexiga&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Extrofia de bexiga&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bexiga neurog&#234;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="5" align="left" valign="top">Doen&#231;as c&#237;sticas renais</td><td class="td" title="table-entry  " align="left" valign="top">Cisto renal isolado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rim displ&#225;sico multic&#237;stico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Doen&#231;a renal polic&#237;stica AD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Doen&#231;a renal polic&#237;stica AR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cistos medulares &#8211; nefronoftise&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1383238.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Anormalidades cong&#234;nitas dos rins e do trato urin&#225;rio</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabela 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">CIV&#44; comunica&#231;&#227;o interventricular&#59; CIA&#44; comunica&#231;&#227;o interatrial&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Modificado de Stoll et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">11</span></a></p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="5" align="left" valign="top">Anomalias cromoss&#244;micas &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>119&#41;</td><td class="td" title="table-entry  " align="left" valign="top">Trissomiado 18 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Trissomiado 21 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Trissomiado 13 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S&#237;ndrome de Turner &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Outras &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="left" valign="top">Associa&#231;&#245;es n&#227;o cromoss&#244;micas &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>168&#41;</td><td class="td" title="table-entry  " align="left" valign="top">Vacterl &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Meckel&#8208;Gruber &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prune&#8208;Belly &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Outras &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Associa&#231;&#245;es de base desconhecida &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>276&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Tecido musculoesquel&#233;tico &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>97&#41;</td><td class="td" title="table-entry  " align="left" valign="top">Polidactilia&#47;sindactilia &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Encurtamento membros &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Outras &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Aparelho digestivo &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>91&#41;</td><td class="td" title="table-entry  " align="left" valign="top">Atresia anal &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">V&#237;cio de rota&#231;&#227;o &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Outros &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Malforma&#231;&#245;es card&#237;acas &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>88&#41;</td><td class="td" title="table-entry  " align="left" valign="top">CIV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CIA &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Outras &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="left" valign="top">Sistema nervoso &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>60&#41;</td><td class="td" title="table-entry  " align="left" valign="top">Espinha b&#237;fida &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Encefalocele &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Microcefalia &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Outras &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Cabe&#231;a e pesco&#231;o &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>53&#41;</td><td class="td" title="table-entry  " align="left" valign="top">Dismorfismo facial &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hipertelorismo &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Outras &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Sistema respirat&#243;rio &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>28&#41;</td><td class="td" title="table-entry  " align="left" valign="top">Hipoplasia pulmonar &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Outras &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Parede abdominal &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#41;</td><td class="td" title="table-entry  " align="left" valign="top">Onfalocele &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gastrosquise &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Outras &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>29&#41;</td><td class="td" title="table-entry  " align="left" valign="top">L&#225;bio leporino &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">H&#233;rnia diafragm&#225;tica &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1383239.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Malforma&#231;&#245;es associadas &#224;s Cakut encontradas em 346&#46;381 casos na Fran&#231;a de 1979 a 2004 &#40;total de 1&#46;678 Cakut&#44; das quais 563 com outras malforma&#231;&#245;es associadas&#41;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Tabela 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Gravidade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Segundo trimestre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Terceiro trimestre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 a<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 a<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>9<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 a &#8804; 10<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 a &#8804; 15<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Grave&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62; 10<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62; 15<span class="elsevierStyleHsp" style=""></span>mm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1383240.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Classifica&#231;&#227;o da hidronefrose antenatal de acirdo com o di&#226;metro anteroposterior da pelve renal</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0025"
        "etiqueta" => "Tabela 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at5"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">SFU&#44; Sociedade de Urologia Fetal&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SFU &#8211; Grau 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SFU &#8211; Grau 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SFU &#8211; Grau 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SFU &#8211; Grau 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><elsevierMultimedia ident="201703310307329041"></elsevierMultimedia>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><elsevierMultimedia ident="201703310307329042"></elsevierMultimedia>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><elsevierMultimedia ident="201703310307329043"></elsevierMultimedia>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><elsevierMultimedia ident="201703310307329044"></elsevierMultimedia>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Seio renal com urina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">P&#233;lvis cheia com c&#225;lices maiores dilatados&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dilata&#231;&#227;o uniforme de c&#225;lices maiores e menores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Afilamento de par&#234;nquima&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1383242.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Representa&#231;&#227;o gr&#225;fica e defini&#231;&#245;es da classifica&#231;&#227;o das altera&#231;&#245;es ultrassonogr&#225;ficas na hidronefrose &#40;adaptado de Timberlake &#38; Herndon<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">25</span></a>&#41;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0030"
        "etiqueta" => "Tabela 6"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at6"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">US&#44; ultrassom&#44; DAP&#44; di&#226;metro anteroposterior&#44; ITU&#44; infec&#231;&#227;o do trato urin&#225;rio&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Antecedentes perinatais&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dados cl&#237;nicos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Malforma&#231;&#245;es associadas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Baixo peso ao nascer<br>Restri&#231;&#227;o do crescimento intrauterino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Noct&#250;ria<br>Poli&#250;ria<br>Polaci&#250;ria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aberra&#231;&#245;es cromoss&#244;micas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Oligo&#226;mnio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Urge&#8208;incontin&#234;ncia<br>Disfun&#231;&#227;o intestinal e vesical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sequ&#234;ncias &#40;Vacterl&#47;Prune&#8208;Belly&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prematuridade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Tecido musculoesquel&#233;tico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">US com DAP aumentado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Enurese n&#227;o monossintom&#225;tica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sistema digestivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">US com afilamento do par&#234;nquima&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Jato urin&#225;rio fraco<br>Dificuldade em iniciar a mic&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cardiopatias cong&#234;nitas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">US com rim &#250;nico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bexigoma<br>Baixo ganho de peso<br>Hipertens&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sistema nervoso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">US com rins pequenos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ITU febril em &#60; 2 anos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hipoplasia pulmonar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1383241.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Sinais de alerta para o diagn&#243;stico de CAKUT em crian&#231;as</p>"
        ]
      ]
      6 => array:5 [
        "identificador" => "201703310307329041"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "fx1.jpeg"
            "Alto" => 315
            "Ancho" => 475
            "Tamanyo" => 28390
          ]
        ]
      ]
      7 => array:5 [
        "identificador" => "201703310307329042"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "fx2.jpeg"
            "Alto" => 314
            "Ancho" => 479
            "Tamanyo" => 35844
          ]
        ]
      ]
      8 => array:5 [
        "identificador" => "201703310307329043"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "fx3.jpeg"
            "Alto" => 314
            "Ancho" => 467
            "Tamanyo" => 31246
          ]
        ]
      ]
      9 => array:5 [
        "identificador" => "201703310307329044"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "fx4.jpeg"
            "Alto" => 315
            "Ancho" => 480
            "Tamanyo" => 29852
          ]
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Refer&#234;ncias"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:38 [
            0 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "K&#47;DOQI clinical practice guidelines for chronic kidney disease&#58; evaluation&#44; classification&#44; and stratification"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "N&#46;K&#46; Foundation"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Kidney Dis&#46;"
                        "fecha" => "2002"
                        "volumen" => "39"
                        "paginaInicial" => "S1"
                        "paginaFinal" => "S266"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11904577"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evolving importance of kidney disease&#58; from subspecialty to global health burden"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;U&#46; Eckardt"
                            1 => "J&#46; Coresh"
                            2 => "O&#46; Devuyst"
                            3 => "R&#46;J&#46; Johnson"
                            4 => "A&#46; K&#246;ttgen"
                            5 => "A&#46;S&#46; Levey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(13)60439-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2013"
                        "volumen" => "382"
                        "paginaInicial" => "158"
                        "paginaFinal" => "169"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23727165"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Worldwide access to treatment for end&#8208;stage kidney disease&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Liyanage"
                            1 => "T&#46; Ninomiya"
                            2 => "V&#46; Jha"
                            3 => "B&#46; Neal"
                            4 => "H&#46;M&#46; Patrice"
                            5 => "I&#46; Okpechi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(14)61601-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2015"
                        "volumen" => "385"
                        "paginaInicial" => "1975"
                        "paginaFinal" => "1982"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25777665"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic kidney disease in children&#58; the global perspective"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46; Warady"
                            1 => "V&#46; Chadha"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00467-006-0410-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Nephrol&#46;"
                        "fecha" => "2007"
                        "volumen" => "22"
                        "paginaInicial" => "1999"
                        "paginaFinal" => "2009"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17310363"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pediatric chronic dialysis in Brazil&#58; epidemiology and regional inequalities"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "T&#46; Konstantyner"
                            1 => "R&#46; Sesso"
                            2 => "M&#46;F&#46; de Camargo"
                            3 => "L&#46; de Santis Feltran"
                            4 => "P&#46;C&#46; Koch-Nogueira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0135649"
                      "Revista" => array:6 [
                        "tituloSerie" => "PLoS ONE"
                        "fecha" => "2015"
                        "volumen" => "10"
                        "paginaInicial" => "e0135649"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26285019"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109704013233"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of chronic kidney disease in children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46; Harambat"
                            1 => "K&#46;J&#46; van Stralen"
                            2 => "J&#46;J&#46; Kim"
                            3 => "E&#46;J&#46; Tizard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00467-011-1939-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Nephrol&#46;"
                        "fecha" => "2012"
                        "volumen" => "27"
                        "paginaInicial" => "363"
                        "paginaFinal" => "373"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21713524"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Environmental and epigenetic factors involved in Cakut"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "N&#46; Nicolaou"
                            1 => "K&#46;Y&#46; Renkema"
                            2 => "E&#46;M&#46; Bongers"
                            3 => "R&#46;H&#46; Giles"
                            4 => "Knoers N&#46;V&#46; Genetic"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/nrneph.2015.140"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Rev Nephrol&#46;"
                        "fecha" => "2015"
                        "volumen" => "11"
                        "paginaInicial" => "720"
                        "paginaFinal" => "731"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26281895"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malformations in newborn&#58; results based on 30&#44;940 infants and fetuses from the Mainz congenital birth defect monitoring system &#40;1990&#8208;1998&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Queisser-Luft"
                            1 => "G&#46; Stolz"
                            2 => "A&#46; Wiesel"
                            3 => "K&#46; Schlaefer"
                            4 => "J&#46; Spranger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Gynecol Obstet&#46;"
                        "fecha" => "2002"
                        "volumen" => "266"
                        "paginaInicial" => "163"
                        "paginaFinal" => "167"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12197558"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Study of urinary tract congenital malformations&#58; analysis of 6&#44;245 pediatric autopsies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "L&#46; Noronha"
                            1 => "V&#46; Adriane Martins"
                            2 => "G&#46; Sampaio"
                            3 => "I&#46; Cat"
                            4 => "M&#46;J&#46; Serapi&#227;o"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Bras Patol Med Lab&#46;"
                        "fecha" => "2003"
                        "volumen" => "39"
                        "paginaInicial" => "237"
                        "paginaFinal" => "243"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Timing and outcome of renal replacement therapy in patients with congenital malformations of the kidney and urinary tract"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; W&#252;hl"
                            1 => "K&#46;J&#46; van Stralen"
                            2 => "E&#46; Verrina"
                            3 => "A&#46; Bjerre"
                            4 => "C&#46; Wanner"
                            5 => "J&#46;G&#46; Heaf"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2215/CJN.03310412"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin J Am Soc Nephrol&#46;"
                        "fecha" => "2013"
                        "volumen" => "8"
                        "paginaInicial" => "67"
                        "paginaFinal" => "74"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23085722"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Associated nonurinary congenital anomalies among infants with congenital anomalies of kidney and urinary tract &#40;Cakut&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46; Stoll"
                            1 => "B&#46; Dott"
                            2 => "Y&#46; Alembik"
                            3 => "M&#46;P&#46; Roth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejmg.2014.04.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Med Genet&#46;"
                        "fecha" => "2014"
                        "volumen" => "57"
                        "paginaInicial" => "322"
                        "paginaFinal" => "328"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24821302"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Selection of infants who potentially have congenital anomalies of the kidney and urinary tract from a large cohort for a more thorough examination"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Yoshino"
                            1 => "M&#46; Honda"
                            2 => "N&#46; Sasaki"
                            3 => "H&#46; Hataya"
                            4 => "K&#46; Ishikura"
                            5 => "S&#46; Sakazume"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10157-014-1036-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Exp Nephrol&#46;"
                        "fecha" => "2015"
                        "volumen" => "19"
                        "paginaInicial" => "678"
                        "paginaFinal" => "682"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25255780"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early risk factors for neonatal mortality in CAKUT&#58; analysis of 524 affected newborns"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46;F&#46; Melo"
                            1 => "M&#46;B&#46; Aguiar"
                            2 => "M&#46;C&#46; Bouzada"
                            3 => "R&#46;L&#46; Aguiar"
                            4 => "A&#46;K&#46; Pereira"
                            5 => "G&#46;M&#46; Paix&#227;o"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00467-012-2107-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Nephrol&#46;"
                        "fecha" => "2012"
                        "volumen" => "27"
                        "paginaInicial" => "965"
                        "paginaFinal" => "972"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22402647"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pattern of clinical presentation of congenital anomalies of the kidney and urinary tract among infants and children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "N&#46;A&#46; Soliman"
                            1 => "R&#46;I&#46; Ali"
                            2 => "E&#46;E&#46; Ghobrial"
                            3 => "E&#46;I&#46; Habib"
                            4 => "A&#46;M&#46; Ziada"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Nephrology &#40;Carlton&#41;"
                        "fecha" => "2015"
                        "volumen" => "20"
                        "paginaInicial" => "413"
                        "paginaFinal" => "418"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prenatal risk factors for childhood CKD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;W&#46; Hsu"
                            1 => "K&#46;T&#46; Yamamoto"
                            2 => "R&#46;K&#46; Henry"
                            3 => "A&#46;J&#46; De Roos"
                            4 => "J&#46;T&#46; Flynn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1681/ASN.2013060582"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Soc Nephrol&#46;"
                        "fecha" => "2014"
                        "volumen" => "25"
                        "paginaInicial" => "2105"
                        "paginaFinal" => "2111"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24744441"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pre&#8208;dialysis chronic kidney disease in children&#58; results of a nationwide survey in Japan"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Ishikura"
                            1 => "O&#46; Uemura"
                            2 => "S&#46; Ito"
                            3 => "N&#46; Wada"
                            4 => "M&#46; Hattori"
                            5 => "Y&#46; Ohashi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ndt/gfs611"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nephrol Dial Transplant"
                        "fecha" => "2013"
                        "volumen" => "28"
                        "paginaInicial" => "2345"
                        "paginaFinal" => "2355"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23825101"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Growth impairment in children with pre&#8208;dialysis chronic kidney disease in Japan"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Y&#46; Hamasaki"
                            1 => "K&#46; Ishikura"
                            2 => "O&#46; Uemura"
                            3 => "S&#46; Ito"
                            4 => "N&#46; Wada"
                            5 => "M&#46; Hattori"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10157-015-1098-y"
                      "Revista" => array:7 [
                        "tituloSerie" => "Clin Exp Nephrol&#46;"
                        "fecha" => "2015"
                        "volumen" => "19"
                        "paginaInicial" => "1142"
                        "paginaFinal" => "1148"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25715867"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109713060233"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early detection of chronic kidney disease&#58; results of the PolNef study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Kr&#243;l"
                            1 => "B&#46; Rutkowski"
                            2 => "P&#46; Czarniak"
                            3 => "E&#46; Kraszewska"
                            4 => "S&#46; Lizakowski"
                            5 => "R&#46; Szubert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000158526"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Nephrol&#46;"
                        "fecha" => "2009"
                        "volumen" => "29"
                        "paginaInicial" => "264"
                        "paginaFinal" => "273"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18812692"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lower urinary tract development and disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46;M&#46; Rasouly"
                            1 => "W&#46; Lu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/wsbm.1212"
                      "Revista" => array:6 [
                        "tituloSerie" => "Wiley Interdiscip Rev Syst Biol Med&#46;"
                        "fecha" => "2013"
                        "volumen" => "5"
                        "paginaInicial" => "307"
                        "paginaFinal" => "342"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23408557"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predicting anatomical urological abnormalities in children who present with their first urinary tract infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46;C&#46; Zanetta"
                            1 => "B&#46;M&#46; Rosman"
                            2 => "C&#46;K&#46; Rowe"
                            3 => "H&#46;B&#46; Buonfiglio"
                            4 => "C&#46;C&#46; Passerotti"
                            5 => "R&#46;N&#46; Yu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Pediatr &#40;Phila&#41;"
                        "fecha" => "2013"
                        "volumen" => "52"
                        "paginaInicial" => "739"
                        "paginaFinal" => "746"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Strict blood&#8208;pressure control and progression of renal failure in children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Wuhl"
                            1 => "A&#46; Trivelli"
                            2 => "S&#46; Picca"
                            3 => "M&#46; Litwin"
                            4 => "A&#46; Peco-Antic"
                            5 => "A&#46; Zurowska"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa0902066"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med&#46;"
                        "fecha" => "2009"
                        "volumen" => "361"
                        "paginaInicial" => "1639"
                        "paginaFinal" => "1650"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19846849"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Summary of the Fourth Report on the Diagnosis&#44; Evaluation&#44; and Treatment of High Blood Pressure in Children and Adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46; Falkner"
                            1 => "S&#46;R&#46; Daniels"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.HYP.0000143545.54637.af"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hypertension"
                        "fecha" => "2004"
                        "volumen" => "44"
                        "paginaInicial" => "387"
                        "paginaFinal" => "388"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15353515"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prenatal detection of congenital renal malformations by fetal ultrasonographic examination&#58; an analysis of 709&#44;030 births in 12 European countries"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Wiesel"
                            1 => "A&#46; Queisser-Luft"
                            2 => "M&#46; Clementi"
                            3 => "S&#46; Bianca"
                            4 => "C&#46; Stoll"
                            5 => "E&#46;S&#46; Group"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejmg.2005.02.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Med Genet&#46;"
                        "fecha" => "2005"
                        "volumen" => "48"
                        "paginaInicial" => "131"
                        "paginaFinal" => "144"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16053904"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46;T&#46; Nguyen"
                            1 => "C&#46;D&#46; Herndon"
                            2 => "C&#46; Cooper"
                            3 => "J&#46; Gatti"
                            4 => "A&#46; Kirsch"
                            5 => "P&#46; Kokorowski"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jpurol.2010.02.205"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Urol&#46;"
                        "fecha" => "2010"
                        "volumen" => "6"
                        "paginaInicial" => "212"
                        "paginaFinal" => "231"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20399145"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mild to moderate postnatal hydronephrosis &#8211; grading systems and management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;D&#46; Timberlake"
                            1 => "C&#46;D&#46; Herndon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/nrurol.2013.172"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Rev Urol&#46;"
                        "fecha" => "2013"
                        "volumen" => "10"
                        "paginaInicial" => "649"
                        "paginaFinal" => "656"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23958828"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Postnatal management of antenatal hydronephrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Woodward"
                            1 => "D&#46; Frank"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "BJU Int&#46;"
                        "fecha" => "2002"
                        "volumen" => "89"
                        "paginaInicial" => "149"
                        "paginaFinal" => "156"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11849184"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antenatal hydronephrosis&#58; changing concepts in diagnosis and subsequent management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;A&#46; Shokeir"
                            1 => "R&#46;J&#46; Nijman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "BJU Int&#46;"
                        "fecha" => "2000"
                        "volumen" => "85"
                        "paginaInicial" => "987"
                        "paginaFinal" => "994"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10792193"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109711028762"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Unilateral renal agenesis&#58; a systematic review on associated anomalies and renal injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46; Westland"
                            1 => "M&#46;F&#46; Schreuder"
                            2 => "J&#46;C&#46; Ket"
                            3 => "J&#46;A&#46; van Wijk"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ndt/gft012"
                      "Revista" => array:7 [
                        "tituloSerie" => "Nephrol Dial Transplant"
                        "fecha" => "2013"
                        "volumen" => "28"
                        "paginaInicial" => "1844"
                        "paginaFinal" => "1855"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23449343"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S014067361160679X"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical implications of the solitary functioning kidney"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46; Westland"
                            1 => "M&#46;F&#46; Schreuder"
                            2 => "J&#46;B&#46; van Goudoever"
                            3 => "S&#46; Sanna-Cherchi"
                            4 => "J&#46;A&#46; van Wijk"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2215/CJN.08900813"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin J Am Soc Nephrol&#46;"
                        "fecha" => "2014"
                        "volumen" => "9"
                        "paginaInicial" => "978"
                        "paginaFinal" => "986"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24370773"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical course of 822 children with prenatally detected nephrouropathies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46;G&#46; Quirino"
                            1 => "J&#46;S&#46; Diniz"
                            2 => "M&#46;C&#46; Bouzada"
                            3 => "A&#46;K&#46; Pereira"
                            4 => "T&#46;J&#46; Lopes"
                            5 => "G&#46;M&#46; Paix&#227;o"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2215/CJN.03400411"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin J Am Soc Nephrol&#46;"
                        "fecha" => "2012"
                        "volumen" => "7"
                        "paginaInicial" => "444"
                        "paginaFinal" => "451"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22266574"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A predictive model of chronic kidney disease in patients with congenital anomalies of the kidney and urinary tract"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46;G&#46; Quirino"
                            1 => "C&#46;S&#46; Dias"
                            2 => "M&#46;A&#46; Vasconcelos"
                            3 => "I&#46;V&#46; Poggiali"
                            4 => "K&#46;C&#46; Gouvea"
                            5 => "A&#46;K&#46; Pereira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00467-014-2870-z"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Nephrol&#46;"
                        "fecha" => "2014"
                        "volumen" => "29"
                        "paginaInicial" => "2357"
                        "paginaFinal" => "2364"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24942863"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Current management of antenatal hydronephrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "K&#46;G&#46; Yama&#231;ake"
                            1 => "H&#46;T&#46; Nguyen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00467-012-2240-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Nephrol&#46;"
                        "fecha" => "2013"
                        "volumen" => "28"
                        "paginaInicial" => "237"
                        "paginaFinal" => "243"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22836304"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The life cycle of the kidney&#58; implications for CKD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;L&#46; Chevalier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1681/ASN.2014040380"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Soc Nephrol&#46;"
                        "fecha" => "2014"
                        "volumen" => "25"
                        "paginaInicial" => "2388"
                        "paginaFinal" => "2390"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24812166"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fetal and infant growth patterns and kidney function at school age"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Bakker"
                            1 => "R&#46; Gaillard"
                            2 => "O&#46;H&#46; Franco"
                            3 => "A&#46; Hofman"
                            4 => "A&#46;J&#46; van der Heijden"
                            5 => "E&#46;A&#46; Steegers"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1681/ASN.2013091003"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Soc Nephrol&#46;"
                        "fecha" => "2014"
                        "volumen" => "25"
                        "paginaInicial" => "2607"
                        "paginaFinal" => "2615"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24812164"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Postnatal follow&#8208;up of antenatal hydronephrosis&#58; a health&#8208;care challenge"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "L&#46; Cordero"
                            1 => "C&#46;A&#46; Nankervis"
                            2 => "R&#46;W&#46; Oshaughnessy"
                            3 => "S&#46;A&#46; Koff"
                            4 => "P&#46;J&#46; Giannone"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/jp.2008.239"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Perinatol&#46;"
                        "fecha" => "2009"
                        "volumen" => "29"
                        "paginaInicial" => "382"
                        "paginaFinal" => "387"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19194456"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Screening for CKD in children&#58; a global controversy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;J&#46; Hogg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2215/CJN.01210308"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin J Am Soc Nephrol&#46;"
                        "fecha" => "2009"
                        "volumen" => "4"
                        "paginaInicial" => "509"
                        "paginaFinal" => "515"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19118121"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0375"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasound of urinary system and urinary screening in 14&#46;256 asymptomatic children in China"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Yang"
                            1 => "Q&#46; Wang"
                            2 => "J&#46; Luo"
                            3 => "Q&#46; Li"
                            4 => "L&#46; Wang"
                            5 => "C&#46;C&#46; Li"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Nephrology &#40;Carlton&#41;"
                        "fecha" => "2010"
                        "volumen" => "15"
                        "paginaInicial" => "362"
                        "paginaFinal" => "367"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A cost&#8208;effectiveness analysis of screening urine dipsticks in well&#8208;child care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46;L&#46; Sekhar"
                            1 => "L&#46; Wang"
                            2 => "C&#46;S&#46; Hollenbeak"
                            3 => "M&#46;D&#46; Widome"
                            4 => "I&#46;M&#46; Paul"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.2009-1980"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2010"
                        "volumen" => "125"
                        "paginaInicial" => "660"
                        "paginaFinal" => "663"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20231188"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "pt"
  "url" => "/22555536/00000092000003S1/v2_201703310303/S2255553616300039/v2_201703310303/pt/main.assets"
  "Apartado" => array:4 [
    "identificador" => "20061"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Artigos de revis&#227;o"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/22555536/00000092000003S1/v2_201703310303/S2255553616300039/v2_201703310303/pt/main.pdf?idApp=UINPBA000049&text.app=https://jped.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2255553616300039?idApp=UINPBA000049"
]