21. Children with renal abnormalities Flashcards
What kind of lesions can there be?
Lesions may be: • Congenital • Infective • Tumours • Inflammatory • Traumatic Others e.g. autoimmune
Kidney development
Uteric bud travels along mesonephric duct and meets the metanephric blastema, and causes an induction which starts to form the kidney
The uteric bud meeting the metanephric blastema is what determines the type of kidney you get
If they meet in the wrong place, results in a dysplastic kidney
What is a duplex kidney?
Uretric bud can also divide. If it divides into two tubes, you can get a duplex kidney (with two renal pelvises and ureters). Can get incomplete duplex kidneys, which meet before going to the bladder, and complete duplex kidneys which go to the bladder separately. The complete one can cause problems.
If one kidney is dysplastic that’s okay but if both are then that’s not good
Consequences of unlilateral absent kidneys
Unilateral Absent kidney –
One good kidney sufficient for a normal life
You can’t be a kidney donor !
What is Mayer-Rokitansky syndrome?
Mayer-Rokitansky syndrome:
Abnormalities of the vagina (agenesis), uterus, fallopian tubes associated most commonly with an absent kidney (unilateral)
How does horseshoe kidney form?
Kidneys ascend and testes descend
When they ascend, if there is fusion of the lower pole of the two kidneys then will not ascend further than mesenteric arteries. So will be lower down in the kidneys and also have a horseshoe shape so are called horseshoe kidney. Can be completely normal in function
UTI
Pyuria Urine culture Difficulties in obtaining MSU (midstream urine) Suprapubic aspiration Dipstix for nitrites High index of suspicion
What is VUR?
vesicoureteral reflux commonest “surgical” cause of uti may be diagnosed after uti antenatal diagnosis secondary reflux when associated with other abnormalities most common in children
How does VUR occur?
In healthy individuals the ureters enter the urinary bladder obliquely and run submucosally for some distance. This, in addition to the ureter’s muscular attachments, helps secure and support them posteriorly. Together these features produce a valvelike effect that occludes the ureteric opening during storage and voiding of urine. In people with VUR, failure of this mechanism occurs, with resultant backward (retrograde) flow of urine.
Grades of VUR
Grade I – reflux into non-dilated ureter
Grade II – reflux into the renal pelvis and calyces without dilatation
Grade III – mild/moderate dilatation of the ureter, renal pelvis and calyces with minimal blunting of the fornices
Grade IV – dilation of the renal pelvis and calyces with moderate ureteral tortuosity
Grade V – gross dilatation of the ureter, pelvis and calyces; ureteral tortuosity; loss of papillary impressions
Management of VUR
mostly non-operative
many will stop refluxing after about the age of 5 years
uroprophylaxis
good follow up
What happens if UTI occurs?
infection not very common uti may result in pyonephrosis - destroy kidney may be diagnosed antenatally investigation - ultrasound nuclear scan - (mcu) uroprophylaxis
What is a mega-ureter
not as common as puj may be associated with other problems like duplex system associated urteroceles rarely simple stenosis has to be differentiated from v-u reflux
PUV
presents in the neonatal period (usually)
infant may be very ill
antenatally diagnosed and some managed antenatally
outcome depends on initial renal damage
Posterior urethral valve (PUV) disorder is an obstructive developmental anomaly in the urethra and genitourinary system of male newborns.[1] A posterior urethral valve is an obstructing membrane in the posterior male urethra as a result of abnormal in utero development.
What is a hypospadia?
Hypospadias is a congenital disorder of the urethra where the urinary opening is not at the usual location on the head of the penis
