Children with Renal Abnormalities Flashcards
The nature of disease:
-
Lesions may be:
- C..
- In..
- Tu..
- In..
- T…
- Others (e.g. autoimmune)
-
Lesions may be:
- Congenital
- Infective
- Tumours
- Inflammatory
- Traumatic
- Others (e.g. autoimmune)
Urology Development - Where it all starts
- The … bud (also known as the metanephrogenic diverticulum) is a protrusion of the … duct that appears during the embryological development of urogenital organs.
- It will eventually form the urinary collecting system (i.e. collecting tubes, calyces, renal pelvis, ureter) of the kidney.
- This occurs after the ureteric bud connects with the metanephric ….
- The ureteric bud (also known as the metanephrogenic diverticulum) is a protrusion of the mesonephric duct that appears during the embryological development of urogenital organs.
- It will eventually form the urinary collecting system (i.e. collecting tubes, calyces, renal pelvis, ureter) of the kidney.
- This occurs after the ureteric bud connects with the metanephric blastema.
Congenital Problems - Urology
- … Absent kidney
- One good kidney sufficient for a normal life
- You can’t be a … …
- Mayer-Rokitansky syndrome:
- Abnormalities of the vagina (…), uterus, fallopian tubes associated most commonly with an … … (unilateral)
-
Unilateral Absent kidney –
- One good kidney sufficient for a normal life
- You can’t be a kidney donor !
- Mayer-Rokitansky syndrome:
- Abnormalities of the vagina (agenesis), uterus, fallopian tubes associated most commonly with an absent kidney (unilateral)
What is Mayer-Rokitansky syndrome?
- Abnormalities of the vagina (agenesis), uterus, fallopian tubes associated most commonly with an absent kidney (unilateral)
What is a horseshoe kidney?
What is a horseshoe kidney?
Abnormalities of the kidney can predisose you to get other complications - what is the most common?
UTI
What is Vesicoureteral reflux (VUR)?
With vesicoureteral reflux, urine flows backward from the bladder, up the ureter to the kidney.
What is the commonest ‘surgical’ cause of UTI?
Vesicoureteral reflux (VUR) (when the flow of urine goes the wrong way)
Vesicoureteral reflux (VUR) may be diagnosed after … or … diagnosis
after a UTI, or may be antenatal diagnosis
When does Secondary Reflux occur? (Secondary vesicoureteral reflux)
- Secondary VUR occurs when an obstruction in the bladder or urethra causes urine to flow backward into the kidneys.
- Secondary VUR can occur at any age and can be caused by surgery, injury, a pattern of emptying the bladder that’s not normal, or a past infection that puts pressure on the bladder.
Anatomy of Vesicoureteral Reflux
- Vesicoureteric reflux is, in the majority of cases, the result of a primary maturation abnormality of the vesicoureteral junction resulting in a short distal … … tunnel.
- If this tunnel is very … - end up with the uteric opening is quite lateral - predisposes to reflux
- Vesicoureteric reflux is, in the majority of cases, the result of a primary maturation abnormality of the vesicoureteral junction resulting in a short distal ureteric submucosal tunnel.
- Normally, ureter approaches bladder - submucosal tunnel
- If this tunnel is very short - end up with the uteric opening is quite lateral - predisposes to reflux
Grades of Vesicoureteric Reflux
- How many are there?
- grade 1: reflux limited to the ureter
- grade 2: reflux up to the renal pelvis
- grade 3: mild dilatation of ureter and pelvicalyceal system
-
grade 4: tortuous ureter with moderate dilatation
- blunting of fornices but preserved papillary impressions
-
grade 5: tortuous ureter with severe dilatation of ureter and pelvicalyceal system
- loss of fornices and papillary impressions 2
What is Bilateral Vesicoureteric Reflux?
Vesicoureteral reflux (VUR) is a condition in which urine flows backward from the bladder to one or both ureters and sometimes to the kidneys (bilateral = both kidneys)
Damage to kidneys after Vesicoureteric Reflux
- Left kidney - chronic scarring as a result of pyelonephritis (after reflux)
- Right kidney is normal
Management of Vesicoureteric Reflux
- Is it operative?
- What age does refluxing usually stop?
- How do we stop the child getting infections?
- Is it operative? - Mostly non-operative
- What age does refluxing usually stop? - about age 5
- How do we stop the child getting infections? - Small dose of Antibiotics as a prophylactic measure
Vesicoureteric reflux (VUR) can be corrected endoscopically by a procedure known as …
- STING
- Submucosal injection - was tefflon - now Deflux
- Introduced - submucosal needle - where the ureter and bladder meet
What is Hydronephrosis?
Hydronephrosis (plural: hydronephroses) is defined as dilatation of the urinary collecting system of the kidney (the calyces, the infundibula, and the pelvis)
Is infection common in Hydronephrosis?
No
Hydronephrosis may be diagnosed … and can be confirmed using a … scan
Hydronephrosis may be diagnosed antenatally and can be confirmed using a MAG3 scan
Hydronephrosis + UTI may result in …
Pyonephrosis (a term given to an infection of the kidney with pus in the upper collecting system which can progress to obstruction.)
Acute pyelonephritis is a sudden and severe …
-
kidney infection
- It causes the kidneys to swell and may permanently damage them.
What is a Mega-Ureter?
Megaureter (dilated ureter) is an abnormality of one or both of the ureters of a child.
Mega-ureter has to be differentiated from …
Vesicoureteric reflux
Mega-ureter
- Not as common as …
- May be associated with other problems like … system
- Associated Urteroceles
- Rarely simple …
- Has to be differentiated from …reflux
- Not as common as PUJ (Pelviureteric junction obstruction)
- May be associated with other problems like duplex system
- Associated Urteroceles
- Rarely simple stenosis
- Has to be differentiated from V-U-reflux
MAG3 scan showing …
obstruction
What is PUV?
Posterior urethral valves (PUV) is a condition found only in boys that affects the urethra (the tube which runs from the bladder to the outside)
PUV (Posterior urethral valves)
- What gender?
- Presents in the … period (usually)
- How ill?
- Diagnosed and managed when?
- Outcome depends on initial … damage
- Boys only
- Presents in the neonatal period (usually)
- Infant may be very ill
- Antenatally diagnosed and some managed antenatally
- Outcome depends on initial renal damage
Some boys are born with a … penis
- Buried penis
- Can be corrected surgically
What is Hypospadias?
Hypospadias is a condition in which the opening of the urethra is on the underside of the penis instead of at the tip
A child with Cryptorchidism and Hypospadias may actually be a …
female with congenital adrenal hyperplasia - important to check actual gender at birth to determine sex of child (USS of pelvis and checking for chromosomes)
What is a Ureterocele?
A ureterocele is a cystic out-pouching of the distal ureter into the urinary bladder (congenital)
Testicular descent
- Usually, the testes descend from abdomen through inguinal canal into scrotum
- As it does this - there are outpouchings - becomes processus vaginalis and tunica vaginalis testes
- If this outpouching doesnt obliterate itself and remains patent, it can cause inguinal … and …
- Usually, the testes descend from abdomen through inguinal canal into scrotum
- As it does this - there are outpouchings - becomes processus vaginalis and tunica vaginalis testes
- If this outpouching doesnt obliterate itself and remains patent, it can cause inguinal hernia and hydrocele
What is an Undescended Testis?
Is a testis that cannot be manipulated to the bottom of the scrotum, without undue tension of the spermatic cord
Incidence of Undescended Testis
- … % newborn boys
- Preterm infants incidence …% or more
- 2/3 descend spontaneously
- full term < 6 weeks
- preterm < 3 months
- …% at the age of one
- … predisposition
- Bilateral 10-25%
- Right=left 55%=45%
- 3.4 % newborn boys
- Preterm infants incidence 20% or more
- 2/3 descend spontaneously
- full term < 6 weeks
- preterm < 3 months
- 1% at the age of one
- Familial predisposition
- Bilateral 10-25%
- Right=left 55%=45%
Undescended Testis
- Impalpable testis: a…, intra-… or intra-…
- Undescended testis: in the …
- Ectopic testis: abdominal wall, thigh, base of penis or contra-lateral side
- … testis - used when testis has normally descended at birth but over the years gets pulled back - quite rare
- Impalpable testis: absent, intra-abdominal or intra-canicular
- Undescended testis: in the groin
- Ectopic testis: abdominal wall, thigh, base of penis or contra-lateral side
- Ascending testis - used when testis has normally descended at birth but over the years gets pulled back - quite rare
