Children with renal abnormalities Flashcards
Embryological development of the kidneys
Of metanephric origin
- the ureteric bud grows out from hindgut to metanephric blastema
- the ureteric bud activates the metanephric cells to initiate further development of kidneys
- Formation of renal tubule, collectig duct and pelvis
Abnormal meeting of the ureteric bud to the metanephric cells causes dysplastic kidneys
Unilateral Absent kidney
Unilateral kidney agenesis
- possibly due to failure of the ureteric bud to meet the metanephric mesenchyme
- Associated with many Mullerian duct abnormalities
Mayer-Rokitansky syndrome
A Mullerian duct abnormality
Can include
- Abnormalities of the vagina (agenesis)
- uterus and fallopian tube abnormalities
- unilateral kidney agenesis
Hematoclopos
Build up of menstrual blood in the uterus
Can be caused by vaginal atresia (closed/absent vagina) seen in Mayer-Rokitansky syndrome
UTI in children
common
Symptoms
-Pyuria
puss in urine
Mid-stream urine in children difficult to obtain
-Suprapubic aspiration to collect urine is more viable
Diagnosis:
Dipstick
-Nitrites
Horseshoe kidneys
Fusion of the kidnyes
-Caused by abnormal migration of the kidneys during development
Vesicouretral reflux
Retrograde flow of urine from bladder into ureter/kidney
Mechanism
- ureter normally enters bladder submucosally
- this creates a valve structure that is absent in VUR
Presents with
- UTI
- Dilated kidney
- Dilated ureter
- Can be asymptomatic
- increases risk of hypertension in later life
Grades of VUR
The higher the grade, the more dilation is present and the further up the urine has travelled
Grades 1-3
- usually does not require surgical intervention as many kids stop refluxing after 5
- Monitored with antibiotics and follow up
Diagnosing reflux nephropathy
DMSA scan
-radioactive scan
Diagnoses acute pyelonephritis where there is tissue damage
Mega-ureter
Abnormally dilated ureter
- More common in males
- not due to reflux
Associations
- Urteroceles
- Rarely simples stenosis
Posterior urethral valve
Only occurs in males
-Fold of mucosa that causes obstruction in the posterior male urethra in utero
Treatment
Valve ablation can be done in utero
Prognosis
- Dependant on how much renal damage has been done by the obstruction
- Many individuals affected get transplants
Buried penis
scrotal and forsekin fuse to hide penis
Congenital cause
-Maldevelopment of penile skin shaft
Treatment
Reconstructive surgery
Hypospadias
Congenital abnormality where the urethra does not from properly during development
-urethral opening of penis elsewhere (not on top of head)
Openings can be
- midshaft
- near the scrotum
associated with undescended testes
Ureterocele
Ureterocele is a congenital anomaly (present at birth) that affects girls more than boys. It is simply a swelling limited to the end of the ureter as it enters the bladder. The swelling resembles a balloon on ultrasound or during a camera examination of the bladder.
