Congenital Anomalies of the Kidney and Urinary Tract Flashcards
Proneprhos
Mesoneprhos
Metanephros
Non functioning - 4th week
Meso - at end of 4th week…develops to the degenerating pronephros
Meta - final human kidney @ 5th week and fully functiona at 9 weeks
Kidney origin
From intermediate mesoderm of urogenital ridge
Wolffian duct is divided into 3 segs
More embryology
Ureteric bud branches from Wolffian duct…forms collecting system
Induces formation of neprhons in metaneprhic blastema
Neprhoblastic cells of blastema diff into glomeruli, PCT, Loos, and DCT
Hydroneprhosis
80% of newborns with urinary tract anomilies will have this
Physiologic is common and is a “slow draining” kidney
Primary vesicoureteral reflux
Related to how ureter is inserting into bladder - shorter or abnormal angle
Needs to be diff from secondary - urinary tract obstruction or neurogenic bladder
Test of primary vesicoureteral reflux and tx
Voiding cystourethrogram, cannot be dx on renal ultrasound
Frequently outgrown over first years of life
Prophylactic ABs to avoid UTIs
Obstructive uropathy
Interference of flow at any site
Leads to urine accumulation behind the obstruction…potentially damaging
Can be congenital or acquired
Obstructive uropathy how to ID
Hydroneprhosis or hydroureter
Acute complete unilat can significantly dec GFR and increase seurm creatinine somewheat…bilateral = renal failure
Renal nuclear scan
Post urethral valves
Obstructing membraneous folds within lumen of prostatic urethra
Only in males
UPJ obstruction
UVJ onbstruction
ONe hydroneprhotic kdiney, normal ureters nad bladde
r
One hydroneprhoitc kdiney…one dilated ureter on same side…normal bladder and other kdiney normal
POst urethral valves Vesicourteral reflux (uni)
Bilateral hydroneprhosis and hydroureter, abnormal nladder with trabeculations and wall thickening
One hydroneprhotic kidney, one dilated ureter on the same side, normal bladder, other kidney normal…similar to UVJ but ureter not as severely dilated
Unilateral renal agensis
Disruption of metaneprhic developemt
Compensatory hypertrophy of contralateral kidney
Look for unusual location of the absent kidney by renal scan
Prognosis of unilateral renal agensis
No evidence it will elad to restircted kidney function in absence of other comorbitieis
Primary renal dysplasia
INteraction bt ureteric bud and metaneprhic mesenchym generates neprhons of each kidney
Low neprhon number
Pure - decreased number but otherwise normal kidney
Renal dysplasia - evidence of aberrant development fates of metaneprhic mesenchyme
Bilateral renal agenesis
Bilateral failure with POtter syndrome
Oligohydramnios in 2nd trimester of pregnancy in severe
Complete absence of renal parenchya and amnitoic fluid predicts grave prognosis
