M9: Fetal GU Flashcards
which structure forms the renal collecting sys
ureteric buds from the wolffian ducts
which structure forms the nephrons (glomeruli and loop of henle)
metanephros
when does urine production start
what produced amniotic fluid before this
11 wks
membranes and lungs
where in the body are the primitive kidneys located
what happens if they fail to migrate
pelvis
ectopic kidney
name for the primitive kidneys
metanephros
in which plane do we image kidneys
TRX, only SAG if there’s pathology
norm kidney length
equal to gestational age in mm
upper limit of norm for renal pelvis dilation
20 wks and 20 + wks
5mm up to 20 wks
8mm from 20 wks- term
2 segments of the cloaca
cloaca is the terminal end of the hindgut….
segments:
urinary and rectal
what does the caudal end of the cloaca form
what does the allantois form
urethra and bladder neck
the rest of the bladder
another name for ureters
mesonephric ducts
when do the genitals form
8-10 wks. (prior to 8 wks they are ambiguous)
male genitals develop w/ testosterone present, w/o, female genitals develop due to maternal estrogen
bilateral renal genesis is associated w/ which other anomalies
risk factors for bilateral renal agenesis
GU, GI and cardiac abnormalities
sirenomelia syndrome
teratogens - warfarin, cocaine, maternal diabetes type 1
US appearance of unilateral renal agenesis
kidney thats present may be enlarged since its doing all the work… fetus may be asymp
US appearance of bilateral renal agenesis
absent bladder
oligohydramnios or anhydramnios
small AC and IUGR
describe potters syndrome
a sequence that refers to the consequence of severe oligohydramnios due to bilateral renal agenesis
describe the phenotype of potters syndrome
pulmonary hypoplasia
abnormal hand and foot positions
facial anomalies
IUGR
describe hydronephrosis
distention of the renal pelvis and calyces w/ urine due to obstruction
usually unilateral
accounts for most renal abnormalities and sometimes associated w/ other syndromes
causes of hydro
obstruction
reflux
ureterocele
which part of the urinary sys will be dilated w/ obstruction at the UPJ
kidneys/renal pelvis
which part of the urinary sys will be dilated w/ obstruction at the UVJ
kidneys/renal pelvis and ureters
which gender does posterior uretheral valve obstruction effect
males only
grading hydro in fetuses
grade 1: only renal pelvis dilated
grade 2: renal pelvis and calyces visible
grade 3: renal pelvis and calyces dilated
grade 4: parenchymal thinning
whats the most common urinary obstruction in neonates
what should you look for
UPJ obstruction
dilated renal pelvis and calyces
US appearance of unilateral UPJ obstruction
bilateral?
normal bladder and amniotic fluid
olihydromnios w/ hydro of varying degrees
US appearance of severe UPJ obstruction
renal parenchyma may be destroyed
false + for UPJ obstruction
extra-renal pelvis
prominent renal veins
reflux (dilation will come and go/be transient)
most common cause of ureterovescial obstruction/UVJ
duplicated collecting sys w/ an ectopic ureter location from the upper pole of the kidney
US appearance of UVJ obstruction w/ duplicated collecting sys
the ureter can mimic which structure
dilated upper pole of kidney w/ dilated ureter, lower pole is normal
bowel (but bowel is medial in the body, ureter is lateral)
define ureterocele
cystic dilation of the intravesicular portion of the ureter, associated w/ dilation of upper pole of kidney in a duplicated collecting sys
what are posterior urethral valves
membranes that occur in the prostatic urethra of a male fetus that obstruct retrograde flow of urine
US appearance of posterior urethral valves
large distended bladder (keyhole)
oligohydramnious
hydro
PUV may be a precursor to which syndrome
prune belly syndrome/eagle-barrett syndrome
describe a bladder exstrophy
what causes it
failure of closure of the bladder, lower urinary tract, symphysis pubis, rectus muscles and skin
defect in development of cloacal membrane
bladder exstrophy is associated w/ which condition
cloacal extrophy
what is the OEIS complex
omphalocele
extrophy of the bladder
imperforate anus
spinal abnormalities
describe infantile polycystic kidney disease (ARPKD)
US appearance/diagnostic criteria
autosomal recessive disorder primarily effecting the collecting ducts/cortex
- bilaterally enlarged echogenic kidneys (many small cysts under 1-2 mm)
- severe oligohydramnios
- absent bladder
ARPKD/IPKD is associated w/ which conditions
meckel Gruber syndrome
Roberts syndrome - IPKD, phocomelia, cleft palate
T13
ddx for IPKD
benign glomerulosclerosis - large echogenic kidneys but hypo pyramids and norm fluid (diagnosed in a lab)
what is phocomelia
hands and feet attached to trunk w/ single bone
describe ADPKD
US appearance
-rarely seen antenatally but fetus is assessed if parents have the condition
enlarged kidneys w/ cysts, may be hyperechoic
norm amniotic fluid and bladder
describe multi cystic dysplastic kidney (MCDK)
US appearance
multiple cystic lesions that arise from tubules of the cortex, cysts dont communicate
- kidneys not reniform shape
- unilateral usually
- bilaterally - low fluid, associated w/ potters sequence, IS FATAL due to lack of fluid
is MCDK a genetic condition
no
2 types of renal tumors
nephroblastoma (wilm’s tumor) - solid mass, not commonly identified in utero
mesoblastic nephroma
most common congenital renal tumor
mesoblastic nephroma
2 adrenal pathologies
neuroblastoma
hemorrhage
possible genital pathologies
Male:
hydrocele
cryptorchidism
Female:
hydrometrocolpos
ovarian cysts
Both:
ambiguous genitals
X linked syndromes - Turners, Noonan’s, hemophilia
which structures can be mistaken for the kidneys if theres renal agenesis
adrenals since they will occupy the space of the kidney (laying down adrenals?)
US appearance of bladder rupture
w/ which pathology can this occur
ascites
thick bladder wall
moderate hydro
PUV
When gendering a male, which structure must be included
Penis
