peds- kidneys pt 1 Flashcards
kidney scan patient prep?
- hydration is prefered
- no fasting needed
Normal Appearance of Kidneys in Neonates?
- renal pyramids or medulla appear as hypoechoic, triangular, or rectangular structures
- can be mistaken for cysts
Normal appearance of kidneys in neonates contour?
- Renal lobulations account for the irregular kidney contour
- normal in neonates and infants
- disappear with age
- aka fetal lobulations
Normal Appearance of Kidneys in Neonates cortex?
thin compared to medulla
Normal Appearance of Kidneys in Neonates renal sinus?
less fat filled in infants and young children
Normal Appearance of Kidneys in Neonates renal pelvis?
located within the renal sinus and should measure <10mm in the supine postition
Normal Pediatric Renal Echo Pattern newborn?
- cortex
- sinus
cortex:
- more echogenic than liver and spleen
sinus:
- poorly defined because of lack of fat in infants
Normal Pediatric Renal Echo Pattern 6-8 weeks? (cortex)
isoechoic to liver and spleen
Normal Pediatric Renal Echo Pattern 2-6 months (cortex)?
hypoechoic to liver and spleen
Normal Pediatric Renal Echo Pattern >6months (cortex)?
hypoechoic to renal sinus
unilateral renal agenesis?
- Unilateral is rare 1/1000 newborn, but more common than bilateral
- Males > females
- Left kidney mostly
- Right kidney undergoes compensatory
- hypertrophy
- Incidental if asymptomatic
- Lying-down adrenal sign on ipsilateral side
Bilateral renal agenesis?
- Incompatible with life
- Most die shortly after birth
- Bladder absent
bilateral renal agenesis is associated with?
- oligohydramnios
- pulmonary hypoplasia
- low set eats, small mandible, flat nose, wide-set eyes (potters syndrome)
cross-fused ectopia?
- one kindey displaced across the midline and fused to the other normally positioned kidney
- prone to obstruction
Duplex Kidney child presents with?
UTI
duplex kidney sono features?
- Duplex kidney is longer than the contralateral side
- Upper pole ureter prone to obstruction
- Dilated ureter
- Lower pole dilates due to vesicoureteric reflux
- Duplex kidneys are often bilateral
what is Hydronephrosis?
- dilation of the collecting system of the urinary tract
- renal calyces
- renal pelvis
- ureters
when is Hydronephrosis frequently diagnosed?
- in utero
common causes of Hydronephrosis?
- UPJ obstruction (main cause)
- UVJ/ disal urethral obstructions
- duplication of the collecting system
Hydronephrosis mild- grade 1?
- minimal separation of sinus echoes
- fluid-filled calyces
hydronephrosis moderate- grade 2?
- anechoic separation of the entire central sinus
- calyces are enlarged
hydronephrosis- severe: grade 3?
- extensive separation of the sinus
- parenchymal thinning
- loss of normal kidney appearance
Hydronephrosis -UPJ obstruction?
- Most common site in infants
- Multiple communicating cystic lesions are seen and are uniform and similar in size
- Ureter appears normal, not seen on US
hydronephrosis UVJ obstruction?
- Distal stenosis or stricture, atresia
- Ectopic insertion of ureter
- In case of bilateral hydro cause might be in bladder or urethra
- Must examine the bladder for obstructing masses or ureterocele
Hydronephrosis: Duplicated collecting system?
- Dilated upper pole and a separate dilated ureter which can be followed to the bladder
- The ureter is dilated due to abnormal ectopic insertion into the bladder
Hypoplasia of the Kidney?
- Small but otherwise normal kidney
- Secondary to infection or vascular occlusion
Dysplasia of the Kidney?
Kidneys are small or large
No corticomedullary junction
May have cysts
Pelvis may be dilated
Dysplasia of the Kidney associated with?
Associated with urinary tract malformations in 90% of cases:
- Obstruction
- Ureterocele with hydroureter
- Prune Belly Syndrome
- PUV (posterior uretral valves)
- Ectopic kidneys
what is the most common cause of urethral obstruction in boys?
Posterior Urethral Valves (PUV)
what is Posterior Urethral Valves (PUV)?
- Most common cause of urethral obstruction in boys
- A mucosal flap or fold or extra urethral tissue in posterior part of urethra
- May be identified in utero
PUV clinical presentation?
- Palpable flank masses
- Infection
- Voiding abnormalities-decreased stream
- Retention
PUV sono features?
- Thick, trabeculated bladder wall
- Dilated posterior urethra
- Dilated, tortuous ureters due to vesicoureteral reflux
- In infants, the renal parenchyma is echogenic and becomes dysplastic due to long-standing reflux and obstruction
- Incomplete voiding
- Key hole sign
Prune Belly Syndrome clinical presentation?
- Absent abdominal muscles
- Urinary tract abnormalities
- Cryptorchidism
