peds- kidneys pt 1

Question 1

kidney scan patient prep?

Answer 1

• hydration is prefered

- no fasting needed

Question 2

Normal Appearance of Kidneys in Neonates?

Answer 2

• renal pyramids or medulla appear as hypoechoic, triangular, or rectangular structures
• can be mistaken for cysts

Question 3

Normal appearance of kidneys in neonates contour?

Answer 3

• Renal lobulations account for the irregular kidney contour
• normal in neonates and infants
• disappear with age
• aka fetal lobulations

Question 4

Normal Appearance of Kidneys in Neonates cortex?

Answer 4

thin compared to medulla

Question 5

Normal Appearance of Kidneys in Neonates renal sinus?

Answer 5

less fat filled in infants and young children

Question 6

Normal Appearance of Kidneys in Neonates renal pelvis?

Answer 6

located within the renal sinus and should measure <10mm in the supine postition

Question 7

Normal Pediatric Renal Echo Pattern newborn?

• cortex
• sinus

Answer 7

cortex:
- more echogenic than liver and spleen

sinus:
- poorly defined because of lack of fat in infants

Question 8

Normal Pediatric Renal Echo Pattern 6-8 weeks? (cortex)

Answer 8

isoechoic to liver and spleen

Question 9

Normal Pediatric Renal Echo Pattern 2-6 months (cortex)?

Answer 9

hypoechoic to liver and spleen

Question 10

Normal Pediatric Renal Echo Pattern >6months (cortex)?

Answer 10

hypoechoic to renal sinus

Question 11

unilateral renal agenesis?

Answer 11

• 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

Question 12

Bilateral renal agenesis?

Answer 12

• Incompatible with life
• Most die shortly after birth
• Bladder absent

Question 13

bilateral renal agenesis is associated with?

Answer 13

• oligohydramnios
• pulmonary hypoplasia
• low set eats, small mandible, flat nose, wide-set eyes (potters syndrome)

Question 14

cross-fused ectopia?

Answer 14

• one kindey displaced across the midline and fused to the other normally positioned kidney
• prone to obstruction

Question 15

Duplex Kidney child presents with?

Answer 15

UTI

Question 16

duplex kidney sono features?

Answer 16

• 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

Question 17

what is Hydronephrosis?

Answer 17

• dilation of the collecting system of the urinary tract
• renal calyces
• renal pelvis
• ureters

Question 18

when is Hydronephrosis frequently diagnosed?

Answer 18

• in utero

Question 19

common causes of Hydronephrosis?

Answer 19

• UPJ obstruction (main cause)
• UVJ/ disal urethral obstructions
• duplication of the collecting system

Question 20

Hydronephrosis mild- grade 1?

Answer 20

• minimal separation of sinus echoes

- fluid-filled calyces

Question 21

hydronephrosis moderate- grade 2?

Answer 21

• anechoic separation of the entire central sinus

- calyces are enlarged

Question 22

hydronephrosis- severe: grade 3?

Answer 22

• extensive separation of the sinus
• parenchymal thinning
• loss of normal kidney appearance

Question 23

Hydronephrosis -UPJ obstruction?

Answer 23

• 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

Question 24

hydronephrosis UVJ obstruction?

Answer 24

• 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

Question 25

Hydronephrosis: Duplicated collecting system?

Answer 25

- 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

Question 26

Hypoplasia of the Kidney?

Answer 26

- Small but otherwise normal kidney | - Secondary to infection or vascular occlusion

Question 27

Dysplasia of the Kidney?

Answer 27

Kidneys are small or large No corticomedullary junction May have cysts Pelvis may be dilated

Question 28

Dysplasia of the Kidney associated with?

Answer 28

Associated with urinary tract malformations in 90% of cases: - Obstruction - Ureterocele with hydroureter - Prune Belly Syndrome - PUV (posterior uretral valves) - Ectopic kidneys

Question 29

what is the most common cause of urethral obstruction in boys?

Answer 29

Posterior Urethral Valves (PUV)

Question 30

what is Posterior Urethral Valves (PUV)?

Answer 30

- 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

Question 31

PUV clinical presentation?

Answer 31

- Palpable flank masses - Infection - Voiding abnormalities-decreased stream - Retention

Question 32

PUV sono features?

Answer 32

- 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

Question 33

Prune Belly Syndrome clinical presentation?

Answer 33

1. Absent abdominal muscles 2. Urinary tract abnormalities 3. Cryptorchidism