Pyelonephritis and Congenital Abnormalities of the Kidney and Urinary Tract Flashcards
At what week of gestation does urine production start?
10 weeks
At what week of gestation do no new nephrons develop?
36 weeks
What is the GFR of a baby at birth?
40-60mls/min/1.73m^2
What renal investigations can be conducted in children?
Anetnatal US ultrasound Micturating cystourethrogram Nuclear medicine CT MRI
List common congenital abnormalities of the kidneys/urinary tract
Renal dysplasia/hypoplasia Renal agenesis MCDK Renal cystic dysplasia Genetic cystic disease Obstructive uropathy Vesicle-ureteric reflux
What is renal genesis?
The congenital absence of renal aprenchumal tissue at the metanephric stage
What is the prognosis of unilateral renal agenesis?
Excellent - many people will go through life not knowing the have the condition
What is the prognosis of bilateral renal agenesis?
Not compatible with life.
Bilateral renal agenesis is usually sporadic. T/F?
True
Which sex is usually affected by renal agenesis?
Males
What is renal hypopalsia?
A reduction in the number of nephrons but with normal architecture
What is renal dysplasia?
Malformed renal tissue
What. is renal hypodysplasia?
Congenitally small kidneys with dysplastic features
How does renal hypodysplasia present?
Present antenatally as US growth
In the neonate with lung issues, low birth weight, acidosis and raised creatinine
In children as failure to thrive, anorexia, vomiting, proteinuria
What are the associated risks of multicystic dysplastic kidney disease?
Hypertension
Malignancy
There can be spontaneous involution of multicystic dysplastic kidney disease. T/F?
True
What are the signs of ARPKD antenatally?
Seen on ultrasound
Oligohydraminos (less than expected amniotic fluid volume)
What are the signs of ARPKD in infancy?
Large palpable renal mass Respiratory distress Renal failure Hypertension Hyponatraemia
What are the associated abnormalities of ARPKD?
Congenital hepatic fibrosis (causes portal hypertension and ascending cholangitis)
What is the prognosis fo ARPKD?
20-30% mortality in neonatal. period
Progression to end stage renal failure in 50% of cases over 15 years
What are the signs ADPKD in children?
Haemturia Hypertension Flank pain UTIs Renal US
In what age group does ADPKD usually present?
Adults
What are the associated conditions of ADPKD?
Mitral valve prolapse Cerebral aneurysm AV malformation Hepatic/pancreatic cysts Colonic diverticula/hernia
What are the associated abnormalities of hydronephrosis?
Renal injury and impairment
What signs of hydronehprosis can be seen on antenatal ultrasound?
Transient, increased. AP diameter
What signs of hydronehprosis can be seen on post-natal ultrasound?
Renal pelvic diameter >10mm
What are the possible causes of hydronephrosis?
Vesicle-ureteric reflux and obstruction of the urinary tract
What is a pelvic/ureteric junction obstruction?
A total of partial blockage of urine at the junction of. the ureter with the kidney
At what point can pelvic-ureteric junction obstruction be diagnosed?
Antenatally
What are the signs/symptoms of pelvic-ureteric junction. obstruction?
Abdominal mass
UTI
Failure to thirve
Abdominal/flank pain
A vesicle-ureter junction obstruction will cause megaureter. How is this defined?
Ureteric dilation >7mm
What is the most common obstructive uropathy?
Posterior urethral valve
How is posterior urethral valve investigated?
Ultrasound
Micturating cystourethrogram
How are posterior urethral valves managed?
Cystoscopy
What complications result from posterior urethral valves?
Hydronephrosis
UTI
What is vesicoureteral reflux?
Retrograde passage of urine from the bladder into the upper urinary tract
How is vesicoureteral reflux diagnosed?
Mictruating cystourethrogram
What grades of vesicourethral reflux need intervention?
Grades 4 and 5
In which sex are UTIs more common?
Females
What is the diagnostic criteria for UTI in children?
Significant bacteriuria >10^5 cooling forming units/ml
and a single pathogenic bacteria
How can urine collection in suspected UTI be done in children?
Clean catch urine collection
Mid-stream sample
Catheter specimen
Supra-pubic aspirate
What bacteria usually causes UTI in children?
E.coli
How does upper tract UTI present in children?
Pyrexia
Vomiting
Systemic upset
Abdominal pain
How does lower tract UTI present in children?
Dysuria
Frequency
Haematuria
Wetting
How can suspected pyelonephritis in children be investigated?
Ultrasound
Microrating cystourethorgram
nuclear medicine
What are the complications of pyelonephritis?
Scarring
Hypertension
End stage renal failure
