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Urogenital Anomalies > Renal > Flashcards

Renal Flashcards

1
Q

Mechanism for the etiology of renal agenesis?

A

Lack/failur of the ureteric bud to interact with the metaneprhic blastema

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2
Q

In bilateral renal agenesis, what are some key findings one sees?

A

Potter facies, oligohydramnios (from no urine output), pulmonary hypoplasia.

Infants are stillborn or die shortly after birth.

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3
Q

What effect does renal agenesis have on the adrenals?

A

NONE.

Different embryology

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4
Q

What test can be done to check on appropriate fetal lung maturity?

A

Lecithin-sphingomyelin ratio (pulmonary surfactants). Lecithin is main component in mature lungs.

Normal ratio is > 2

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5
Q

What is the indication for getting prenatal ultrasound?

A

First degree relative (parents, siblings, childrent) with congenital solitary kidneys or infants with bilateral renal agenesis

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6
Q

What are 3 etiologies of unilateral renal agenesis?

A
  1. Congenital agenesis (embryo-defect; ureteric bud malformation and RET mutations)
  2. Involution of dysplastic kidney
  3. Multicystic dysplastic kidney.
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7
Q

How is the colon positioned vs normal in unilateral renal agenesis? Dysplastic kidney?

A

In renal agenesis, the colon will be malpositioned into the renal fossa. In dysplastic kidney, colon will be in correct spot

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8
Q

Unilateral renal agenesis: more common in males/females? Left or right side?

A

Males:female ~ 2:1; most commonly on the left side

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9
Q

Associated defects in males with unilateral renal agenesis?

A

Absent ipsilateral epididymis, vas deferens, ampulla, seminal vesicle, and ejaculatory duct (messed up mesonephric duct)

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10
Q

Associated defects in females with unilateral renal agenesis?

A

Unicornuate uterus or uteri didelphis (double chambered uterus with 2 cervices; due to bad promesoneprhos fusion), hematocolpos, infertility

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11
Q

What happens to the other kidney in unilateral renal agenesis?

A

Compensatory renal hypertrophy

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12
Q

Those with unilateral renal agenesis are at higher risk of what comorbidities?

A

HTN, renal insufficiency, proteinuria, VUR

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13
Q

Is there indication for VCUG in children with unilateral renal agenesis?

A

YES. 1/3 will have reflux

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14
Q

Etiology of supernumerary kidney?

A

Two distinct metanephric diverticula form two separate ureteric buds or ureteric bud branches and each meets an independent metanephric blastema

May cause a bifid or duplex ureter

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15
Q

What is more common: fused or non-fused crossed renal ectopia?

A

Fused 90% vs non-fused 10%

  • most common is ureteric bud crosses to contralateral blastema, fusing to inferior pole of normal positioned kidney (imagine two kidneys on one side, lower kidney crosses over to other side)
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16
Q

Crossed renal ectopia: Males or females? Left or right?

A

Males > females 2:1; Left > right 2:1

17
Q

Etiology of horseshoe kidney?

A

Metanephrogenic blastema fuse at lower poles, resulting in the inability to ascend superior to the IMA

18
Q

Horshoe kidney: males or females?

A

Males > females 2:1

19
Q

Which gene may be mutated in horseshoe kidney?

A

Sonic hedgehog gene

- involved in renal positioning

20
Q

Associated renal problems and tumors specific to horseshoe kidney?

A

~1/3 have UPJ obstruction with hydronephrosis (high ureteral insertion)

Highly variable blood supply (multiple renal arteries)

Wilm’s tumor (increased incidence)

21
Q

What two genetic syndromes have increased incidence of horseshoe kidney?

A

Edward’s syndrome (trisomy 18; 20%)

Turner’s syndrome (45, XO; 60%)

22
Q

During PCNL on a horseshoe kidney, access should be more medial or lateral?

Are calyces more anterior or posteriorly directed?

A

Medial (closer to vertebrae)

**Calyces are directed posteriorly

23
Q

Associated renal problems with ectopic kidneys?

A

50% have obstruction with hydronephrosis
25% have VUR
25% have malrotation
–**anteriorly directly renal pelvis vs medial

24
Q

A thoracic ectopic kidney tranverses what foramen into the posterior mediastinum during development?

Is the adrenal gland affected?

A

Foramen of Bochdalek

Adrenal gland is in normal spot

25
Q

As kidneys ascend during development, they rotate ____ so that the hilum faces the midline/aorta, and outer concavity faces laterally

A

rotates ventromedially

  • begins with hilum facing posteriorly
26
Q

Difference b/w Type 1 and Type 2 calyceal diverticulum?

A

Type 1: upper or lower pole calyx outpouching

Type 2: Outpouching with thin connection directly to the renal pelvis

27
Q

If the calyceal diverticulum is located posteriorly, what is the preferred approach for diverticular ablation?

A

PCNL

28
Q

If the calyceal diverticulum is located at the anterior superior pole, what is the preferred approach for diverticular ablation?

A

Ureteroscopy

29
Q

If the calyceal diverticulum is located at the anterior mid/lower pole, what is the preferred approach for diverticular ablation?

A

Laparoscopic ablation

30
Q

Common problems seen with calyceal diverticula?

Where in the kidney are they more likely located?

A

UTIs, nephrolithiasis, milk of calcium (calcium crystals without stones), hematuria.
- most commonly are asymptomatic

More common in the superior and mid poles

31
Q

What is megacalycosis?

A

Malformation of renal papillae that results in enlarged and increased number of calyces without evidence of obstruction
- male: female 6:1

32
Q

What is the treatment of megacalycosis?

A

None. No evidence of renal injury in the long term. Important to distinguish it from hydronephrosis to avoid unnecessary procedures.

33
Q

A pt with a solitary kidney has imaging that shows a central tumor between the upper and lower calyces. What is this most likely to be?

What imaging test is best used to differentiate?

A

Hypertrophied column of Bertin, an renal psuedotumor.

DMSA scan will show normal or increased radioisotope uptake

34
Q

A solitary, renal parenchyma bulge is seen laterally and on the left kidney that has a normal variant contour. Most likely diagnosis?

A

Dromedary hump, a renal psuedotumor

Urogenital Anomalies (5 decks)

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