T2 L21: children with renal abnormalities Flashcards
describe the process of how unilateral kidney abnormalities start ?
the kidneys in the embryo- Metanephric Blastema - becomes attached to the abnormal ureteric bud-resulting in a blind ureter
what is the Mayer-Rokitansky syndrome:
1 Kidney- Unilateral
Abnormalities of the vagina (agenesis), uterus, fallopian tubes associated most commonly with an absent kidney
look at slide 5 for the fusion of the kidneys an google horse shaped kidneys
How was it ?
what are the signs of a UTI and how can we get samples in young children
signs:
- PYURIA
- URINE CULTURE
-DIFFICULTIES IN
OBTAINING MSU
Sampling procedures:
- SUPRAPUBIC ASPIRATION-(Suprapubic aspirate is the gold standard for obtaining urine specimens for culture in children under 2 years. )
- DIPSTIX FOR NITRITES
what is VUR
-COMMONEST “SURGICAL” CAUSE OF UTI
-MAY BE DIAGNOSED AFTER UTI
-ANTENATAL DIAGNOSIS
-SECONDARY REFLUX WHEN ASSOCIATED WITH OTHER ABNORMALITIES
How is VUR caused ?
Ureter doesn’t join the bladder at right angles
When urethra is shorter the valvular mechanism doesn’t work, so urine can reflux
Any microbes can multiply as there is more urine in the bladder, less is emptied
How are the grades of VUR established
Grade 1-5 ureters : dilation due to reflux
If infection is well established renal tissue destroyed and scars in the tissue occur
(look at slide 10)
what is a DMSA scan
DMSA Kidney Scan. A DMSA kidney scan is a nuclear medicine test of the kidneys. It can be used to detect any damaged areas of the kidneys, for example as a result of repeated urinary tract infections. It is also able to see whether both kidneys are working equally well.
what does DMSA detect and how does this relate to high blood pressure
2nd pic is an isotope scan that shows damage done to the kidneys
High blood pressure results because if there are parts of the kidney that doesn’t work but is still perfused there is excess renin released creating high bp
(look at slide 11)
how do you manage VUR
MOSTLY NON-OPERATIVE
MANY WILL STOP REFLUXING AFTER ABOUT THE AGE OF 5 YEARS
UROPROPHYLAXIS
GOOD FOLLOW UP
what is hydronephrosis
look at slide 16, is the swelling of a kidney due to a build-up of urine. It happens when urine cannot drain out from the kidney to the bladder from a blockage or obstruction. Hydronephrosis can occur in one or both kidneys.
describe the aetiology of a UTI and how you investigate it and treat it
- INFECTION NOT VERY COMMON
- UTI MAY RESULT IN PYONEPHROSIS - DESTROY KIDNEY
- MAY BE DIAGNOSED ANTENATALLY
-INVESTIGATION - ULTRASOUND
NUCLEAR SCAN - (MCU)
-UROPROPHYLAXIS & ureteric stents for any blockage
aetiology of Mega-Ureters
-NOT AS COMMON AS PUJ (pelvic ureteric junction obstruction’. … The renal pelvis is where the urine collects, to then drain down the ureter into the bladder. Sometimes the connection between the renal pelvis and the ureter is too narrow)
–MAY BE ASSOCIATED WITH OTHER PROBLEMS LIKE DUPLEX SYSTEM
- ASSOCIATED URTEROCELES
- RARELY SIMPLE STENOSIS
-HAS TO BE DIFFERENTIATED FROM V-U REFLUX
what is duplex kidney
Children with a duplex kidney (also called a duplicated collecting system) have two ureters coming from a single kidney. … Duplex kidneys can occur in one or both kidneys.
Having a duplex kidney is not always bad. In fact, some people never know they have it. However, it can cause problems. One example is a condition known as vesicoureteral reflux, in which urine in the bladder flows back into the ureter and can reach the kidneys
look at slides 21-24 for mri scans of diseases
how was it
