Urinary tract anomalies

Question 1

What mutation causes CAKUT

(congenital anomalies of kidney and urinary tract)

Answer 1

PAX 2 gene mutation

Question 2

What renal anomalies can occur? (4)

Answer 2

Multicystic kidneys

Renal agenesis

Medullary spongy kidney

Horseshoe kidney

Question 3

What non-renal anomalies can occur?

Answer 3

Pelvoureteric junction (PUJ) obstruction (2nd to stenosis, atresia of proximal ureter)

Vesicoureteral reflux (VUR) – in 30% of children presenting with UTIs

Bladder outlet obstruction

Question 4

Antenatal signs and symptoms of CAKUT

Answer 4

Oligohydramnios + decreased foetal urine output

Question 5

What are post natal signs and symptoms of urinary tract anomalies?

Answer 5

• irritability, infections

o Decreased foetal urine output

o Intra- abdominal mass

o Haematuria

o Renal calculi and failure

o HTN

o Hepatosplenomegaly

Question 6

What is Potter sequence?

Answer 6

Fetal compression in womb due to oligohydramnios

causes abnormal CAKUT sx

Question 7

How to investigate urinary symptoms in neonate?

Answer 7

USS

DMSA scan: scarring, renal agenesis, duplex system

MCUG scan: vesico ureteric reflux or posterior utheral valve (only under 6m)

Question 8

What is vesico-ureteric reflux?

Answer 8

30% of children with UTIs will have this

• Ureter enters bladder perpendicularly, so urine doesnt enter bladder right and can get backed up = hydronephrosis