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12. UroPed (1583) > 1 - pediatric abnormalities > Flashcards

1 - pediatric abnormalities Flashcards

1
Q

most common cause of prenatal hydronephrosis

A

transient (50-70%)

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2
Q

most common pathologic cause of prenatal hydro

A

UPJO (10-30%)

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3
Q

% with upjo presenting bilaterally

A

10%

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4
Q

most common side for UPJO

A

left > right

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5
Q

muscle fiber type involved in intrinsic UPJO

A

CIRCULAR muscle fibers at UPJ

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6
Q

how does secondary UPJO due to reflux happen

A

severe VUR may cause totuous ureter and kinking at UPJ

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7
Q

mgmt of 2ndary UPJO

A

fix UPJO before reflux

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8
Q

how does mag 3 work in the kidney

A

tubular secretion

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9
Q

how does DTPA work in kidney

A

glomerular filtration

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10
Q

how does DMSA work in kidney

A

proximal tubular binding

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11
Q

purpose of mag 3

A

function and drainage, same as MAG 3

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12
Q

stent effect on urine leak after pyeloplasty

A

reduces leakage

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13
Q

endoscopic management for pyeloplasty failure in kids?

A

not used very often

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14
Q

pro and con of nuclear cystogram in kids

A

less radiation, poor anatomy

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15
Q

3 indications for surgical correction of VUR

A
  1. poor compliance with prophylaxis, 2. breakthrough pyelo on prophylaxis, 3. parental decision
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16
Q

ratio of ureter to tunnel for reimplant

A

5:01

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17
Q

success rate of reimplant

A

98%

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18
Q

overall success rate of deflux

A

72%

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19
Q

2 things that predict improved outcomes in deflux

A

low grade, multiple injections

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20
Q

post-procedure VCUG for deflux vs reimplant

A

needed for deflux, not reimplant

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21
Q

definition of megaureter

A

> 7 mm

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22
Q

2 major classifications of megaureter

A

obstructed or refluxing

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23
Q

when to observe obstructed megaureter

A

normally functioning kidney

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24
Q

megaureter vs refluxing ureter - quality

A

megaureter&raquo_space; refluxing

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25
Q

4 indications for megaureter surgery

A
  1. uti, 2. pain, 3. stones, 4. progression
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26
Q

pathophysiology of obstructed megaureter

A

aperistaltic DISTAL segment of ureter

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27
Q

what makes distal ureter aeristaltic in megaureter

A

circular fibers on only

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28
Q

3 steps in mgmt of refluxing megaureter

A
  1. prophylaxis during observation (1yr), 2. observation for 1st yr, 3. surgery
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29
Q

what kindof megaureter gets cutaneous ureterostomy

A

refluxing with recurrent pyelo

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30
Q

how to taper megaureter

A

excision of lateral wall to preserve medial blood supply

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31
Q

what ureter gets taper vs tailor

A

taper for ureter > 1.5 cm

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32
Q

mgmt of moderate VUR after megaureter surgery

A
  1. r/o bladder problem, 2. consider surgical correction (deflux vs re-reimplant)
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33
Q

2 major complications of megaureter surgery

A
  1. obstruction, 2. VUR
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34
Q

2 causes of obstruciton after megaureter surgery

A
  1. edema, 2. ischemia
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35
Q

mgmt of obstruction after megaureter surgery - 2

A
  1. postop edema - transient and resolves w/in 8 wks. may need stent, 2. related to ischemia of ureter - resect ischemic ureter and reimplant
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36
Q

mgmt of VUR after megaureter surg

A

r/o bladder dysfunction, consider surgical repair - deflux vs reimplant

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37
Q

6 genetic causes of renal cystic disease

A
  1. ARPKD, 2. ADPKD, 3. medullary cystic disease, 4. congenital nephrosis, 5. familial hypoplastic glomerulocystic disease, 6. multiple malformation syndromes (VHL, TS, ect)
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38
Q

7 non-genetic cuses of renal cystic disease

A
  1. MCDK, 2. benign multilocular cyst (cystic nephroma), 3. simple cyst, 4. medullary sponge kidney, 5. acquired renal cystic disease, 6. sporadic glomerulocystic kidney disease, 7. calyceal diverticulum
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39
Q

ADPKD vs ARPKD - liver

A

AD - liver cysts later in life, AR - liver fibrosis

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40
Q

ADPKD vs ARPKD - RCC

A

no increased incidence

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41
Q

ADPKD vs ARPKD - aneurism

A

ADPKD only - berry aneurism 10-30%

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42
Q

ARPKD and development

A

oligohydramnios common, pulmonary hypoplasia –> incompatible with life

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43
Q

2 contralateral findings in MCDK

A
  1. UPJO (3-12%), 2. VUR (30%)
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44
Q

natural history of MCDK

A

invoute, no assn with HTN

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45
Q

histology of MCDK

A

heterogenious non-communicating cysts

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46
Q

most common type of posterior urethral valves

A

type 1

47
Q

% with VUR at time of PUV dx

A

50-70%

48
Q

outcome of VUR after PUV ablation

A

30% resolve

49
Q

findings with PUV in utero

A

bilateral hydro and bladder distention

50
Q

fetal urine sampling significance

A

hypertonic urine is poor prognosis

51
Q

ascites in PUV due to

A

40% due to urologic condition

52
Q

nadir serum creatinine predicting ESRD in newborn

A

> 1

53
Q

4 predictos of poor renal function

A
  1. renal dysplasia on us, 2. presentation < 1 yo, 3. bilateral VUR, 4. nadir cr > 1.0 in 1st yr of life
54
Q

where on valves is ablation done

A

at 5 and 7 oclock

55
Q

result of complete valve ablation

A

high risk of urethral and sphincter injuries with complete resection

56
Q

3 major findings in VCUG of kid with PUV

A
  1. trabeculated bladder, 2. hypertrophied bladder neck, 3. dilated and elongated posterior urethra
57
Q

when to remove dysplastic kidney with high grade VUR inpt with PUV

A

only if recurrent infection. if no infection, leave it alone

58
Q

if PUV ablation cant be done because urethra is too small

A

temporary vesicostomy

59
Q

what does VURD stand for

A

valves, unilateral reflux, renal dysplasia

60
Q

significance of VURD

A

reflux happens into dysplastic kidney functioning as pop-off valve and protecting other kidney

61
Q

common bladder problem after PUV ablation

A

persistent VUR

62
Q

mgmt of persistent VUR after PUV ablation

A

make sure bladder function is nl, otherwise make sure bladder is rehabilitated before re-implanting

63
Q

non-refluxing hydronephrosis in PUV after ablation

A

1/2 resolve after ablation, if persistent make sure bladder ok

64
Q

3 outcomes of PUV bladder

A
  1. decreased compliance/small capacity, 2. DO, 3. myogenic failure
65
Q

3 outcomes of PUV bladder and age of presentation

A
  1. decreased compliance/small capacity (infants), 2. DO (older kids), 3. myogenic failure (post pubertal)
66
Q

3 outcomes of PUV bladder and mgmt

A
  1. decreased compliance/small capacity (anticholinergics) 2. DO (anticholinergics), 3. myogenic failure (double void, alpha blockers, +/-CIC)
67
Q

3 predictors of poor outcome in PUV

A
  1. nadir cr > 1 at 1 yo 2. renal dysplasia, 3. younger age at presentation
68
Q

transplant outcome in PUV depends on

A

good bladder function

69
Q

how is renal function maximized in PUV

A

good bladder control

70
Q

what is weigert myer rule

A

upper pole oriface is caudal to lower pole oriface

71
Q

reflux and obstruction in duplication

A

upper pole obstruction, lower pole reflux

72
Q

most common location of insertion in males for ectopic ureter

A

posterior urethra

73
Q

most common location of insertion in females for ectopic ureter

A

bladder neck –> incontinence if below sphincter

74
Q

cause of ureterocele

A

failure of chwalla membrane to rupture in distal ureter

75
Q

% ureterocele with reflux - ipsilateral/ contralateral

A

70% / 10%

76
Q

vcug finding suggestive of duplication

A

drooping lilly of lower pole kidney

77
Q

3 goals in treatment of duplication

A
  1. preserve renal function, 2. prevent uti 3. maintain continence
78
Q

ureterocele mgmt if sepsis

A

incise asap

79
Q

ureterocele mgmt if it extends down bladder neck

A

incise below bladder neck to prevent flap-valve

80
Q

ureterocele caveat with family

A

let family know all mgmt options may require additional future surgery

81
Q

ectopic ureter - 3 mgmt options

A
  1. UU or pyeloureterostomy, 2. upper pole hemi-nx, 3. common sheath reimplant
82
Q

when to do UU/PU in ectopic ureter

A

when there is no ipsilateral reflux

83
Q

when to do upper pole heminx in ectopic ureter

A

no upper pole function

84
Q

when to do common sheath reimplant in ectopic ureter

A

if ipsilateral or contralateral reflux is present

85
Q

prune belly syndrome aka

A

eagle-barrett

86
Q

triad of prune belly

A
  1. bilateral hydro, 2. bilateral intra-abdominal cryptorchidism, 3. abdominal wall laxity
87
Q

4 associated urologic findings in prune belly

A
  1. renal dysplasia (50%), 2. large bladder +/- urachal diverticulum, 3. dilated posterior urethra (from prostatic hypoplasia not valves), 4. megalourethra
88
Q

biggest urologic problem in PBS

A

urine stasis

89
Q

early orchiopexy in PBS?

A

by 6 mo

90
Q

what is megacystis-megaureter

A

huge bladder with megaureter only, no other physical findings

91
Q

mgmt of megacystis-megaureter

A

reimplant

92
Q

where in the kidney does scarring usually happen after pyelo

A

polar regions of kidney

93
Q

fetal ureter bud forms when

A

5th wk

94
Q

when can fetal kidneys be visualixed

A

12-13 wk

95
Q

when can fetal bladder be seen

A

14th wk

96
Q

when is amniotic fluid volume dependent on kidneys

A

16th wk

97
Q

what diameter (mm) is fetal hydro mild, moderate, severe

A

mild 7-9mm, moderate 9- 15 mm, severe > 15 mm

98
Q

what makes hydro more likely to be pathological - 5

A
  1. calyceal dilation, 2. ureteral dilation, 3. chromosomal abnormalities, 4. multiple malformations, 5. oligohydramios
99
Q

% of the time is hydro transient

A

40-80%

100
Q

elevated urine N-acetyl-β-D-glucosaminidase found in what condition

A

obstructed kidney

101
Q

elevated urine TGF-β1 found in what condition

A

unilateral UPJO

102
Q

hypothesized etiology of posterior urethral valve

A

terminal ends of wolfian ducts mismigrate and are integrated into urethral wall abnormally resulting in obliquely oriented ridges that act as one way alves

103
Q

who gets admitted for pyelo for iv abx

A
  1. pyelo in infants and “young kids”, 2. renal abscess, 3. urosepsis
104
Q

when does a UTI always get admitted for IV abx

A

always in infants < 1 mo old

105
Q

when not to give bactrim or nitrofurantoin

A

bactrim < 2 mo, nitrofurantoin < 1 mo

106
Q

options for antibiotic prophylaxis - 4

A
  1. nitrofurantoin, 2. bactrim, 3. keflex, 4. amoxicillin
107
Q

risk of VUR if parent, sibling, twin have it

A

parent 50%, sibling 50%, twin 80%

108
Q

spontaneous resolution rate for grade 1 VUR

A

90%

109
Q

spontaneous resolution rate for grade 2 VUR

A

60-80%

110
Q

spontaneous resolution rate for grade 3 VUR

A

50%

111
Q

spontaneous resolution rate for grade 4 VUR

A

25-40%

112
Q

spontaneous resolution rate for grade 5 VUR

A

<20%

113
Q

before observing grade 1-2 VUR without abx, need to confirm what

A

normal bladder/bowel function

114
Q

most common renal function abnormality associated with PUV

A

urine concentration defect

12. UroPed (1583) (13 decks)

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