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Flashcards in Urology Deck (71)
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1

Definition of unresolved congenital hydronephrosis based on 3rd trimester antenatal ultrasound

>= 7mm

2

What could a single umbilical artery signify re: the kidney?

Unilateral renal agenesis

3

Incidence of unilateral renal agenesis

approx 1/750

4

Potter syndrome

Bilateral renal agenesis
Incompatible with life
Pulmonary hypoplasia
Potter facies (widely set eyes, low set ears, broad/flat nose)
Limb anomalies

5

What is multicystic dysplastic kidney

Usually unilateral, NOT inherited condition causing replacement of the kidney by cysts

May be due to ureteral atresia

Most common cause of abdominal mass in the newborn!

6

What is the most common cause of an abdominal mass in the newborn?

Multicystic dysplastic kidney

7

Risks associated with multicystic dysplastic kidney

Hypertension (0.2-1.2%)
Wilms Tumour (1/333)

8

Ask-Upmark kidney

aka segmental hypoplasia

small kidneys with grooves
pts have severe hypertension
(resolves w/ nephrectomy)

9

Anatomic kidney anomalies with increased risk of Wilms

Multicystic dysplastic kidney
Horseshoe kidney

10

Complication of horseshoe kidney

Wilms tumour
stone disease
hydronephrosis (due to UPJ obstruction)

11

Things that predispose to urinary reflux

kidney duplication (with an extra ureter inserting into bladder on one side)

ureterocele (cyst of the intramural portion of the distal ureter)

ureter diverticulum

neuropathic bladder (in myelomeningocele, sacral agenesis)

posterior urethral valves

renal agenesis, MCDK (predisposes to reflux on the contralateral side)

constipation

12

Reflux is more likely to resolve if....

lower grade
unilateral
younger age at diagnosis

13

AAP recommends to treat what grade of VUR?

Grade IV + V

14

Diagnosis of UTI

Urinanalysis demonstrating pyuria and culture growing > 50,000 CFU/mL (from a cath/suprapubic aspirate)

15

When do you do a VCUG?

VCUG is indicated if U/S shows hydronephrosis,
scarring, or other findings suggestive of high-grade VUR or obstructive
uropathy, and in other atypical or complex
clinical circumstances

16

Is there a role for antimicrobial prophylaxis if you are concerned about VUR?

No. The evidence does not support that antimicrobial prophylaxis prevents renal scarring or UTI

17

How should you counsel parents of a child with VUR?

Prompt assessment when febrile (within 48 hrs) is important - early treatment is key in preventing renal scarring!

18

Complications of VUR

UTI
hypertension
CKD

19

How can you manage severe VUR with frequent UTIs?

Can try prophylaxis (Not recommended though - septra or nitrofurantoin)

Deflux injections into ureter

Reimplantation of ureter

20

symptoms of obstructive renal insufficiency

non-specific!
nausea, vomiting
mild abdo pain
diarrhea
poor urine stream

21

walnut-sized palpable mass just above the pubic symphysis in a newborn boy

posterior urethral valves

22

palpable abdominal mass in newborn

most likely multicystic dysplastic kidney

(could also be hydronephrosis)

23

AP diameter grading system for hydronephrosis

mild = 6-9mm

moderate = 9-15mm

severe = > 15 mm

24

For what degree of antenatal hydronephrosis would you perform a post-natal RBUS?

>= 10mm in the 3rd trimester

25

When should do you an urgent post-natal ultrasound?

If severe bilateral hydronephrosis
OR
if severe single kidney hydronephrosis

26

When should you start a baby with antenatally detected hydronephrosis on prophylactic antibiotics after birth?

when RPD > 10mm in 3rd trimester
OR
SFU grade IV

27

When does a baby require a post-natal VCUG?

If postnatal U/S shows persistent hydronephrosis RPD >10mm

28

If the post-natal VCUG does not show reflux, then what do you do?

If RPD 10-15mm, stop antibiotics and repeat U/S at 3 mos & 1 yr

If RPD > 15mm, do diuretic scan to look for obstruction

29

Gene/protein affected in autosomal recessive polycystic kidney disease

PKHD1, which encodes fibrocystin

30

What other organ is involved/affected in AR PCKD?

the liver - can cause bile duct proliferation and fibrosis

(indistinguishable from congenital hepatic fibrosis)