Professional Documents
Culture Documents
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Learning Objectives
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Congenital abnormalities of
kidney
Uncommon ( <1:1000)
Commonly Symptomless found incidentally
US,IVU, CT. Why ????
sometimes detected only when have caused
sufficient damage
Endanger kidneys to various complications
Bilateral fatal
Unilateral compatable
with normal life,
contralateral kidney
hypertrophed
Failure of mesonephric
duct to bud
Ureteric orifice absent on
cystoscopy
Rarely ureters & pelvis
may be present but renal
tissue is absent or so
Infecti
Have some element of on
obstruction causing Stone,
Renal
inadequate drainage failure
leading to infection &
stone formation
30-march, 2010, tuesday 12
low lying ascent impeded by
inferior mesenteric artery Horse shoe kidney
Infec
tion
Stone,
Pain, hematuria, fever,
Renal
mass failure
Treatment
Asymptomatic = nothing doing
Mild sypmtoms = treat accordingly
PUJ or ureteric obstruction, recurrent infections,
Stones surgery (pyelolithotomy + /-
reconstruction) ISTHEMECTOMY
with straightening of ureters less commonly
done.
Nonspecific symptoms:
anorexia, headache, vague
abdominal discomfort,
vomiting, drowsiness,
anemia.
US and CT:
cysts in kidneys,liver & others
Simple (aquired) cysts: solitary, smooth walled &
homogeneous contants
Blood & debris cystic adenocarcinoma
FNA- cytology differentiates
IVU
Enlarged renal shadow,
Renal pelvis compressed & elongated
Calyces narrow, stretched over cysts ( spider legs /
bell shaped)
Nephrologist :
BP control, infection,anemia, disturbances of Ca
metabolism, low protein diet to delay need for
DIALYSIS
Urologist:
Surgical / laproscopic deroofing of cysts ( Rovsings
operation)
Relieves pain & pressure saving kidneys
Rarely performed / not preserve function
Renal transplant/ pretransplant bilateral native
kidneys nephrectomy
Rare
Inheritance- autosomal recessive
Enlarged kidneys may obstruct labour,
Many stillborn
Die of renal failure in in early childhood
Asymptomatic no treatnment
Aseptic
dilatation of
pelvicaliceal
system due to
complete or
partial
obstruction.
Unilateral
hydronephrosis
Epsilateral ureteric
obstruction
( unilateral
supravesical
obstruction)
30-march, 2010, tuesday 50
30-march, 2010, tuesday 51
Hydronephrosis:
Bilateral
Bilateral ureteric obstruction (
bilateral supravesical
obstruction)
Urethral obstruction (
bladder outlet obstruction,
infravesical obstruction )
Detrusor hypertrophy
intramural ureteric
obstruction
VUR
Pregnancy physiologic
dilatation - progesterone,
early pregnancy 20 weeks
marked reverts 12 week
of delivery
Infection, diagnostic
difficulty in acute abdominal
pain in pregnancy
30-march, 2010, tuesday 52
Causes of Ureteric Obstruction
Extramural
Tumors of cervix, ovary, uterous, vagina, urinary bladder, prostate, rectum,
colon, caecum & lymphomas
Idiopathic retroperitoneal fibrosis
Retrocaval ureter
Pararenal cysts
Aberent vessels
Intraluminal
Calculus, sloughed papilla, clot, ureteric malignancy
Intramural
Congenital PUJ obstruction or stenosis
Ureterocele and congenital small ureteric orifice
Strictures ( stone, repair, tuberculosis, schistosomiasis)
Ureteric / vecsical malignanncy
Kenks & adhesions ( sec to VUR)