Small parts Neonatal & Ped Adrenal and Urinary System - Ch 26

What age does renal lobulation disappear?

by 6 years old

What do neonate kidneys look like

Large pyramids, thin rim of cortex, increased cortical echos until 1 month of age

what side to side kidney length should be monitored

>1 cm

at what age do infant adrenal glands look like adult adrenals?

1 year

where are adrenal glands?

superior to upper pole of kidney, left extends more medial than right, V or Y shape in long, central medulla is a thin echogenic stripe

what size should normal Neonate bladder wall measure

distended s/b < 3 mm, 1.5 mean; empty s/b <5 mm

what is unique about pediatric bladder wall measurements

it can be taken from posterior wall due to excessive ring-down artifact and prominent urachal remnant

what is most common cause of palpable mass in neonate?

UTD (urinary tract dilation)/hyronephrosis

what is most common cause of abdominal mass in newborn

MCDK multicystic displastic kidney

what is most common urinary tract anomoly?

UTD/hydronephrosis

what is most common CONGENITAL URETERAL anomaly?

duplex collecting system/double kidney - considered a normal variant

what are most common causes of UTD/hydronephrosis

obstruction, reflux, abnormal muscle development

what is normal renal pelvis dilation

up to 10 mm a/p

what is a common nonobstructive cause of UTD/hydro?

Vesicoureteral reflux (VUR) , usually resolves in 2 years

what is VUR

abnormal refluxing of urine from bladder through ureters back into kidney

sono of VUR

wall thickening, dilation of collecting system, megaureter, diplaced jet

what is most common type of obstruction causing UTD/hydro

ureteropelvic junction obstruction (UPJ)

what causes UPJ obstruction

from intrinsic narrowing or extrinsic vascular compression at UPJ

sono of UPJ obstruction

pelvocallectasis (dilation of renal pelvis and calyces) WITHOUT ureteral dilation (may cause extrarenal pelvis)

UPJ more common in men or women

men 3:1

what are intense specular echoes at corticomedullary junction

arcuate vessels

which kidney is typically longer

left

what is one of the most common causes of ureterocele in children

duplex collecting system

what does an ectopic ureterocele look like sono

fluid mass within bladder, dilated upper pole

are duplex collecting systems more common in men or women?

women - on Left

what is usual cause for bilateral hydro

bladder outlet obstruction

sono of bladder outlet obstruction

possible perirenal urinoma

most common cause of bladder obstruction in men

PUV post urethral valve obstruction

What is PUV caused by?

Excessive flaps of tissue in posterior urethra

less common female version of PUV

urethral atresia (blockage)

what is sono of PUV/urethral atresia

keyhole appearance of bladder

what is prune belly syndrome

congenital - deficient ab muscles

what is another name for prune belly syndrome

Eagle Berrett Syndrome

Does prune belly syndrom affect men or women more

96% men

what is the triad of clinical findings in prune belly syndrome

deficient ab muscles, bi lateral cryptochrodism, urinary tract anomolies

what is most common cause of renal cystic disease in neonate WITHOUT hydro

MCDK multi cystic dysplastic kidney

sono of MCDK

unilateral grapelike cysts, cannot see kidney, congenital, sporadic

what is MCDK

development abnormality - renal dysplasia caused by interference w/ureteral bud function in 1st trimester. malformation from ureteral obstruction

what is most common HEREDITARY renal cystic disease

PCKD polycystic kidney disease

What is included in hereditary renal cystic disease

ARPKD autosomal recessive polycystic kidney disease, ADPKD autosomal recessive dominant polycystic kidney disease (adult), tuberous sclerosus, von Hippel-Lindau disease, medulary cystic disease

sono of ARPKD

enlarged, hyperechoic, hypo rim representing cortex compressed by expanding pyramids (sponge like)

what is potter fascies (facial features due to oligohydrominos) and pulmonary hyperplasia associated with

ARPKD

what age is ADPKD (adult dominant form of PCKD)

30-50

what patho is associated with ADPKD

cerebral berry aneurisms, increase in RCC

what is most common bacterial infection in children and most common nosocomial infection

UTI

sono of UTI

no flow in affected area of kidney

what does chronic pyelonephritis cause

scarring, small, coretx more echos than liver

where are calcifications of nephrocalcinosis often found

medulla, not cortex

causes of nephrocalcinosis

long term heart and lung treatment, medullary spong kidney (Cacchi-Ricci), Barter syndrome (electrolyte issues)

what is MSK - medullary sponge kidney

birth defect of tubules, cysts in medulla block urine flow

what causes renal vein thrombosis

dehydrated or septic infnats, DM

clinical of RVT

hematurea, proteinuria, decreased platelets

sono of RVT

enlarged K, intrarenal vasc calcs, coexisting adrenal hemorrhage

causes of adrenal hemorrhage

diff deliver, hypoxia, DM

sono of adrenal hemorrhage

ovoid enlargement, Will shrink overtime

clinical of adrenal hemorrhage

mass, jaundice, anemia

most common intraabdominal MALIGNANT renal tumor

nephroblastoma/Wilm’s tumor

peak age of nephroblastoma

2-5 YO

Sono of Wilma tumor/ nephroblastim

Bulky solid mass that distorts renal architecture

predisposing factors of nephroblastoma/Wilm’s tumor

hepatoblastoma, beckwith-wiedmann syndrome

most common BENIGN solid renal tumor of neonate

congenital mesoblastic nephroma - very rare - looks like Wilm’s tumor/nephroblastoma

peak age of congential mesoblastic nephroma

<1 year

what is most common malignancy <1 year and most common ab tumore between 2 mo - 5 years?

neuroblastoma

how will kidney displace with neuroblastoma

inferior (arises from adrenal) (maybe laterally too)

sono of neuroblastoma

highly echogenic, poss calcs, poorly defined, heterogenous

what is hypospadias

genital malformation of abnormal urethra opening along ventral aspect of penis

what is Hermaphrodites

ambiguous genitalia, both ovaries and testes

what is Guevedoces

born male, looks femal, grows penis @ puberty, lacks testosterone enzyme