Peds urinary/renal

enuresis

diuresis

-involuntary urination especially at night (by kids)

-increased/excessive production of urine

most common reason for peds renal scan?

UTI (urinary tract infection)

normal kidney appearance

symmetric anechoic, prominent pyramids

small amount of sinus echogenicity

pelvis <10 mm (should not see the wall = reflux)

resitive index

normal <.7

neonates can have a little higher until 6 weeks

helpful in determining if dilated system is obstructed

junctional parenchymal defect

variant from incomplete embryonic fusion

hyperechoic, triangle shape cortical defect w/sinus tract

usually in superior pole

bilateral agenesis

associated w/oligohydramnios

no bladder

renal agenesis

associated w/Potter Syndrome

-usually stillborn

hydronephrosis

most common cause of abdominal mass palpated in neonate

US: anechoic, communicating cysts or uniform size connecting to renal pelvs

exam needs to be performed between day 4-7

UPJ hydronephrosis

most common cause of congenital hydronephrosis

proximal obstruction at renal pelvis & ureter

pelvis & calyces dilated

UVJ hydronephrosis

next most common cause of cong. hydro

distal ureter obstruction at site where it inserts into bladder

what’s the most common cause of abdominal mass in neonate?

hydronephrosis

what’s the most common cause of congenital hydronephrosis?

UPJ obstruction

reflux

backflow from bladder back up into kidney

can mimic obstructed ureter

hard to dx by US

signs of reflex w/uroepithelial thickening

cystourethrography is gold standard

ureterocele & ectopic ureter

both assoiciated w/duplicated collecting system

ureterocele- round, thin-walled fluid filled mass at end of ureter in posterior aspect of bladder

ectopic ureter- extends below bladder

urethral/bladder outlet obstruction

due to posterior urethral valves

only in males

hydro is usually bilateral

bladder wall is thick

keyhole bladder sign

Prune Belly/Eagle-Barrett Syndrome

rare congenital disorder or urinary system

rare cause of hydro

triad: absent abdominal musculature, urinary tract dilation, & cryptorchidism, (absence of testes)

mostly affects males

multicystic dysplastic kidney

second most common cause of renal mass

need to make sure cysts are NOT communicating (otherwise it’s hydro)

contralateral UPJ obstruction common

autosomal recessive polycystic kidney disease (ARPKD)

usually presents in newborn

cysts result from tubular dilation & are microscopic

on US, actually cause pyramids or medulla to reflect multiple bright echoes (hyperechoic instead of anechoic/cystic)

large & diffusely echogenic at birth

hepatic fibrosis often associated

bilateral

medullary cystic disease

metabolic dysfunction

2 types:

medullary sponge kidney (rarely seen)- echogenic pyramids from calcium deposits

renal collecting tubular ectasia

renal cysts

simple cysts are rare in children (<1%)

inflammatory cysts from tuberous sclerosis do occur

Wilms tumor

most common malignant renal tumor in peds

most common solid abdominal tumor follow by neuroblastoma

palpable, hematuria/hypertension, 3-4 years old, may be bilateral

large, well-circumscribed, smooth, homogenous

has 4 stages based on severity of mass

nephroblastomatosis

abnormal tissue growth on kidney

precursor of Wilms & can be confused with it

found in 25% pts w/Wilms & 100% on pts w/bilateral Wilms

mesoblastic nephroma

most common abdominal neoplasm seen in neonates

sometimes dx prenatally

younger than 3 months

resembles Wilms tumor

angiomyolipoma

benign, focal formation in tissue

associated w/tuberous sclerosis

located w/in renal cortex

homogenous, hyperechoic, usuallt bilateral, increased risk of RCC

renal cell carcinoma (RCC)

rarely in kids but highly malignant

isoechoic or slightly hypo

lymphoma

rare malignant renal tumor

kidneys are most frequent spot for mets from lymphoma

nephrocalcinosis

deposit of calcium in kidney

looks exactly like medullary sponge, need labs to dx

renal trauma

unusual but may be related to birth

cause of flank pain more often adrenal hemorrhage

CT is modality of choice

urachus

tubular structure continuous w/anterior dome of bladder

goes away at or near birth

occasionally can persist

urachal cyst

may present as palpable mass but more often present as infection symptoms

masses are continuous w/bladder & can be complex or simple

rhabdomyosarcoma

bladder tumor

pt presents w: hematuria, dysuria, urine retention, UTI

US: homogenous, immovable in bladder

cystitis

most common UTU in kids

more common in girls

bladder wall may be thickened >3mm (full) & 5mm (empty)

adrenal glands

neonatal adrenals are proportionally larger than adult glands (1/3 size of kidney)

w/agenesis, they can flatten & look like kidneys

2 parts: medulla (thin, echogenic central) & cortex (thick, anechoic area)

2 layers of cortex: thick fetal zone & thin peripheral zone

neuroblastoma

most common adrenal tumor in infancy

occurs in first year of life

usually has calcifications

rare adrenal tumors

congenital adrenocortical carcinoma

pheochromocytomas

adrenal metastasis

adrenal hemorrhage

results from prematurity, birth trauma, hypoxia

neonatal adrenal glands susceptible bc their large sized & high vascularity

US appearance varies depending on stage

congenital adrenal hyperplasia (CAH)

inborn error of metabolism

autosomal recessive trait

diagnosed by increased adrenal size on US