Pediatric Nephrology

Overview

Kidney:

• malignancy

• Hematuria (glomerular)

Ureter:

• ureteropelvic junction obxtruction

• ureterovesicular junction obstruction

• ectopic ureter

• vesiculoretero reflux

Bladder:

• Hematuria (nonglomerular)

Urethra:

• posterior urethral valves

• hypo/epispadius

Hematuria

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Labs

US: Use for hydro or not to see obstruction/reflux

Voiding cystourethrogram (VCUG): catheter + dye, if in ureter = reflex

CT scan:

• trauma: use contrast

• stones: noncontrast

cystoscopy: camera to see where blood is. Intraluminal lesions (bladder hematuria, cancers)

Intravenous pyelogram, IVP: never use

Renal biopsy: almost never use

Urethra Diseases

Posterior Urethra Valves

Pathogenesis

• Redundant tissues cause obstruction like BPH. Babies can't get urine out from day 1. Bladder gets bigger, urine goes back to ureter

Symptoms

• Oligohydramnios in prenatal care from no urine. Diagnosed from hydro on US

• No urine output and distended bladder

• Creatinine maybe normal or high with maternal clearance

Diagnosis

• US: hydro

• VCUG: rule out reflux

• Catheter: massive urine output

Treatment

• Catheter for temporary relief

• Surgery for permanent fix

Hypo/Epi-spadius

Pathogenesis

• Penis created from zipping up top and bottom of vagina and pull out, with urethra in middle. If one zipper moves too fast, urethra end up at different place:

  • Epi: on top, dorsal, pee on face

  • Hypo: bottom, ventral

Symptoms

• Not much of a problem at first because on diapers anyway. Fix with surgery

Treatment

• Never to circumcision, need extra tissue foreskin to rebuild urethra

Ureters

Ureteropelvic junction obstruction

Pathogenesis

• narrow lumen

• normal urine flow at most of life

• increased flow: simulate obstruction

Symptoms

• Normal teenager at first alcohol binge, taking large volume and large diuresis from alcohol

• Colicky abd pain that spontaneously resolves

Diagnosis

• Ultrasound:

  • Ureteropelvic: obstruction at pelvis, big kidney, no hydroureter

  • Ureterovesicular: obstruction at bladder, hydronephrosis and hydroureter

• VCUG: rule out reflux

Treatment

• Stent

• Surgery

Ectopic Ureter

Pathogenesis and Symptoms

• One normal ureter to bladder

• One that implants anywhere

  • Boys: Always implant above external sphincter, asymptomatic

  • Girls: Normal urinary function + constant leaking from planting below vagina/sphincter, never dry

  • Similar to fistula symptoms but in very young population

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Diagnosis

• US: no hydro

• VCUG: no reflux

• Radionucleotide scan: assess renal function

Treatment

• Rurgery: re implant

Vesiculouretero Reflux

Pathogenesis

• retrograde flow

Symptoms

• Recurrent UTI

• Pyelonephritis (usually don't happen in kids unless congenital defect)

Diagnosis

• Prenatal US: hydro

• US: hydro

• VCUG: reflux

Treatment

• moderate: suppressive antiobiotics, kids may grow out of it

• Surgery