Renal_Urinary Tracvcnt Abnormalities.ppt

8/14/2019 Renal_Urinary Tracvcnt Abnormalities.ppt

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Abnormalities of theUrinary Tract

Dr. K A W Karunasekera


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Vesico-Ureteric Reflux

Backflow of urine from bladder to ureters

Reflux - Iry- Most VUR are congenital

- IIry- trauma, neuropathic

bladder

Has a strong familial tendency


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Classification

International classification

I Reflux in to lower ureter

II VR in ureter/s + nodilatation

III With dilatation

IV With gross dilatation

V IRR (urine from renal pelvis

to papillae)


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Effect of VUR on kidney

Direct transmission of organisms

with pressure


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Prognosis

70-80% of all, but severe disappear

Recurrent UTI with VUR causesrenal scarring

Reflux nephropathy


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Management

Medical managementUninterrupted low dose prophylaxis

Regular frequent voidingDouble maturation at bedtime

Liberal fluid intakeRegular bowel habitsFollow up


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Management contd.

Surgical management

Indications:

Recurrent UTI on medicaltherapy

Grade IV & V

Ureteric re-implantation


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Urinary Tract Obstruction

From urethral meatus to calices

Causes:Congenital Trauma

Tumours Stones

Inflammation Post-surgery


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Clinical Presentation

For investigation of UTI and renalimpairment

FTT, diarrhoea, vomiting

Poor stream of urine, incontinence

and dribbling Acute retention


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Common Conditions in

Children

P-U junction obstruction

Posterior urethral valves

Functional obstruction - Neuropathicbladder

Other causes: megaureter,ectopicureter, ureterocele,diverticulum, urethralstricture


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Posterior Urethral Valves

Due to v shaped mucosal folds

in the prostatic urethra in males

Urinary obstruction and dilatation

of the bladder and post.urethra

VUR is associated in 2/3 of cases


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Presentation

Majority present in infancywith UTI, uremia, FTT, poor

stream, dribbling

Incontinence especially daytime

Neonates with palpable bladder

and poor stream Acute retention

Antenatal USS


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Diagnosis & Treatment

MCUG

Surgery- Referral- Iryablation of valves

or

- vesicotomy and latesurgery


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Presentations :

Palpable renal mass

Abdominal / flank or back painHaematuria with minor trauma

UTIRenal failure

Antenatal maternal USS

PUJ Obstruction


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Diagnosis & Treatment

IVU

Surgery


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Other Congenital Abnormalities

of UT Renal agenesis

B/L - incompatible with life

Potter syndrome

Unilateral - compatible with life

Renal dysplasia & hypoplasiaRare, end up in CRF


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Infantile Polycystic Kidney

Autosomal recessive

cysts due to dilated collecting ducts

Majority have liver involvement Presentation : B\L renal lumps

microscopic haematuria

HT& RF Diagnosed by IVU

Treatment: Supportive and renal

transplant


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Adult Polycystic Kidney

A.dominant

Symptoms in 3rd and 4th decades


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Abnormalities contd.

Duplication of renal pelvis & ureter varying degree can occur with or

without other abnormalities

Neuropathic or Neurogenic bladder

due to abnormal or faultyinnervations


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Bladder Neck Obstruction

Causes:

Often congenital

- Spina bifida, cerebral palsy,

sacral agenesis, spinal cord

lesions, sacrococcygeal

tumour


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Neurogenic Bladder

Deterioration of upper urinary tract

Urinary incontinence

Associated VUR present in 50% of

cases


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Types of Neurogenic Bladder

Low pressure bladder:

- Low back pressure

- Bladder is atonic- Sphincters paralyzed

High pressure bladder

- Due to incordination

(sphincter dys-synergia)

- High back pressure +VUR


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Treatment

To decrease back pressure

To decrease infection To achieve continence, if possible


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To reduce back pressure

- Intermittent catheterization

- Increased bladder volume- Sphincterotomy

Infection

- Antibiotic prophylaxis

- Treatment of acute infection

Treatment contd.


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To achieve continence

- repeated catheterization

- urinary diversion- artificial sphincter device

Prognosis :HT & RF are common

Treatment contd.


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Bladder Extrophy

(Ectopia vesicae)

Rare , Bladder protrudes, mucosa is

exposed

Treatment

cover the lesion with a silastic

shield and transfer to the surgical unit

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Renal_Urinary Tracvcnt Abnormalities.ppt