Download Free Medical Kidney and Ureters-Agenesis Horseshoe Kidneys Congenital Cysts Megaureter Ectopic Ureter Ureterocele PowerPoint Presentation

Kidney and Ureters-Agenesis Horseshoe Kidneys Congenital Cysts Megaureter Ectopic Ureter Ureterocele PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Kidney and Ureters-Agenesis, Horseshoe kidneys, congenital cysts, Megaureter, Ectopic ureter, Ureterocele” by Dr Amit Gupta.

This medical PowerPoint presentation is about Agenesis, Horseshoe kidneys, congenital cysts, Megaureter, Ectopic ureter, and Ureterocele, all related to congenital anomalies of the kidney and urinary tract.

Tags : Kidney, Ureters, Agenesis, Horseshoe kidneys, congenital cysts, Megaureter, Ectopic ureter, Ureterocele, congenital anomalies of the kidney and urinary tract, Nephrology, Nephrology PowerPoint presentation

Published on : Jun 07, 2023 | Views : 1352 | Downloads : 2

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Slide 1-

Kidney and Ureters : Agenesis, Horseshoe kidneys, congenital cysts, Megaureter, Ectopic ureter, Ureterocele Dr Amit Gupta Associate Professor Dept Of Surgery
Slide 2-

Bilateral Renal Agenesis Bilateral Renal Agenesis was first recognized in 1671 by Wolfstrigel Can occur secondary to a defect of the wolffian duct, ureteric bud, or metanephric blastema Bilateral agenesis occurs in 1 of every 4000 births Male predominance
Slide 3-

40% of the affected infants are stillborn Children who are born alive do not survive beyond 48 hours because of respiratory distress associated with pulmonary hypoplasia The adrenal glands are usually normally positioned Characteristic Potter facies and presence of oligohydramnios are pathognomonic Complete ureteral atresia is observed in slightly more than 50% of affected individuals
Slide 4-

Potter's facial appearance
Slide 5-

Diagnosis The characteristic Potter facies and the presence of oligohydramnios are pathognomonic and should alert for this severe urinary malformation. Amnion nodosum—small white, keratinized nodules found on the surface of the amniotic sac—may also suggest this anomaly Anuria after the first 24 hours without distention of the bladder should suggest renal agenesis
Slide 6-

Diagnosis BRA has been detected in higher proportion in cryptophthalmos or Frazer's syndrome, Klinefelter's syndrome , Kallmann's syndrome, esophageal atresia. Renal ultrasonography confirm the presence or absence of urine within these structures. Absence of uptake of the radionuclide in the renal fossa above background activity confirms the diagnosis of BRA. Umbilical artery catheterization and an aortogram defines the absence of renal arteries and kidneys.
Slide 7-

Unilateral Renal Agenesis There are no tell tale signs (as with BRA) that suggest an absent kidney . Diagnosis not suspected unless careful examination of the external and internal genitalia uncovers an abnormality that is associated with renal agenesis or an imaging study is done. Unilateral agenesis occurs once in 1100 births Males predominate in a ratio of 1.8:1
Slide 8-

More frequent on the left side Ipsilateral ureter is completely absent in about half of the patients Structures derived from the müllerian or wolffian duct are most often anomalous Anomalies of other organ systems involve the cardiovascular (30%), gastrointestinal (25%), and musculoskeletal (14%) systems
Slide 9-

Unilateral renal agenesis to be associated with other urologic abnormalities in 48% of patients Primary vesicoureteral reflux (28%) Obstructive megaureter (11%) Ureteropelvic junction obstruction (3%)
Slide 10-

Diagnosis No specific symptoms heralding an absent kidney The diagnosis should be suspected during a physical examination when the vas deferens or body and tail of the epididymis is missing or hypoplastic vagina is associated with a unicornuate or bicornuate uterus Radionuclide imaging No clear-cut evidence that patients with a solitary kidney have an increased susceptibility to other diseases
Slide 11-

Most common of all renal fusion anomalies Occurs in 0.25% of the population fusion occurs before the kidneys have rotated on their long axis Horseshoe kidneys
Slide 12-

The lower poles of the two kidneys touch and fuse as they cross the iliac arteries
Slide 13-

In 95% of patients, the kidneys join at the lower pole; in a small number, an isthmus connects both upper poles instead Calyces normal in number, are atypical in orientation Ureter may insert high on the renal pelvis and lie laterally Blood supply to the horseshoe kidney can be quite variable
Slide 14-

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Slide 15-

Arteriogram showing a multiplicity of arteries supplying kidney arising from aorta and common iliac arteries
Slide 16-

UPJ obstruction, causing hydronephrosis, occurs in one third of individuals 60% patients remain asymptomatic for aprox. 10 years
Slide 17-

Associated Anomalies
Slide 18-

Diagnosis Excretory urogram
Slide 19-

Prognosis 13% have persistent urinary infection or pain 17% develop recurrent calculi Renal carcinoma has been reported within a horseshoe kidney in 123 patients Incidence of Wilms' tumor in horseshoe kidneys is more than twice
Slide 20-

Congenital cysts Kidney is one of the MC sites in body for cysts Arise from the nephrons and collecting ducts after they have formed
Slide 21-

Cystic Diseases of the Kidney
Slide 22-

Multicystic refers to a dysplastic entity Polycystic most inherited, all without dysplasia and all with nephrons throughout the kidney Many of the polycystic kidney disease entities progress to renal failure
Slide 23-

‘Snowstorm’ appearance of infantile polycystic disease
Slide 24-

Ectopic Kidney Kidney not located in usual position 1 in 1,000 births, but only about one in 10 of these are ever diagnosed; up to 10% bilateral Most common: Horseshoe Kidney Unilateral renal agenesis Pelvic kidney (Left kidney more likely to be abnormal)
Slide 25-

Ectopic Kidney Function is generally normal initially Abnormal position leads to obstruction in 50% of ectopic kidneys Increased risk UTI, kidney stones, VUR Frequently associated with abnormalities of other organ systems (uterine, cardiac, skeletal)
Slide 26-

Ectopic Kidney Locations
Slide 27-

Ectopic Kidney(simple renal ectopia)
Slide 28-

Mega ureter Ureters wider than 7 to 8 mm Normal ureteral diameter is rarely greater than 5 mm Primary MGU is 2-4 times more common in boys than girls Slight predilection (1.6 to 4.5 times) for the left side Bilateral in approximately 25% of patients In 10% to 15% of children contralateral kidney may be absent or dysplastic
Slide 29-

Three major classifications of megaureter based on primary and secondary causes
Slide 30-

Pathophysiology Distal end of the ureter, as it becomes intramural and subsequently submucosal, rearranges the muscular layers in its wall. All layers become longitudinally oriented Ureteral adventitia fuses to the bladder trigone by attachment to Waldeyer's sheath Sympathetic and parasympathetic innervation to the distal ureter and UVJ area is believed to modulate primarily ureteral peristalsis
Slide 31-

Diagnosis Ultrasound Distinguishes MGU from UPJ obstruction based on the presence or absence of a dilated ureter VCUG to rule out reflux Renal scintigraphy Provides objective, reproducible parameters of function and obstruction
Slide 32-

Whitaker's perfusion test & ureteral opening pressure To evaluate obstruction, but their invasiveness and requirement for anaesthesia are drawbacks in children Magnetic resonance urography
Slide 33-

Magnetic resonance urogram showing obstruction at the right ureterovesical junction
Slide 34-

Management Primary Refluxing Megaureter Medical management is often the initial approach Surgery Endoscopic subureteric injection, is recommended for persistent high-grade reflux in older children Reconstructive surgery of a dilated ureter distal ureterostomy for unilateral reflux vesicostomy for bilateral disease
Slide 35-

Secondary Refluxing or Obstructive Megaureter Management of secondary MGUs is initially directed at their root cause Primary “Dilated” Nonrefluxing Megaureter: Nonobstructive versus Obstructive Expectant management is preferred Antibiotic suppression & radiologic surveillance is appropriate in most cases Surgical correction
Slide 36-

Surgical Options Plication or infolding for moderately dilated ureter Complications Persistent reflux and obstruction Postoperative VUR
Slide 37-

Ectopic ureter Ureter whose orifice terminates anywhere other than the normal trigonal position Lateral ectopia : an orifice more cranial and lateral than normal Caudal ectopia : orifice is more medial and distal than the normal position
Slide 38-

80% are associated with a duplicated collecting system Females : More than 80% are duplicated Urethra and vestibule are the most common sites Males: most ectopic ureters drain single systems posterior urethra is the most common site Drainage into the genital tract involves the seminal vesicle three times more often than the ejaculatory duct and vas deferens combined
Slide 39-

Ureterocele(outpouching of ureter as it enters bladder)