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Renal calculi
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Eleni Papageorgiou, Naima Smeulders
In general, children are maintained on low-dose antibiotics until investigations are complete. Follow-up investigations include US to confirm complete absence of calculi, and MAG3 or DMSA. Surgery may occasionally be required to correct vesicoureteric reflux or an obstructive etiology. The risk of recurrent stones in children is as high as 50%. For children with no metabolic abnormality, who remain stone-free and have sterile urine for 2 years, recurrences are rare.
Nephrology, including fluid and electrolytes
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
Familial incidence of vesicoureteric reflux is high. Vesicoureteric reflux is uncommon in later childhood as there is resolution with time. The best way of diagnosing vesicoureteric reflux is by a micturating cystourethrogram. DMSA scan is a more sensitive method of diagnosing renal scarring than renal ultrasonography. Trimethoprim with sulphamethoxazole (Bactrim) but not amoxycillin is the drug of choice for long-term prophylaxis for urinary tract infection in children with vesicoureteric reflux as organisms develop resistance to amoxycillin very rapidly.
Paediatric Urology
Published in Manit Arya, Taimur T. Shah, Jas S. Kalsi, Herman S. Fernando, Iqbal S. Shergill, Asif Muneer, Hashim U. Ahmed, MCQs for the FRCS(Urol) and Postgraduate Urology Examinations, 2020
Jemma Hale, Arash K. Taghizadeh
The abnormalities seen in bladder exstrophy represent a failure of development of the lower abdominal wall; possibly because of the failure of mesoderm to migrate into the cloacal membrane. In classic bladder exstrophy the abnormalities seen all follow from this failure. The bladder lies open and exposed as a bladder plate. The umbilicus lies immediately adjacent to the bladder plate. When the bladder plate is mobilised for closure the umbilicus becomes ischaemic and is subsequently lost. The ureters do not enter the bladder obliquely and there is an increased tendency to subsequent vesicoureteric reflux. There is diastasis of the pubic rami, (i.e., they fail to meet in the midline). The lower abdominal wall demonstrates a series of characteristic features: the rectus muscle divaricates inferiorly, the umbilicus is sited rather low, and the perineum is foreshortened resulting in a slightly anterior anus. The separated pubic rami result in the bony attachments of the corpora cavernosa being widely separated. This contributes to a rather short and wide penis in boys, and a bifid clitoris in girls.
Comparing the role of renal ultrasound vs MAG3 renal scans for evaluation of neurogenic bladder after spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2023
Ryan Solinsky, Susan V. Garstang, Todd A. Linsenmeyer
This retrospective chart review of patients with SCI included consecutive individuals with neurogenic bladder who were being seen for annual urologic evaluation at our single-site academic medical center in the Northeastern United States from 1997 to 1999. This date range was selected as a unique time period when the standard of care included both MAG3 renal scans and renal ultrasound, performed together as part of a single evaluation. All ages and sexes, individuals with both upper and lower motor neuron bladders, and individuals using any methods of urinary drainage were included. At the time of the retrospective review, all individuals with SCI had a MAG3 renal scan without diuretic, renal ultrasound and cystogram as part of their annual evaluation. Since vesicoureteral reflux has the potential to appear as upper tract stasis and not give the true picture of urine transport from the kidneys, individuals were excluded if they demonstrated ureteral reflux or had a history of urinary diversion procedures with ureteral reimplantation.
The relevance of practical laboratory markers in predicting high-grade vesicoureteral reflux and renal scarring
Published in Hospital Practice, 2023
Fatma Yazılıtaş, Evrim Kargın Çakıcı, Ayse Secil Eksioglu, Tülin Güngör, Evra Çelikkaya, Deniz Karakaya, Çiğdem Üner, Mehmet Bülbül
Vesicoureteral reflux (VUR), is one of the most common congenital urinary tract abnormalities, known as retrograde urine flows from the bladder up to one or both ureters and the collecting duct systems of the kidney. It is also a risk factor for recurrent UTIs, and it is associated with serious consequences such as acquired renal scarring, hypertension, and renal failure, especially for infants [1,2]. The higher grade of VUR is the greatest risk for recurrent febrile UTI and renal scarring [3]. Recently, it has been reported that low-grade VUR may not cause kidney damage [3–5]. It is important to detect the presence of high-grade VUR to preserve kidney function by minimizing the risk of UTIs in children [1–3]. The gold standard imaging method for the diagnosis of VUR is voiding cystourethrography (VCUG) which offers accurate anatomic detail and grading of VUR. Unfortunately, this method is an invasive and expensive procedure with complications such as pain, and risk of infection, and exposure to radiation [3,5,6]. There is no study examining potential accurate, noninvasive biomarkers for the ability to discriminate high-grade VUR from low-grade VUR in children. Due to the invasive and discomfort nature of VCUG described above, researchers have investigated procalcitonin, C-reactive protein (CRP), WBC as noninvasive and widely used serum biomarkers to predict VUR [5,7,8].
Incomplete Renal Duplex System with Lower Moiety Hydroureteronephrosis Due to Aberrant Blood Vessel
Published in Fetal and Pediatric Pathology, 2022
Hassan Alhellani, Fabio Beretta, Michele Corroppolo, Federica Fati, Giosuè Mazzero, Elisa Pani, Clara Revetria, Hamid Reza Sadri, Enrico Ciardini
Our case is a 14-months-old female with a prenatal diagnosis of right hydronephrosis. After birth, a renal echography showed a dilated renal pelvis (anterior posterior diameter – APD: 7 mm) but no dilated ureters. At one month of age, echography showed an increase of pelvicalyceal dilatation (APD 11 mm) with ureteral dilatation limited only to the proximal ureter and renal cortex thickness was more than 6 mm. Vesicoureteral reflux (VUR) was excluded via micturating cystourethrography (MCU). Five months later, echography demonstrated a worsening of the renal status: pelvicalyceal dilatation, APD was 18 mm, renal cortex thickness less than 6 mm and ureteral dilation was 9 mm. During the follow-up period, due to an E. coli urinary tract infection, a new echography control showed further dilation of the proximal third of the ureter around 25 mm. To exclude different causes of ureteral obstruction such as an anomalous renal vessel, primary obstructive megaureter, kinking, ureteral valves or any obstructing anomaly, an Uro-magnetic resonance was then performed showing a partially duplicated right renal collection system with a marked dilatation of the medial-inferior pole. The right inferior ureter was obstructed at an unclear level with no evident anomalies (Figure 1). Scintigraphy showed 56,7% left kidney and 43,3% right kidney split functions. On the right kidney, it showed a 65.6% split function of the upper pole compared to 34.4% of the lower pole. Scintigraphy further confirmed a flow obstruction.