Renal: Childhood Disorders Of The Ut

Front 1

Acute UT obstruction causes
1) ____Natremia
2) ____kalemia
3) Metabolic ____osis
4) Change in the medullary interstitial gradient

Back 1

1) Hyponatremia
2) Hyperkalemia
3) Metabolic Acidosis
4) Dissipation

Front 2

Acute obstruction of the UT leads to mechanical stretch which triggers _______ due to TxA2, AII, macrophage recruitment, and ischemia

Back 2

Vasoconstriction

Front 3

1) Neonatal urinary obstruction is almost always due to.....
2 Name the three most common sites that this occurs, and star the most common one.
3) Is complete or partial obstruction more common?

Back 3

1) failure to recanalize a tubular structure during organogenesis
2) Ureteropelvic junction *
Uretervesicle junction
Bladder outlet (proximal urethra)
3) partial

Front 4

What is the leading cause of abdominal masses in newborns?

Back 4

UT obstruction

Front 5

You see a male newboen with bilateral hydronephrosis and hydroureter. He has a palpable distended bladder. What should you be thinking for a diagnosis?

Back 5

Posterior urethral valves.

Front 6

1) Special case of neonatal urinary obstruction

Name the syndrome:
No abdominal muscles
Renal dysplasia
Lower GU tract malformation
Obstruction, including posterior urethral valve
Maldescent of testes

2) Inheritance?

Back 6

1) Eagle-Barret Syndrome (Prune Belly syndrome)

2) XLR - Only seen in males (1/50,000)

Front 7

Name the three most common causes of acquired UT obstruction in children. Star the most common

Back 7

Tumor*
Dyssynergia (detrusor/sphincter un-coordination)
Constipation- bowel compresses ureters

Front 8

1) What is the inital physiological response to bladder outlet obstruction?

2) Over time, there sill be mismatch of vessels and muscle, with nerve compression. What happens now?

3) To what two problems does this predisose the child to

Back 8

1) Bladder hypertrophy--> thick walls with trabeculae used to overcome obstruction
2) Bladder atonia with high residual urine volume

3) Chronic UTIs and Bladder Diverticuli

Front 9

What changes in the bladder can cause Vesicoureteral reflux?

Back 9

inflammation (chronic UTIs) and distortion which changes the oblique entry of the ureter into the bladder.

Front 10

VUR is more common in boys or girls?

Back 10

Girls- associated with chronic UTIs

Front 11

Explain why the angle of entry of the ureter into the bladder matters in VUR

Back 11

At an oblique angle, bladder distension shuts the ureter off from the bladder.
At a right angle, bladder distension stretches open the uteter ostium. This causes backflow during bladder contraction.

Front 12

What finding, besides dilation can we see in the ureters of a child with VUR?

Back 12

Tortuous path of ureter

Front 13

How does VUR hurt this kidneys?

Back 13

Back pressure to the calyces dilates, the ureter, blunts the calyces, and obliterates the cortex of the kidneys. Also intrarenal reflux, back through the renal papilla and into the cortex causes an inflammatory reaction.

Front 14

What helps prevent intrarenal reflux beyond the calyces?

Back 14

papillary valves that shut with increased calyx pressure

Front 15

Two things we can do to surgically treat VUR?

Back 15

1) Ureteral reimplanatation
2) Injection of teflon or collagen at entrance.

Front 16

1) How would we treat an acute bladder outlet obstruction (posterior urethral valve)?
2) what if the obstruction was at the ureteropelvic junction

Back 16

1) catheter
2) Nephrostomy drainage

Front 17

The capacity to recover from urinary obstruction wanes after about...

Back 17

3 weeks

Front 18

Name the two renal histological findings associated with obstruction

Back 18

tubular dilation and atrophy
chronic interstitial fibrosis

Front 19

in chronic partial obstruction, what is most likley to "do in" the kidney"

Back 19

Ascending infection

Front 20

Besides UT obtruction and tumors, what can case an abdominal mass in newborn?

Back 20

MCDK- multicystic dysplastic kidney.

Front 21

1) What is the contralateral finding in 30% of MCDK?
2) IS MCDK heritable?

Back 21

1) VUR
2) No

Front 22

1) What causes MCDK?
2) Describe its histology

Back 22

1) In utero UT obstruction
2) disordered, few functionl nephrons,

Front 23

In older children, what do we worry about with an abdominal mass?

Back 23

Tumor!!!

Front 24

1) What is the most common solid childhood tumor?

2) What is its tissue of origin?

Back 24

1) Neuroblastoma
2) Neural crest

Front 25

Why is enuresis nocturnal?

Back 25

We attain daytime volitional control before nighttime, which remains a spinal reflex for a period. (This reflex is inhibited by the cortex during wakefulness)

Front 26

Normal age range for control of daytime voiding?

Back 26

2-4 yrs.

Front 27

1) We see a staccato (intermittent) urine stream, and post-void retained volume- what is going on?

Back 27

child is unable to fully relax sphincter

Front 28

1) Define dyssynergia
2) what event ca precipitate this condition

3) what is a complication due to problems voiding?

Back 28

1) discoordinated relaxation of sphincter/contraction of detrusor

2) Post UTI
3) VUR

Front 29

Constipation and voiding problems constitute what syndrome?

Back 29

Dysfunctional elimination syndrome

Front 30

Recurring UTIs in the setting of VUR can cause distal tubular dysfunction, loss of GFR, and need for transplant. What do we do to prevent this bad outcome?

Back 30

Sonogram for child the first time that they have UTI with fever.
Voiding cystourethrography is also considered.

Prophylactic Abx.

Anti-cholinergics (stop unopposed dtrusor contractions, allowing normal voiding)

Front 31

1) Name three theories explaining primary nocturnal enuresis

2) in a year, how many kids will hae spontaneous resolution of nocturnal enuresis?

3) major sequelae with enuresis?

Back 31

1) small for age bladder
ADH deficiency
Alteration in cental arousal mechanism

2) 1/6
3) stress on family

Front 32

1) How is secondary enuresis distinguished from primary?

2) This is a bad sign, what can it indicate?

Back 32

After bladder control is obtained, it is again lost.

2) Hypothalamic tumor ablating ADH, spinal nerve trauma, concentrating defect (SCD)

Front 33

Given that enuresis causes no physical harm Tx, should....

Back 33

entail no risk

Front 34

What drugs ca we use for medical therapy of enureis?

Back 34

DDAVP
anti-cholinergic (stop detrusor contractions, and increase capacity)

Front 35

1) What therapy works better than medicine at treating enuresis?

2) name an example of this

Back 35

1) Behavioral

2) Enuresis sensor and alarm