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urinary system
1- Pronephros
2- Mesonephros
3- Metanephros
A: 5th -6th wk the mature kidneys lie in the pelvis with their hila pointed anteriorly
B: 7th wk the hilum points medially , kidneys in the abdomen.
C: 9th wk kidneys in the retroperitoneal position at level of L1 ,
complete rotation , anteromedially.
Normal Function of the Urinary system:
Kidney :
1- Filters blood- remove and eliminate soluble waste ( urine).
2- Regulates blood volume and composition.
3- Maintains water and electrolyte balance.
4- Hormonal production; Erythropoietin, Renin.
5- Metabolizes vitamin D to active form.
Ureters:
convey urine from kidneys to bladder.
Urinary bladder:
Temporary urine storage.
Urethra:
Conveys urine from bladder to outside.
Note: the kidney function will reach adult level at the age of 2
years, while the kidney size will reach the adult size at the age of 9
years. Bladdernwill reach adult size by 2 years.
Abnormalities during development:
UNILATERAL BILATERAL
1- Unilateral : absent kidney, no symptoms. Avoid contact sport to protect
the contralateral kidney, other kidney will be hypertrophied due to increase
workload. There is an increased incidence with single umbilical artery;
therefore, do an U/S to check for unilateral kidney agenesis), absent ureter
& hemitrigone. Hypertrophy, VUR in contra lateral kidney, because in 50%
of the cases, there may be other urinary anomalies specially VUR.
Sometimes unilateral agenesis might be asymptomatic and discovered
incidentally with UTI or hypertension, but can lose the kidney when exposed
to harsh trauma. l.
Complications:
Conservative:
1- cysts < 5cm , high chance of involution, which means the kidney is
shrinking, or cause no problems.
If > 5cm, it most likely will not involute so follow up the patients for any
complication, and if they develop complications do a nephrectomy.
2- reviewed annually for:
- BP
- urinary protein.
- US for cysts involution, of MCDK.
growth of contra-lateral kidney. Up to 2yrs of
age then at 5yrs of age if normal.
Nephrectomy:
1- no involution by 2 yrs of age. Some do nephrectomy at
the age of 5 because they fear malignancy or any complications..
2- HTN
3- recurrent infections.
11- Abnormalities in shape & position:
Complications:
-50% VUR, abnormal vascular supply.
- Stone (ureter is no longer positioned anterolaterally, and
kidney causes pressure on it, leading to hydronephrosis 2
PUJO.
- Wilms tumor
- HTN due to vascular abnormality.
- one kidney cross the midline to the other side and lie in an
abnormal rotation
- position & fused upper pole fused to the normal kidneys lower
pole.
- ureters inserted in normal position.
- anomalies of urogenital system
III-Abnormalities of the collecting system:
A- Duplex kidney :
1% , Familial, more in girls , 70% unilateral.
-Two pelvicalyceal system within the kidney, complete or partial.
- Kidney larger than normal.
-Diagnosed by IVP.
Incomplete:
-Uncomplicated divided pelvis, or 2 Ureters join before entering
the bladder.
Hydronephrosis:
Associated abnormalities:
1- VUR
2- Incontinence
3- Repeated UTI
Posterior urethral valve (PUV):Commonest obstructive
Uropathy in boys ,
1:5000- 8000
Postnatal presentations:
1- pulmonary Hypoplasia.
2- Poor urinary stream
3- Voiding dysfunction.
4- Urosepsis.
5- FTT.
Renal & urological manifestation:
1- Chronic kidney diseases (if discovered late it will lead to CRF). 60%
dysplastic kidney.
2- VUR
3- Bladder dysfunction.
Management:
1- correction of electrolytes.
2- Treatment of sepsis.
3- Resp.distress
4- Temporary relieve of pressure
5- cystoscopy : valve ablation
6- Vesicostomy
Prune belly syndrome ( Eagle-Barrett syndrome, Triad syndrome)
Triad of:
1- Deficiency or absence of anterior abdominal wall musculature.
2- Bilateral cryptorchidism
3- bilateral Ureter ,bladder,& urethral abnormalities( megacystis, Megaureter 2
dysplasia.
Antenatal Screening US
1- Fetal kidney
2- Collecting system
3- Amniotic fluid
Postnatal Exam:
Physical exam: Associated anomalies
Urgent evaluation : Bilateral involvement, solitary affected kidney,
oligohyddramnios.
Renal studies: Renal US, VCUG, MAG3
Take home messages: