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2011-12-11 14:46:04
27 Neonatal ped kidney adrenal

The neonatal and pediatric kidneys and adrenal glands
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  1. kidneys after birth
    • cortex grows through childhood and pyramids become smaller
    • not a large amount of cortical fat
    • cortex fairly thin equal or greater echogen than the liver
    • 4-6 months decreases to less than liver
    • arcuate vessles-specular echos btwn cortex and medulla
    • contour lobulated from fetal lobulation
  2. arcuate arteries
    at base of pyramids
  3. adrenal glands
    • larger in neonate than older infant and young child
    • superior to upper pole of kidney
    • left is more medial
    • looks like inverted V in long, linear in short
    • if kidney is absent adrenal gland is still in renal fossa
  4. bladder
    • 3-5mm wall depending on distention
    • color can be used to see distal ureter entering posterior wall of bladder
  5. hydronephrosis
    • dilitation of collecting system
    • common causes: obstruction, reflux, abn muscle development
    • check other side and ureter and bladder for dilation
    • grade hydro
  6. ureteropelvic junction obstruction
    • most common obstruction of urinary tract
    • caused by intrinsic narrowing or extrinsic vascular compression
    • hydro in kidney with normal ureter
    • coronal scan plane best
  7. ureteral obstruction
    • ureter obstructed anywhere- can be ureterovesicle junction
    • can be caused by abcess or lymphnode
    • may see diminished ureteral jet
  8. bladder outlet obstruction
    • bilateral hydro usually bladder or outlet
    • can be neurogenic bladder, pelvic mass, or congen. anom. like uretheral valves
    • thick bladder wall, urinary ascites, urinoma at kidney
  9. posterior urethral valves
    • most common cause of bladder outlet obstruction in neonate male
    • can be pelvic mass or tumor
  10. ectopic ureterocele
    • females, left side
    • ectopic insertion and dilitation of distal ureter in completely duplicated collecting system
    • fluid mass within bladder inferiomedially to urethral insertion of lower pole ureter
  11. prune belly syndrome
    • abdominal deficiency syndrome
    • three things: hypoplasia or deficency of abd musculature, cryptorchidism, urinary tract anomolies
    • dilated tortuous ureters, large bladder
    • reflux common problem
    • can be very severe with fatal pulmonary hypoplasia, dysplastic echogenic kidneys
    • wrinkled prune like abdomen physically
  12. multicystic dysplastic kidney
    • MCDK
    • most common cause of renal cystic disease in neonate
    • congenital- interference with ureteral bud function in first trimester
    • ureteral atresia
    • unilateral mass resembling a cluster of grapes
    • bilateral is fatal
    • may resemble ureteropelvic juncion obst
    • involute and disappear completely or are small echogenic kidney
  13. medullary cystic disease
    • indistinguishable from juvinile nephronophthisis
    • small echogenic kidney variable sized cysts at corticomedullary junction
  14. autosomal recessive polycystic kidney disease ARPKD
    • aka infantile polycystic disease
    • not common
    • female
    • diffuse enlargement
    • associated with biliary ectasia and hepatic fibrosis
    • most severe in neonatal- less in infant/juv
    • third trimester-kidneys protrude in abd
    • hyperechoic enlarged with hypo outter rim (cortex)
    • juv form- later on hepatic fibrosis and portal htn, gi bleeding
    • overall bilateral enlarge echogenic kidneys with loss of definintion btw parts
    • oligohydraminos 16-18wks inutero
  15. autosomal dominant polycystic kidney disease ADPKD
    • adult form usually appears during middle ages
    • 40s- htn, hematuria, enlarged kidneys
    • cysts can be in liver, spleen, panc
    • increased rcc
    • well defined cysts on both kidneys
  16. renal cysts
    like with adults can be associated with various syndromes (tuberous sclerosis- 40% incidence of cysts- and vonhippel lindau)
  17. acute pyelonephritis
    • fever flank pain tenderness
    • usually begins with bladder and ascends
    • thickening of pelvis and ureter
    • abcess forms as infection walls itself off
    • can follow pts after antibiotic therapy
  18. chronic pyelonephritis
    • repeated episodes of acute
    • kidneys become scarred and decrease size
    • cortex becomes more echogenic than liver
    • pyramids difficult to separate from parenchyma
  19. renal vein thrombosis
    • most likely in dehydrated or septic infant
    • in infants of diabetic mothers
    • renal enlargement, low platelet, proteinuria, hematuria
    • thrombus starts in intrarenal venous branches if reaches renal vein or ivc may be visualized in vascular structures
    • calcification may result
  20. congenital mesoblastic nephroma
    • most common renal tumor of neonate
    • aka fetal renal hamartoma or congential Wilms tumor
    • rare
    • connective tissue replaces parenchyma
    • benign but looks like wilms, nephrectomy
    • can extend through capsule into retroper.
    • children less than 1 yr
  21. nephroblastoma
    wilms tumor
    • most common intraabdominal malignant renal tumor in children
    • 2-5 yrs
    • unilateral usually
    • distortion and displacement of collecting system
    • can be monitored during chemo- surgery best
    • liquification when necrosis and hemorrhage
    • tumor may spread through renal veins, ivc, and into right atrium of heart. Also to other kidney
  22. neuroblastoma
    • malignant tumor in adrenal medulla
    • second most common tumor 2mo-2yr
    • highly echogenic
    • may have calcifications
    • increased vascularity
    • many pts have mets. check liver
    • neuroblastoma is poorly defined whereas wilms is well encapsulated
  23. adrenal hemorrhage
    • difficult delivery, large size, diabetic mother, stress/hypoxia at delivery, septicemia, predispose to adrenal hemorrhage
    • abd mass, jaundice, anemia
    • usually secondary to other complications
    • ovoid enlargement of gland
    • blunting of sup pole of kidney with inf placement
    • looks like neuroblastoma