production of Angiotensin II when
there is fall in intravascular volume
Renin
Eyes widely separated with epicanthal folds
o Ears low set
o Nose broad and compressed flat due to
oligohydramnios
o Chin receding
o Limb anomalies
Potter facies
Increased in those with SINGLE UMBILICAL
ARTERY
Unilateral renal agenesis
Associated with ipsilateral vaginal agenesis in
Mayer-Rokitansky-Kuster-Hauser Syndrome
Unilateral renal agenesis
Most common cause of abdominal mass in newborn
• Contralateral Hydronephrosis present in 5-10%
• Confirm diagnosis with Renal Scan
MULTICYSTIC DYSPLASTIC KIDNEY (MCDK)
Autosomal dominant inheritance
advise screening first-degree relatives of
individuals identified with Renal Agenesis or Dysplasia
FAMILIAL RENAL ADYSPLASIA
Seen in 7% of patients with Turner Syndrome • Wilms’ Tumor development is 4x more common • Increased incidence of MCDK
HORSESHOE KIDNEYS
MOST COMMON FUNCTIONAL ANOMALY OF THE KIDNEYS
PRIMARY VESICOURETERAL REFLUX (VUR)
MOST COMMON FUNCTIONAL ANOMALY OF THE KIDNEYS
PRIMARY VESICOURETERAL REFLUX (VUR)
accounts
for 5-10% of children and adults
with End-Stage Renal Failure
Reflux nephropathy
Most common cause of severe obstructive uropathy in
children
POSTERIOR URETHRAL VALVES (PUV)
MOST SENSITIVE AND ACCURATE study for demonstrating Renal Scarring,
DMSA - renal cortical scintigraphy
Treatment for Acute Cystitis
Trimethoprim-Sulfamethoxazole
Trimethoprim-Sulfamethoxazole (8-
10 MG TMP/kg/24 hr in 2 divided doses), 3-5 day course, effective against most E. coli
Treatment for Acute Cystitis
Nitrofurantoin
(5-7 mg/kg/24 hr in 3-4
divided doses) effective even for Klebsiella-Enterobacter organism
Treatment for Acute Pyelonephritis
Parenteral Antibiotic Treatment:
a. Ceftriaxone
Drug of choice for oral therapy
50-75 mg/kg/24 hr not to
exceed 2 gm)
Treatment for Acute Pyelonephritis
Parenteral Antibiotic Treatment:
Ampicillin
100 mg/kg/24 hr)
Parenteral antibiotic Treatment
+ aminoglycoside
Gentamicin : 3-5 mg/kg/24 hr in 1-3 divided doses)
alternative for resistant organisms
especially Pseudomonas in >17 years
Oral Fluoroquinolone Ciprofloxacin
What is Acute Lobar Nephronia or Nephritis?
Localized renal bacterial infection involving >1 lobe either a complication of Pyelonephritis or Early Renal Abscess
Manifestations identical to Pyelonephritis
What is a Renal Abscess?
Following Pyelonephritis or secondary to Primary Bacteremia (Staph. Aureus)
WBC markedly elevated to >20,000-25,000/mm3
What is a Perinephric Abscess?
Secondary to contiguous infection such as in Vertebral Osteomyelitis or Psoas Abscess or Pyelonephritis
Dissected Renal Capsule
What is Acute Hemorrhagic Cystitis?
Often by E. coli but also Adenovirus types 11 and 21
Adenovirus more common in males
Self-limiting with hematuria lasting about 4 days
What is Interstitial Cystitis?
Irritating voiding symptoms (urgency, frequency, dysuria and bladder/pelvic pain) relieved by voiding with (-) urine culture
Idiopathic, most likely in adolescent girls
Diagnosis by cystoscopic observation of mucosal ulcers with bladder distention
Treatments include bladder hydrodistension and laser ablation of ulcers
What is Eosinophilic Cystitis?
Rare, in children exposed to an allergen
Cystitis with hematuria, ureteral dilatation, occasional hydronephrosis and filling defects in bladder caused by masses of inflammatory infiltrates with eosinophils
Bladder biopsy often necessary to rule out neoplasm
Treatment: Antihistamines and NSAIDs, in some, Intravesical Dimethyl Sulfoxide instillation necessary
