The kidneys and ureter
Congenital anomalies of the kidneys:
*Absence
of the kidney (Agenesis):
unilateral, discovered incidentally, the contralateral
kidney is hypertrophied.
*Renal ectopia:
In emberional life the kidney not ascend and found near
pelvic brim, may present diagnostic problems as
unexpected pelvic mass.
*Horseshoe kidney:
The kidneys fused at lower pole by isthmus, lying in
front of the fourth lumber vertebra and great vessels.
Liable to disease, because the ureters angulated over
the fused isthmus, lead to urinary stases and infection
and nephrolithiasis, sometime true pelvi ureteric
junction obstruction.
Dx: radiological diagnosis as the lower pole calyx
directed medially bilaterally.
No need for separation.
*Unilateral
fusion (crossed fused ectopia):
Bothe kidneys on same loin usually fused, but have two
ureter enter the bladder at the usual site.
*Congenital
cystic kidney (polycystic
kidney):
Hereditary, autosomal dominant trait, lethal. The
disease is not usually detected on standard imaging
study until the second or third decades, and not
manifests itself clinically before the age of 30 year.
The kidneys huge and fill with a large number of variable
size cyst that distort the parenchyma, may associated
with liver cyst.
Clinical feature:
1. Irregular upper quadrant abdominal mass.
2. Loin pain.
3. Infection (renal infection).
4. Hypertension.
5. Uraemia.
6. Haematuria.
Dx: by imaging by U/S as multiple renal cyst in the
kidneys and other organ, also by excretory urography.
Treatment:
*treatment of infection.
*renal failure: low diet protein, replacement therapy,
treatment of hypertension and anemia, dialysis. The
best surgical treatment is kidney transplant.
*Infantile
polycystic disease:
Rare autosomal recessive, May stillborn or die from
renal failure in early life.
*Unilateral multicystic
disease:
Dysplastic kidney is much more common, usually
unilateral as amass treated by surgical excision.
*Simple
renal cyst:
In one kidney or both discovered incidentally, rarely give
symptom: mass, pain, infection.may causes obstruction
and hydronephrosis.
Diagnosed by U/S ,Ctscan.
Rarely require treatment, only if causing obstruction.