Renal anomalis
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Abnormalities of the kidney
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Renal anomalis
- 1. Anomalies of the Upper Urinary Tract By Hassaan Ali Gad Assistant lecturer of urology and Andrology Aswan University Dr.Hassaan Ali 2014
- 2. Embryology of kidney. Normal Anatomy of kidney. Congenital abnormalities of the kidney. Complication. Dr.Hassaan Ali 2014
- 3. kidneys develop from the intermediate mesoderm(Kidneys, Adrenals and Gonads) 3 embryonic kidneys, in order of appearance pronephros . mesonephros metanephros first two regress in utero, and the third becomes the permanent kidney Kidney Development Dr.Hassaan Ali 2014
- 5. Embryology of kidney Dr.Hassaan Ali 2014
- 6. Embryology of kidney Dr.Hassaan Ali 2014
- 8. The nephron (glomerulus, proximal tubule, loop of Henle, and distal tubule) is thought to derive from the metanephric mesenchyme The collecting system (collecting ducts, calyces, pelvis, and ureter) formed from the ureteric bud Development of Nephrons/Collecting System Dr.Hassaan Ali 2014
- 10. - From 6th to 9th weeks: kidneys ascend to a lumbar site just below adrenals - the differential growth of the lumbar and sacral regions of the embryo plays a role renal ascent. as the kidneys migrate, they are vascularized by a succession of transient aortic sprouts that arise at progressively higher levels final pair forms in the upper lumbar region and becomes the definitive renal arteries Renal Ascent Dr.Hassaan Ali 2014
- 12. Normal Anatomy Dr.Hassaan Ali 2014
- 13. Developmental anomalies of the kidney Abnormalities of the kidney number Abnormalities of the kidney position Abnormalities of the kidney rotation Collecting system abnormalities Cystic abnormalities of the kidney Anomalies of renal vasculature Dr.Hassaan Ali 2014
- 14. Bilateral renal agenesis Unilateral renal agenesis Supernumerary kidney abnormalities of the kidney number Dr.Hassaan Ali 2014
- 15. 1 : 4800 births Origin ureteral bud failure or absence of the nephrogenic ridge Associated findings : - absent renal arteries - complete ureteral atresia (50%) - bladder atresia (50%) - low birth weight, oligohydramnion Bilateral renal agenesis Dr.Hassaan Ali 2014
- 16. 1 : 1500, 2 : 1 male, left kidney more often Origin ureteral bud failure; familial trend Associated findings : - absent ureter with hemitrigone (50%) - adrenal agenesis (10%) - genital anomalies Unilateral renal agenesis Dr.Hassaan Ali 2014
- 18. Origin combined defect of ureteral bud & metanephros Associated findings : - hydronephrosis (50%) - common ureter (40%) - duplex ureter (40%) - ectopic ureter (20%) Supernumerary kidney Dr.Hassaan Ali 2014
- 19. Simple ectopia Thoracic ectopia Crossed ectopia ectopiaFusion Abnormalities of the kidney position Dr.Hassaan Ali 2014
- 21. Incidens 1 : 900, left side favored Associated findings : - Anomalous vasculature - Contralateral agenesis - VUR - undescended testes, hypospadia - urethral duplication (10-20% male) - skeletal & cardiac anomalies (20%) Simple ectopia Dr.Hassaan Ali 2014
- 24. < 5% of ectopic kidney Origin is delayed closure of diaphragmatic Adrenal may or may not be thoracic THORACIC ECTOPIA Dr.Hassaan Ali 2014
- 25. 1 : 1000 to 1 : 2000, 90% crossed with fusion 2 : 1 male, 3 : 1 left crossed Origin abnormal migration of ureteral bud or rotation of caudal end CROSSED ECTOPIA & FUSION Dr.Hassaan Ali 2014
- 30. 1 : 400, 2:1 males Origin fusion of lower poles before or during rotation (4 ½ - 6 wks of gestation) Associated findings : - anomalous vessels - skeletal, CV, CNS anomalies - hypospadias & cryptorchidism, UTI, stone. HORSESHOE KIDNEY Dr.Hassaan Ali 2014
- 33. Rotation of the kidney during its ascent from the pelvis rotation during its ascent to the adult site. A, Primitive embryonic position; hilus faces ventrad (anterior) B, Normal adult position; hilus faces mediad C, Incomplete rotation. D, Hyper-rotation; hilus faces dorsad (posterior). E, Hyper-rotation; hilus faces laterad. F, Reverse rotation; hilus faces laterad. Dr.Hassaan Ali 2014
- 34. Rotation of the kidney during its ascent from the pelvis. Dr.Hassaan Ali 2014
- 37. 1. Autosomal dominant polycystic kidney disease 2. Autosomal recessive polycystic kidney disease 3. Medullary sponge kidney (tubular ectasia) 4. Medullary cystic disease . 5. Unilateral multicyctic dysplastic kidney Cystic abnormalities of the kidney Dr.Hassaan Ali 2014
- 38. Adult type is the most common cystic disease in humans 1 : 1250, 10 % of all ESRD Present at age 30 – 50 yrs, can occur in children Pain, hematuria, progressive renal impairment IVU irregular renal enlargement + calyceal distortion Assoc. findings : liver cysts, berry aneurism Autosomal dominant polycystic kidney disease Dr.Hassaan Ali 2014
- 39. Infantile type, rare (1 : 10.000) IVU streaked appearance (sunburst pattern) Usually die within the first 2 mo of life Autosomal recessive polycystic kidney disease Dr.Hassaan Ali 2014
- 40. Adult disease Enlarged tortuous collecting ducts 1 : 20.000 IVU bristles on a brush Complication : infection, stones, distal renal tubular acidosis, hematuria 1/3 pat with hypercalcemia Medullary sponge kidney (tubular ectasia) Dr.Hassaan Ali 2014
- 42. Bilateral small kidney, amedullary cysts Progress to ESRD by age 20 Juvenile type 20% of childhood renal failure deaths Polydipsia & polyuria in 80% Retinitis pigmentosa in 16% Medullary cystic disease Dr.Hassaan Ali 2014
- 43. Most common cystic disease of the newborn Second most common abdominal mass in infant after hydronephrosis Left kidney is more common, = Unilateral multicyctic dysplastic kidney Dr.Hassaan Ali 2014
- 44. Ureteropelvic junction obstruction (UPJO) Calyceal diverticulum Hydrocalycosis Megacalycosis Infundibulopelvic stenosis Collecting system abnormalities. Dr.Hassaan Ali 2014
- 45. Usual cause of the most common abdominal mass in children (hydronephrosis) Male: Female = 2 : 1 (in child), left side predominance Episodic flank pain, flank mass, hematuria, infection, nausea & vomiting, uremia. UPJO (uretero pelvic junction obstruction) Dr.Hassaan Ali 2014
- 48. 4,5 : 1000 Origin failure of degeneration of 3rd & 4th order branches of ureteral bud In 1/3 patients stones will be form Th/ : removal stones, drainage of pus, marsupialization to the renal surface CALYCEAL DIVERTICULUM Dr.Hassaan Ali 2014
- 50. Rare Involving vascular compression, cicatrization or achalasia of the infundibulum Rarely requires any intervention HYDROCALICOSIS Dr.Hassaan Ali 2014
- 52. Rare, one or both kidney Dilated unobstructed calyces, > 25 / kidney (N : 8 – 10) Faulty uretral bud division, hypoplasia of juxtamedullary glomeruli & maldevelopment of calyceal musculature : = 6 : 1, only in Caucasian X-linked recessice MEGACALYCOSIS Dr.Hassaan Ali 2014
- 54. May involve part or all of one or both kidney Calyces quite large No progressive functional deterioration Maybe with dysplasia & lower tract anomalies Common with vesicoureteral reflux INFUNDIBULOPELVIC STENOSIS Dr.Hassaan Ali 2014
- 55. Aberrant, Accessory, or Multiple Vessels Renal Artery Aneurysm Renal Arteriovenous Fistula Dr.Hassaan Ali 2014 Anomalies of renal vasculature
- 57. Dr.Hassaan Ali 2014 THANK YOU