Laboratory and instrumental method of studying the kidneys and urinary system in children

1. Topic- Laboratory and
instrumental methods of
studying the kidneys and
urinary system in children.
Submitted by
Group No.:
3014

2. The location of the kidney
• The two kidneys lie against the muscles of the back
in the upper abdomen.
• Each kidney is enclosed in a membranous capsule.
• The kidneys, as well as the ureters, lie behind the
peritoneum, in the retro peritoneal space.

3. Functions of the kidneys
• •Regulation of the volume of the extra cellular fluids and PH of the
organism
• •Excretion of the toxic substances or the waste products of the
human metabolism that should be removed from the human body
• •Production of renin, an enzyme which is important in the regulation
of blood pressure.
• •Production of the hormone erythropoetine, which stimulates the
production of red blood cells in red bone marrow (when the kidneys
do not get enough oxygen).

4. 1.Development of the kidneys
The whole urinary system has 3 stages of the development
• The 1st stage is called pronephros “the 3rd week” has dorsal-lateral
caudal position, has no excretory function.
• The 2nd stage is called mesonephros “the 4th week of gestation”
develops as a tubular part up to collecting tubules entering cloacae.
• The 3rd stage is called metanephros is the final kidney and develops
from two parts:-mesoderm and the mesonephros.
2.The budging of mesonephrotic duct grows and differentiates into uretras,
pelvis, calyxes and collecting tubules.
• •Along with the development of the tubules the mesoderm accumulates
and regroups around them forming the capsule of the glomeruli.
• The parietal cells multiply more rapidly than the visceral.
• Capillary system enters Bowman’s capsule forming future glomeruli of
the kidney.

5. 3.The abnormal development of the urinary system
results in the formation of the different malformations
• cystic kidney
• renal agenesis or aplasia
• dislocations
• S – like kidney
• L – like kidney horseshoe kidney and so on.
• Placenta plays a role of kidney before the full
development of the urinary tract is finished.

6. Imaging may be used in combination to diagnose underlying
pathologies and is often used to assess for anatomical
obstructions or abnormalities
• urinary obstructions caused by
1. kidney stones
2. renal masses.
• renal function tests, urinalysis, urine
dipstick
• renal biopsy see diagnostic evaluation of
Diagnostic investigations in urology

7. Assessment of the urinary system
Anamnesis: -,
• History of the disease
• Family history.
The main complaints are
• Pains on urination (sharp or burning pains/colic on
urination)
• Back pain
• Headaches
• Changing of the urine color and /or the amount of daily
urine output
• Edema
• Thirst

8. Laboratory examination:
• General urine analysis evaluation includes
• the physical and the chemical characteristics
Ex:- the transparency, color, odor, density.
• microscopy of the urine for determination the celcontent.
Ex:- epithelial cells, leucocytes, erythrocytes,cylinders.
• Normal urine Color is yellowish or amber.
• Abnormal urine Color can be changed to:
1. reddish – hematuria, amidopyrinum intake
2. dark red – hemoglobinuria in hemolytic anemias,
noncompatable blood transfusion
3. dark brown – alcaptonuria, mechanical jaundice
4. yellowish –intake of the santonin
5. milky white – chyluria in case of lymphostasis
6. beer color – hepatitis

9. Uroflowmetry
Description
• Measures the volume of urine voided over time
• The patient is asked to void into a funnel that measures the volume and
rate of urine flow.
• Normal: a continuous, single bell-shaped curve with urine volume >
200 mL (over 15–30 seconds) and at a rate > 15 mL/sec
• Abnormal: an abnormal curve or urine volume at a rate < 15
mL/sec (a urine volume < 150 mL increases the risk of an inaccurate
assessment)
Indications
• Outlet obstruction (e.g., benign prostatic hypertrophy,urethral
overactivity, urethral stricture following surgery)
• Weak detrusor(e.g., hypotonic bladder)
• Increased valsalva during voiding

10. Instrumental methods of examination
• Ultrasound
• CT
• MRI
• Voiding cystourethrogram
• Retrograde urethrogram
• CT urography

11. •Ultrasound
•Renal: visualization of renal
tumors, renal cysts,
nephrolithiasis, hydronephrosis
•Bladder: bladder wall
thickness, bladder calculi,
tumors, urinary retention
•Prostate :to estimate prostate
volume, shape, echogenicity
and prostatic abscesses or masses
Scrotal and penile: to evaluate
for testicular
torsion, cryptorchidism, trauma, t
esticular tumors, varicocele,
and epididymitis.

12. CT
• Investigation of choice to
detect urinary calculi and renal
masses
• Visualization of the urothelium in
suspected malignancies and cases
of obstruction
• CT angiography helps evaluate
acute pelvic trauma and tumor
blood supply, as well as diagnose
renal vascular malformations .

13. Voiding cystourethrogram
Description:
• Radiocontrast dye is injected into the bladder by means of a urinary
catheter (retrograde contrast filling of the bladder)
• Serial x-rays are performed during voiding.
• Allows the ureter and urethra to be visualized
• During voiding pressure increases in the bladder and this may reveal
reveal previously hidden reflux
Indications
• Diagnosis of vesicoureteral reflux and urethral stricture
• Recurrent UTIs
• Suspected obstruction (e.g. bilateral hydronephrosis)
• Suspected bladder trauma or rupture

15. CT urography
•Description: a CT with contrast dye injected inravenously to
assess the anatomy and, to a certain degree, function of the
urinary collecting system, renal calyces, ureters, and bladder.
•Indications: a first-line imaging test to assess for genitourinary
abnormalities (e.g., malignancy, stricture)

16. Retrograde urethrogram
Description
• Contrast dye is injected into
the bladder via the urethra.
• Serial x-rays are performed
to visualize the integrity of
the urethra up to
the bladder.
Indication: suspected anatomical and
functional lesions of the urethra
(e.g., urethral stricture, injuries)