Urinary Tract Abnormalities

Posted by e-Medical PPT
Embryology:Intermediate mesoderma: Pronephros, Mesonephros and finally Metanephros
Mesonephros:
 Longitudinal swelling minimal urine production 6-10 weeks
 Mesonephric duct connecting cloaca to kidney
Metanephros
 Mesonephric buds
 Connection of ureteral bud with metanephric blastema induces nephron formation
 Functional by 10 weeks
 
Antenatally detected hydronephrosis
0,5% out of 12 000 antenatal scans revealed fetal malformations
0,25% had genitourinary tract abnormalities

Differential diagnosis
UPJ obstruction
VUR
Primary nonrefluxing megaureter
Ureterocele
Uterovesical junction obstruction
Ectopic ureter
Posterior urethral valves
Megacystitis megaureter
Physiological dilatation
Multicystic dysplastic kidney
Autosomal recessive polycystic kidney disease
Extrophy
Prune belly syndrome

Fetal intervention for hydronephrosis
Types of interventions:
Vesico-amniotic shunts
Fetal cystoscopy and endoscopic valve ablation

Post natal evaluation:
Day 1: Cases with oligohydramnios, urethral obstruction, multicystic renal dyplasia, bilateral moderate-to-severe hydronephrosis or uncertainty of diagnosis
Days 7-10: For mild or unilateral hydronephrosis
Voiding cystourethrography
 Not indicated if normal sonogram post natal
 Value if still post natal hydronephrosis

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