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Congenital anomalies of the kidneys

الكلية كلية الطب     القسم  الجراحة     المرحلة 4
أستاذ المادة محمد رضا جودي عبود جلو       17/12/2015 18:20:38
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.


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