CH. 64 OB

Ureteropelvic Junction Obstruction (UPJ): Renal pelvis may take on _____ _____ appearance surrounded by dilated or normal calyces

"bullet shape"

In second trimester, identification of female fetus should only be determined when major and minor labia seen Visualization of labia is often called __________ sign. Male fetus in second trimester determined by visualization of penis and scrotal sac, known as __________

"hamburger" "turtle sign"

Infants born with bilateral renal agenesis exhibit Potter facies which are? These deformities are caused by?

(flat nose, recessed chin, abnormal ears, and wide-set eyes) and abnormal or malpositioned limbs. lack of amniotic fluid.

Development of the Kidneys: - First pair of "kidneys," _________, are? -Second pair of "kidneys," __________, function for? ...Degenerate after replaced by -Permanent kidneys (_________) begin to develop early in _________ while mesonephroi still developing.

-pronephros= rudimentary and nonfunctional. -mesonephros= short time during early fetal period. ...metanephros, or permanent kidneys -metanephros= fifth week

Multicystic Dysplastic Kidney Disease (MCDK): Renal tissue replaced by cysts of varying sizes throughout the kidney Entire kidney or only portion of kidney may be affected. Incidence is ___ of ____ births; is found more often in ____ Is linked to _____ ______ A variant of?

1 of 3000 males maternal diabetes renal dysplasia

Kidneys should be sonographically documented in all fetuses beginning at ______ weeks' gestation. a. 12 b. 15 c. 18 d. 20

12

Renal Agenesis: Sonographic findings: Severe oligohydramnios after? Persistent absence of? Failure to visualize? Abnormally small?

13 to 15 weeks menstrual age urine in fetal bladder (observe for period of 1 hour) kidneys or renal arteries (use color flow to outline renal arteries) thorax

Ultrasound Appearance of Kidney: Between _______ of gestation, kidneys slightly hyperechoic compared to surrounding tissues By _________, it is possible to distinguish the renal cortex from the medulla, outline the renal capsule clearly, and see a central echogenic area in renal sinus region.

18 and 20 weeks 25 weeks

Infantile Polycystic Kidney Disease: Enlargement of kidneys may not occur until ? Enlargement will lead to ?

24th week of gestation. abdominal circumference large for gestational age

Bladder lying low within pelvis. Three-vessel cord demonstrated. Fetal bladder usually takes at least ___ _____ to fill and empty.

30 minutes

review slide 54-58

56 is severe

Ureters typically measure _________ in diameter and should not be filled with _______ _____. Slight dilation of ureter may be visible at ____ ___. Urine jets may be seen in bladder where ureters enter.

<1 to 2 mm anechoic fluid. renal pelvis.

Findings suggesting hydronephrosis include abnormal intrapelvic anteroposterior (AP) diameter measurement Intrapelvic diameter _______, considered mild hydronephrosis Intrapelvic diameter measuring ______, considered moderate hydronephrosis Intrapelvic diameter measuring_____ considered marked dilation or severe hydronephrosis

>7 mm 7 - 15 mm >15 mm,

Review slide 49

Adult Dominant Polycystic Kidney Disease

Refers to sonographic inability to delineate fetal gender True _________ is rare condition in which both ovarian and testicular tissues are present.

Ambiguous Genitalia hermaphroditism

Development of the Kidneys: Urine is excreted into ______ ____ ; is major part of amniotic fluid _____ ____ Is a critical marker in assessment of renal function Kidneys do not need to function in utero because?

Amniotic cavity Amniotic Fluid placenta eliminates waste from fetal blood.

______ renal agenesis is lethal disorder due to renal insufficiency can cause? Absence of amniotic fluid plays role in underdevelopment of fetal lungs. In cases of unilateral agenesis, presence of at least one functioning kidney contributes to excellent survival rates.

Bilateral hypoplasia of lungs.

________ imaged as rounded, echo-free area centrally located in pelvis.

Bladder

Anomalies occurring with horseshoe kidneys include: Incidence of what are also increased?

Central nervous system disorders Cardiac abnormalities Urogenital abnormalities trisomy 18 and 45,X

Prune Belly Syndrome Is characterized by three features:

Cryptorchidism Agenesis or hypoplasia of abdominal wall muscle Dilation of collecting system

Sonographic Findings Suggesting Abnormalities of the Urogenital System?

Dilation of any component of urinary tract Appearance of hydronephrosis in only one pole of kidney Renal cyst Enlarged echogenic kidneys Kidney not seen No bladder seen Anechoic tortuous pelvic mass Dilated urethra Abnormal amniotic fluid volume

Prune Belly Syndrome is referred to as?

Eagle Barrett syndrome

Ambiguous Genitalia: Most common cause is congenital virilizing adrenal hyperplasia that causes masculinization of external genitalia.

Enlarged clitoris Abnormalities of urogenital sinus Partial fusion of labia majora

Renal Cystic Disease= __________ group of ___,____,____ disorders

Heterogeneous heritable, developmental, acquired

Bridge of tissue connecting lower poles must be demonstrated for accurate diagnosis.

Horseshoe Kidneys

review slide 43

Infantile Polycystic Kidney Disease

Obstructive Urinary Tract Abnormalities: Urinary tract may be obstructed at: Junction of ureter entering renal pelvis= Junction of ureter where it enters bladder= Level of urethra=

Junction of ureter entering renal pelvis (ureteropelvic junction/UPJ) Junction of ureter where it enters bladder (ureterovesical junction/UVJ) Level of urethra (megacystis)

Prune Belly Syndrome : Other anomalies present that can affect prognosis:

Microcolon Intestinal malrotation Cardiac anomalies

review slide 47

Multicystic Dysplastic Kidney Disease

Is most common form of renal cystic disease in childhood; is one of the most common abdominal masses in neonates

Multicystic Dysplastic Kidney Disease (MCDK)

________ of adrenal gland is malignant tumor that develops from nerve tissue in adrenal gland.

Neuroblastoma

P- O- T- T- E- R-

P- Pulmonary hypoplasia O- Oligohydraminos T- Twisted Skin T- Twisted Face E- Extremities deffect R-Renal Agenesis

Bilateral renal agenesis often referred to as?

Potter syndrome

Renal agenesis, oligohydramnios, pulmonary hypoplasia, abnormal facies, and malformed hands and feet may be found in which one of the following conditions?

Potter syndrome

What are the three sets of excretory organs that develop in embryo: Only ___ set remains as the permanent kidneys (Review pic on slide 4)

Pronephros Mesonephros Metanephros Third

Review slides 24-27

Renal agenesis

Renal Abnormalities

Renal agenesis Multicystic renal dysplasia Congenital hydronephrosis Renal duplication Pelvic kidney Horseshoe kidney Infantile polycystic kidney disease Adult polycystic kidney disease Meckel-Gruber syndrome

Review slide 33

Renal ectopia

In the majority of cases of a simple hydrocele, testes normal and hydrocele will resolve after birth T or F

TRUE

Renal malformations may be divided into two categories: Consequences of renal malformation vary depending of type of?

Those involving congenital malformation Those resulting from obstructive process Lesion and extent of obstruction

Several sonographic clues that may indicate horseshoe kidney: transverse : spine down: sagittal and coronal:

Transverse images of fetal abdomen demonstrate abnormal lie of kidney. If spine down, connecting isthmus may be seen anterior to aorta In sagittal and coronal views, clear delineation of inferior pole of kidney not well seen; kidneys may appear oblique

Exstrophy of the Bladder: Genitalia malformations commonly seen:

Undescended testes Anterior displaced scrotum Small penis with episadias in males Cleft clitoris in females Multiple surgical procedures required to correct bladder abnormality as well as other associated genital anomalies

Ureterocele: Ureter typically inserts into ectopic location on bladder and can easily become obstructed. ____ pole more prone to obstruction

Upper pole

Occurs at junction between renal pelvis and ureter

Ureteropelvic Junction Obstruction

What is most common reason for hydronephrosis in neonate? Is more common in______; is usually _____

Ureteropelvic Junction Obstruction (UPJ) males unilateral

Review slide 61

Ureteropelvic Junction Obstruction (UPJ): pic

Renal Ectopia: Sonography will demonstrate absence of kidney in normal position, with _____ ____ filling space of ______ fossa. Abnormally located kidney will typically be? If kidney located in pelvis, is typically found lying superior to ______or adjacent to ____ ____.

adrenal gland renal smaller and rotated obliquely or horizontally. bladder iliac wing

What is Infantile Polycystic Kidney Disease? Is characterized by?

an autosomal-recessive congenital disorder that affects both fetal kidneys and liver. Is characterized by development of small cysts in both kidneys and liver cysts

Sonographic Evaluation of Kidneys: Are evaluated by assessing their ___,___, and___ Fetal kidneys have been documented as early as ________ of gestation. By _______ of gestation, 86% of fetal kidneys may be imaged. Fetal kidneys and bladder are seen by _______ of gestation

anatomy, texture, and size 9 weeks 12 weeks 13 weeks

Ureterocele: Sonographic appearance? Best visualized when ?

anechoic cystic appearance, surrounded by thin echogenic membrane within bladder. bladder somewhat full If bladder empty, ureterocele may be mistaken for small bladder If bladder too full, ureterocele may be compressed

Exstrophy of the Bladder: No muscle or connective tissue forms in_____ ______wall to cover urinary bladder. Therefore, bladder is formed?

anterior abdominal external to abdominal wall.

The kidneys initially lie in which one of the following positions? a. Far apart in the pelvis b. Very close together in the pelvis c. Close together in the upper abdomen d.Far apart in the upper abdomen

b. Very close together in the pelvis

Which one of the following characteristics of multicystic dysplastic kidney disease is most common? a.Distinct renal pelvis b.Multiple noncommunicating cysts of variable size c.Large kidneys with hyperechoic parenchyma d. Oligohydramnios

b.Multiple noncommunicating cysts of variable size

Ultrasound Appearance of Kidney: Appear as _____ ______ structures in __________ regions. At _______ of gestation, overall echogencity will decrease; renal pelvis may be seen as ______ areas within central kidney. As fetal age advances, _____ deposits in perinephric and sinus regions become visible.

bilateral hyperechoic paravertebral 15 weeks- sonolucent fat

Review slide 14 & 15 picture

bladder / femur

No specific bladder measurement usually applied; documentation of ___________________is important. Identify fetal bladder early in ultrasound examination to make sure? If no bladder seen or bladder appears too large, reevaluate at end of examination

bladder filling and emptying adequate fluid present

Renal malformations may be divided into which of the following two categories? a.Cystic and solid b.Cystic and obstructive c.Congenital and obstructive d.Congenital and cystic

c.Congenital and obstructive

Sonographic findings in complete renal agenesis include all of the following except: a.oligohydramnios. b.absence of urine in the fetal bladder. c.dilated fetal bladder. d.small thorax.

c.dilated fetal bladder.

Exstrophy of the Bladder: Sagittal view of abdominal pelvic region of fetus will reveal an anterior mass that appears as mound of soft tissue. Transverse view of pelvic bones will demonstrate widening of iliac crest. Important to differentiate this from _____ _____. In this condition, bladder findings are same. However, large and small intestines included in?

cloacal exstrophy anterior wall mass as well as multiple other anomalies

Multicystic Dysplastic Kidney Disease: If only one kidney affected, contralateral kidney may be enlarged as a result of? When bilateral, there is ____ & _____ ___ _____ As the disease progresses, nonfunctioning kidney _______ in size. This process may not be evident until?

compensatory hypertrophy. oligohydramnios and absence of bladder. decreases after birth

Adult Dominant Polycystic Kidney Disease: Congenital adult (autosomal) dominant polycystic kidney disease (ADPKD) is associated with?

cystic dilation of nephrons and of collecting tubule walls in both kidneys.

All of the following findings are observed in hydronephrosis except: a. anteroposterior (AP) renal pelvic diameter is greater than 5 to 10 millimeters (mm). b .rim of renal parenchyma is preserved. c. calyceal distention is seen with central pelvis communication. d. renal enlargement is found.

d.renal enlargement is found.

ADPKD: Is thought to be caused by? Results in cystic development of? Cysts typically do not enlarge or impair renal function until??

defective gene that does not allow for normal epithelial cell development cortex and medulla adulthood.

Development of the Kidneys: Urine formation begins toward?.... and continues actively throughout fetal life. do not become major contributor of fetal urine until?

end of first trimester, around 11th to 12th week 14 to 16 weeks of pregnancy

Normal _____ ______ usually not seen. Normal ______ ______ should always be seen.

fetal ureters fetal bladder

Amount and degree of obstruction depends on _____ ______ when obstruction began. If obstruction early, ... If obstruction occurs in first or second trimester, ..... Late obstruction produces ...

gestational age multicystic kidney may develop cystic dysplasia may result. hydronephrosis

Term pelviectasis commonly used in conjunction with _____________ Pylectasis refers to? Hydronephrosis refers to?

hydronephrosis dilation of renal pelvis without dilation of calyces. dilation of renal pelvis and calyces.

Recognition of urinary tract anomalies of significant clinical concern because several fetal conditions are? Recognition of lethal or treatable renal anomalies necessary to ensure appropriate clinical and therapeutic management

incompatible with life

Infantile Polycystic Kidney Disease: Sonographically, ______ ____ not identified; instead _____ massively enlarged because of hundreds of ______ ____.

individual cysts kidneys dilated tubules

Exstrophy of the Bladder: Is caused by defective closure of ? during ______ week of gestation

inferior part of anterior abdominal wall fourth

If descent interrupted or stopped, testes will remain located within ____ ____ Referred to as undescended testes, or _________ review pic on slide 82

inguinal canal cryptorchidism

Review pic of keyhole sign slide 70-71

keyhole

Horseshoe Kidneys: May be found as isolated anomaly or be associated with other anomalies or syndromes Prevalence of ? Difficult to diagnosis in _____

kidney stones, urinary tract infections, hydronephrosis, as well as reflux common utero

Review pic on slide 19

kidneys

Exstrophy of the Bladder: Fluid-filled bladder not visualized; however, normal ___ & _____ evident _____ _____ _____ representing everted atrophied bladder identified where? Sonographer should note __________________ when anomaly present

kidneys and amniotic fluid Small irregular mass lower abdomen below umbilical cord insertion abnormally low cord insertion

Prune Belly Syndrome: Is thought to result from embryologic defect of mesoderm or as urethral obstruction malformation complex Is rare condition seen mostly in males Association with males thought to be due to complex development of ____ _____ Prognosis dependent on _____ ____ . With normal ____ ____ ___, prognosis typically good

male urethra renal function amniotic fluid levels

Horseshoe Kidneys: Fusion may occur in 1 to 4 in 1000 births; is two to three times more common in_____. Review slide 29.

males

Wilms tumor is ______ tumor thought to be derived from ____ ____ ___. s more commonly seen in______

malignant abnormal renal cells females

Most common renal tumor is?

mesoblastic nephroma (harmartoma). A benign tumor composed of a collection of oddly arranged tissue indigenous to the area

Multicystic Dysplastic Kidney Disease (MCDK): Is characterized by?

multiple, smooth-walled, nonfunctioning, noncommunicating cysts of variable size and number

Early development of external genitalia similar for both sexes Distinguishing sexual characteristics begin during____ week External genital organs are fully differentiated by ____ week of gestation

ninth week 12th

Review slide 11

normal kidney

In some cases, one of kidneys may remain in _____ cavity while other migrates into? The kidney lies outside of its normal position in the _____ ____

pelvic posterior flank of abdomen. renal fossa

Development of the Kidneys: Initially lie very close together in ____ Gradually migrate into? Normally complete migration by _____ ____ of gestation

pelvis abdomen and become separated from one another ninth week

review slide 37

pic

Is characterized by protrusion of ____ wall of urinary bladder

posterior Exstrophy of the Bladder

Complete absence of kidney(s) is known as?

renal agenesis.

Ureteropelvic Junction Obstruction Results in back up of urine into? Causes include?

renal pelvis and calyces Abnormal bends or kinks in ureter Adhesions Abnormal valves in ureter Abnormal outlet shape at ureteropelvic junction Absence of longitudinal muscle

Fetal hydronephrosis may occur as unilateral or bilateral process. Unilateral renal hydronephrosis commonly results from obstruction at junction of?

renal pelvis and ureter.

Potters Syndrome Classification type 1-4 (slide 40)

review

Potter's classification or Potter's ______ used to describe diseases associated with?

sequence renal failure, oligohydramnios, and Potter facies

Review slide 87-89

sex sign pic

•Normal fetal bladder wall should be? •Normal measurement of wall is? •Is best measured at level of ________ ______

thin. 2 mm or less umbilical artery

The kidney lies outside of its normal position in the renal fossa: Usually lies in area of pelvis In rare incidences, the kidney may be located in _______ cavity, more commonly on the ____ side.

thoracic cavity, more commonly on left side.

Undescended Testicles: Is associated with risk of ____ and development of ____ Risks significantly lowered if testes surgically placed within scrotum sac early in childhood

torsion cancer

Infantile Polycystic Kidney Disease: Cysts in kidney thought to be caused by? Causes overall..? Leading to?

tubular malformation and ectasia of collecting ducts overall enlargement of the kidneys. Leading to renal failure

Review slide 78

tumor pic

Renal Agenesis: Condition occurs when _______ _____ fail to develop or when they degenerate before they can induce metanephric mesoderm to form _______. Prognosis dependent on _____ or ______ involvement of kidneys as well as _____ _____. In diagnosing renal agenesis, acquiring complete clinical history and thorough examination of _______________ is critical.

ureteric buds nephrons. unilateral or bilateral associated abnormalities all fetal structures

Urogenital system = Excretory ducts of both systems initially enter common cavity called ______. Creating?

urinary system and genital system . Cloaca. Creating the anus, the vagina and urethra

Hydronephrosis: Dilation of renal pelvis occurs in response to blockage of ___ at some junction in urinary system. _____ _____ is most common fetal anomaly. Commonly occurs when there is obstruction in __,__,___

urine Fetal hydronephrosis ureter, bladder, or urethra