Summary Final year MD notes - paediatric renal and urology
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Macquarie University (MQ
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A collection suite of final paediatric MD notes to ace your penultimate and final year exams!
Look no further and save the stress of accessing multiple resources as this PDF collates and summarises information from several resources including but not limited to:
-Talley and O’Connor clinica...
PAEDIATRIC RENAL & UROLOGY
URINARY SYSTEM EMBRYOLOGY
• Urogenital system derived from intermediate mesoderm ® forms a urogenital ridge on either side of the developing aorta.
• Kidneys develop through 3 successive sets of tubular nephric structures:
(1) Pronephros ® (2) Mesonephros ® (3) Metanephros (gonads)
Urine production in utero
Metanephros– primordia of permanent kidneys begin to produce urine early in week 9 ® mixed with the amniotic fluid ® continues
throughout foetal life +
• A mature foetus swallows several hundred millilitres of amniotic fluid each day ® then absorbed by intestine.
• Waste products eliminated by placental circulation into maternal blood for elimination by the kidneys.
The metanephros develops from an outgrowth of the:
Outgrowth Forms the Function Adult derivatives of
Secretes growth factors that induce • Podocytes and bowman’s capsule
Condensation growth of the ureteric bud
Metanephric • Proximal convoluted tubules
of intermediate
blastema • Loop of Henle
mesoderm
• Distal convoluted tubule
Caudal Ureteric bud responds and secretes • Collecting tubules and ducts
mesonephric Ureteric bud growth factors to induces growth and • Minor and major calyces
duct differentiation of metanephric blastema • Ureters
Positional changes of kidneys [ascending ® inferior ® superior inc. renal arteries]
• During ascent of the embryonic kidneys (from pelvis ® upper posterior abdominal wall
• New blood vessels arise from the aorta and supply the kidney, while the vessels at the lower level disappear.
Development of the urinary bladder and urethra
• Cloaca = terminal hindgut lined with endoderm + • Bladder (lined by mesoderm) ç vesical part of the urogenital sinus,
receives the allantois (finger-like diverticulum) on its • BUT Trigone region ç caudal ends of mesonephric ducts.
ventral side.
o Due to traction with kidney ascent + ureters needing to
• urorectal septum (mesenchyme) divides cloaca into: enter obliquely through the base of the bladder.
o Ventral (urogenital sinus) • Orifices of mesonephric ducts move close together and enter
o Dorsal parts (rectum and anal canal) prostatic part of the urethra to become the ejaculatory ducts.
, Types of embryological renal anomalies
Anomalies of number What embryological urinary tract abnormality will cause oligohydramnios
during pregnancy?
• Unilateral renal agenesis (absence of one
kidney) • If foetus kidneys are not
• Supernumerary right kidney (separate or producing urine (e.g. bilateral
partially fused extra kidney) renal agenesis)
• decrease in amount of the
amniotic fluid in pregnancy
(oligohydramnios) since urine
produced is usually mixed
with amniotic fluid
• No fluid to cushion umbilical
cord from uterine
compression
• baby cannot survive
Anomalies of ascent Anomalies of form and fusion
• Renal ectopia is a congenital renal anomaly • Crossed renal ectopia with or without fusion
characterized by the abnormal location of one or • Horseshoe kidney (arrested by IMA)
both kidneys
• e.g. diaphragmatic kidney, pelvic kidney,
cephalad renal ectopia, thoracic kidney
PELVIC KIDNEY DIAPHRAGMATIC KIDNEY
Anomalies of rotation Anomalies of renal vasculature
• Malrotation Accessory renal vessels
• Failure of lower vessels to degenerate
during embryonic kidney ascending =
persistent accessory renal arteries (end
arteries)
• Consequently, if damaged or ligated the
part of the kidney supplied by accessory
artery is likely to become ischemic è may
need transplant
Anomalies of collecting Patent Urachus
system • Opening between the bladder and the umbilicus ® closes before birth
• Duplicated collecting system • An open urachus typically occurs in infants è can lead to cysts or
umbilical polyps
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