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Pediatric Surgery (Pg 68-81) - page 26 / 33

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threshold for renal exploration lower for penetrating injury

Renal Exploration: incision of posterior peritoneum medial to inferior mesenteric vein and anterior to aorta with isolation of renal vessels before colonic retraction

1. Congenital Disorders

Horseshoe Kidney

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Most common renal fusion anomaly, usually lower pole

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Dx by IVP

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Si/Sx: obstruction, infection, vague abdominal discomfort

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Tx: symphisiostomy (surgical division)

Congenital obstruction of the urinary tract

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occurs most often at the uretopelvic jxn

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leads to hydronephrosis:

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si/sx: palpable abdominal mass, pain, hematuria, urinary infection, fever, hypertension, renal stones

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Dx: IVP or ultrasonogram

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Nuclear scan is preferable to IVP in kids due to quantification of renal fxn and obstruction

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Tx: Surgical repair of obstruction to prevent renal fxn loss and UTI’s

Inflammatory Diseases

Pyleonephritis

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A clinical Dx

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Si/Sx: fever, flank pain, UTI, CVA tenderness on involved side

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E. coli

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Chronic pyelo → renal failure (common reason for transplant)

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IVP: nonspecific findings – diffuse renal enlargement w/calyceal distortion

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If uncomplicated Tx outpatient with oral ABx

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With sepsis or significant compromise, admit for IV ABx

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If si/sx persist > a few days, CT scan to exclude abscess

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Tx renal abscess by percutaneous drainage and ABx

Emphysematous Pyleonephritis

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Life threatening

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E. coli (mostly) form gas in renal parenchyma

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Seen in poorly controlled diabetics

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CT diagnostic

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Septic, deteriorate rapidly

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Emergency nephrectomy

Xanthogranulomatous pyelonephritis

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Females>males

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History of failure to thrive and chronic UTI, presents 5th-7th decade

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CT scan: imaging of choice

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Diffuse enlargement, central nephrolithiasis, spherical areas surrounding kidney in hydronephrotic pattern

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Affected kidney is nonfunctional → Tx: nephrectomy

GU TB

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Painless frequency esp at night

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