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Pediatric Surgery (Pg 68-81) - page 27 / 33

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Sterile pyuria → suspect TB!

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Positive PPD helpful, Dx by isolation of M. tuberculosis in urine

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IVP is mandatory, also get chest films and spine imaging

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Give anti-TB drugs, maybe nephrectomy

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Tx ureteral stricture with temp internal stenting, corticosteroids, or uereteral reimplantation in distal ureteral strictures

Neoplasms

Most common presentation: painless hematuria

Charcot’s triad: flank pain, abdominal mass, hematuria (rarely seen all together)

CT scan

Cystic lesions identified by IVP and confirmed by US

If tumor invasion of IVC is suspected, get an MRI

Benign Neoplasms

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simple cystic lesions require no intervention

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complex (septations, wall thickening, calcifications) require further investigation

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consider complex cyst cancer until proven otherwise

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needle biopsy of little value → do partial or radical nephrectomy

Malignant Neoplasms

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Renal Cell Carcinoma

most common primary neoplasm of kidney

usually from proximal convoluted tubules

typically unilateral

hematuria is most common sign

flank pain and palpable flank mass next most common signs

may also see fever, anemia, elevated sed rate

no reliable tumor markers

tends to invade renal vein and IVC → right atrium

mets to lungs, bone brain

late mets to liver

Tx: radical or partial nephrectomy

Get a bone scan for bone pain or elevated Alk Phos

Preop get CXR and LFTs

Post op complications: bleeding, retroperitoneal abscess, ileus, wound infection

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Transitional Cell Carcinoma

may present as renal mass or filling defect on IVP

ereteroscopy to visualize or biopsy suspicious lesions

upper tract seeds lower tract ALWAYS evaluate upper tract if TCC is found in lower tract

Tx: nephroureterectomy with removal of cuff of bladder

Urinary Stone Disease

Mostly calcium oxalate

Calcium stone risk factors: RTA, hyperparathyroidism, poor hydration, immobilization, family history

Uric acid stone risk factors: high purine intake, hx of gout, poor hydration, hyperuricosuria

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