Anatomical & physiological features of urinary tract in children. Semiotics of urinary tract diseases. Renal failure презентация

PH.D., Professor of pediatrics, the Head of propedeutics of pediatrics department

ANATOMICAL & PHYSIOLOGICAL FEATURES
OF URINARY TRACT IN CHILDREN.
SEMIOTICS OF URINARY TRACT DISEASES.
RENAL FAILURE.

N.V. Kizima – M.D., associate professor

calyx-pelvis system of the kidney, ureter, urinary bladder, female or male urethra).

colligation renal tubes

tubules formed from Ureteric bud (metanephric diverticulum).
The urogenital sinus (also known as the persistent cloaca) is a part of the human body only present in the development of the urinary and reproductive organs. The upper part of the urogenital sinus gives rise to the URINARY BLADDER.

the urinari Bladder

Megacystis (Megaureter) Syndrome

and Ectopic Ureter

in a female presenting with a normal voiding pattern and constant urinary dribbling. The left kidney is normal and the right side, well visualized, is the lower collecting system of a duplicated kidney. On the upper pole opposite the 1st and 2nd vertebral bodies, note the accumulation of contrast material corresponding with a poorly functioning upper pole drained by a ureter opening in the vestibule.

THE TYPES OF CONGENITAL DEVELOPMENTAL PATHOLOGY OF URINARY TRACTS ORGANS

Septa of the Bladder

Outlet Obstruction

bladder during urination results in an abnormal backflow of urine into the kidneys.

calyx-pelvis system of the kidney, ureter, urinary bladder, female or male urethra).

colligation renal tubes

allowing to suspect the urinary tract disease

Dysuric syndrome

Urinary syndrome: laboratory tests revealing bacteriuria, leukocytouria, postrenal (or painful) hematuria

Typical signs of urinary tract lesions obtained by instrumental and X-ray methods of examination

loin pain

Intoxication syndrome:
fever, anorexia (refusal of meals), vomiting and headache

Anomalies of development of urethra and urinary bladder.

urination with very small intermittent portions (urine by drops)

Incontinence of urine
is disuric symptom and means incapacity to keep urine in bladder leading to undesirable urination without urinary bladder`s tenesmus.

can be true in congenital and acquired diseases of a spinal cord which is responsible to regulate a normal intermittent urination and false in developmental anomalies of bladder or urethra forming abnormal apertures taking out detrusor function. This conditions must be distinguished from imperative feeling to make urination off. Also this last symptom can be described as an irresistible desire to void with short time (about few seconds) from occurrence of desire to void up to urinary bladder emptying. For prevention of imperative feeling to make urination off the children assume some characteristic poses. They squat pressing by a heel on perineum (Vincete`s “curtsey”), compress perineum crossing a legs, incline a trunk forwards, press an external genitals by their hands.

incontinence during the sleeping and it is wide spread in children.

The seldom urination
can be also a disuric symptom if it is not connected with water intake restriction. It means that the quantity of urination acts in day is less than normative date. The normative parameters differ in a wide range from 25 times per day in infants up to 6 times in adult children.

total urinary retention is owing to an absolute urine stocking in bladder due to, for example, stone formation in urethra, uretheral traumas and other reasons.

congenital and acquired diseases of a spinal cord, peripheral nerves, nerve plexus of a urinary bladder

the structural abnormality of urinary tract

Hypospadias

Classic bladder exstrophy in newborn

urine tract infection (including processes without clear clinical presentations) in the urine taken from the mean portion of stream the 10Е5 (100000) and more microorganisms in 1 ml can be found out.
Use microbiological tests.

of urine sediment for diagnosis leukocytouria or
Quantity urinalyses:
Addis`s test: The test is positive and leukocytouria is presented if more than 2 million (2000000 un.) leukocytes per day. Nechiporenko`s test : The test is positive and leukocytouria is presented if more than 2 thousand (2000 un.) leukocytes in 1 ml of urine.

The LEUKOCYTOURIA
is the presence of more than 5 leukocytes in visual field during the microscopic investigation of urine sediment.

presence more than one half of visual field at microscopy of urinary sediment.

tract is
POSTRENAL (PAINFUL) HEMATURIA.
Three measuring glass urine collect test:
the blood (erythrocytes) is presented in the beginning of urination (in the 1st measuring glass of urine) as result of urethra lesion

- the terminal (finishing) blood is presented in the end of urination act (in 3-th measuring glass) as result of urine bladder disease
- the proportional distribution of erythrocytes in all 3 portions (in measuring glasses) of urine as result of kidneys lesion either pelvis or ureter.

diagnose a quantity, position, sizes and anatomical structure of kidneys as a pelvis dilation and abnormal cavities or cysts. Also the ultrasonography is used for calculi diagnosing in any part of urinary tract.

performed by intravenous injection of water-soluble X-Ray contrast media substance. After that urine tract visible on X-Ray films and that is way the possible structural abnormalities can be seen (as result the kidney`s tubular secretion of contrast media into the urine).

urethral catheter. In the bladder the urine mixes with contrast media. The internal cavity and the walls of bladder becomes to be visible. In the X-Ray series this is the first film. After that the patient has to start voiding and others X-Ray films of kidney, ureter, bladder (KUB) area are to obtain. This series demonstrate any important details of urine tract including state of urethra.

bacilli - from patients own normal flora of his/her gastrointestinal system i.e. endogenous infection ( he/she is infecting him/herself!!)

most common gram negative bacteria - E. coli , Proteus , Kliebsiella and enterobacter

two ways the bacteria can reach the kidney: through the blood stream - hematogenous infection - less common . Occurs in septicaemia , bacterial endocarditis and immunocompromised patients

can start in early childhood (in infants)

inflammation of urinary bladder

Pain in the inguinal region of the abdomen
- Dysuria: frequent, painful urination, urinary incontinence
- Bacteriuria,
Leukocyturia, pyuria
Terminal according to test of three measuring glass microhematuria

substance of kidney caused by bacterial infection

PREDISPOSING FACTORS
urinary obstruction - either congenital or acquired
vesicoureteric reflux
diabetes mellitus - due to increased susceptiblity to infection
immunodepression and immunodeficiency

The pyelonephritis it is the complicated form of urine tract infection.
In pyelonephritis the microbes contaminate the pelvis of kidneys, tubular system in medullar substance of kidney.

headache

is UROLITHIASIS.

The cramping pain, hematuria, leukocytouria, dysuria are characteristic for UROLITHIASIS.
The acute retention of urine in bladder occurs due to urethra occlusion by a calculus.

often secondary to chest infection. The foci of caseosis and cavernes are typical for this disease. The ureters and bladder are affected by contaminated urine. Macro- or microhematuria is the most common laboratory sign of kidney TB. It reveals in 80—90 % of cases.

in which the kidneys fail to adequately filter toxins and waste products from the blood.

acute kidney injury

chronic kidney disease

- decrease in the glomerular filtration rate
- elevated serum creatinine level
- abnormal fluid levels in the body, deranged acid - levels, abnormal levels of potassium, calcium, phosphate, and (in the longer term) - anemia
- hematuria
- proteinuria

production, and characteristic laboratory findings, such as elevated blood urea nitrogen and creatinine.

PRERENAL:
decrease effective blood flow to the kidney
(low blood volume, low blood pressure, and heart failure, as well as local changes to the blood vessels supplying the kidney)

(to damage to the glomeruli, renal tubules, or interstitium. Common causes of each are glomerulonephritis, acute tubular necrosis (ATN), and acute interstitial nephritis (AIN)

POSTRENAL: consequence of urinary tract obstruction.
This may be related to benign kidney stones, obstructed urinary catheter, bladder stone, bladder, ureteral or renal malignancy. A renal ultrasound will demonstrate hydronephrosis if present.

process of the kidney`s excretory and regulatory functional losses and the development of uremia (serum urea overload).

NICTURIA

LOW
SPECIFIC URINE GRAVITY

HIGH LEVEL SERUM CREATININ

UREMIA

OLIGURIA

LOW GROMERULAR FILTRATION RATE

INCREASED BLOOD PRESSURE

PROTEINURIA, EDEMA,THIRST

on
heir growth and development!

Nausea
Vomiting
Headache
Loss of energy
Sore mouth
Drowsiness
Muscle twitches
Muscle cramps
Abnormal skin sensations
Skin discoloration
Skin itch

DELAY OF PHYSICAL GROWTH

ANEMIA

and urea, as well as free water from the blood when the kidneys are in renal failure.

patient with end-stage renal disease.