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Book Details
Abstract
Kidney anomalies are the most frequent abnormality detected on prenatal ultrasound. Some are inconsequential and others are life-threatening. All must be addressed by neonatologists. This edition of Pediatric Clinics of Perinatology covers these anomalies. In addition, it addresses a variety of other nephrology and urology issues that neonatologists confront. Some are rare and the chapter may then serve as an important resource. Others are common, and thus will provide updated information on diagnosis and management.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Renal and Urologic Issues\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| Contents | vii | ||
| Clinics In Perinatology\r | xiv | ||
| Foreword\r | xv | ||
| Preface\r | xix | ||
| Acute Kidney Injury in the Neonate | 487 | ||
| Key points | 487 | ||
| Introduction | 487 | ||
| AKI incidence and at-risk populations in the neonatal intensive care unit | 488 | ||
| AKI definitions and diagnosis | 488 | ||
| Identifying the cause of AKI in the critically ill neonate | 490 | ||
| Renal Hypoperfusion (Prerenal Injury) | 490 | ||
| Parenchymal (Intrinsic) Kidney Injury | 490 | ||
| Urinary Tract Obstruction (Postrenal) | 492 | ||
| Diagnostic evaluation | 492 | ||
| History and Risk Factors | 492 | ||
| Physical Examination | 492 | ||
| Laboratory and Radiology Findings | 492 | ||
| Medical management of AKI in the neonate | 493 | ||
| Electrolyte and Mineral Homeostasis | 493 | ||
| Acid-Base Homeostasis | 494 | ||
| Therapeutics | 494 | ||
| Other Medications | 494 | ||
| Renal Supportive Therapy | 494 | ||
| Novel biomarkers | 495 | ||
| Long-term outcomes | 495 | ||
| Future directions | 496 | ||
| References | 496 | ||
| Chronic Kidney Disease in the Neonate | 503 | ||
| Key points | 503 | ||
| Defining CKD in the neonate | 503 | ||
| Incidence and common causes | 505 | ||
| Ethical considerations | 506 | ||
| Nutritional management | 508 | ||
| Outcomes | 510 | ||
| References | 512 | ||
| Renal Replacement Therapy in Neonates | 517 | ||
| Key points | 517 | ||
| Introduction | 517 | ||
| RRT for AKI | 518 | ||
| Acute PD for AKI in Neonates | 518 | ||
| PD access | 518 | ||
| PD fluids | 518 | ||
| Osmotic agents | 518 | ||
| Buffers | 519 | ||
| Electrolytes | 519 | ||
| Acute PD prescription | 520 | ||
| Special case: acute PD for neonatal AKI after cardiopulmonary bypass | 520 | ||
| CRRT for AKI in Neonates | 521 | ||
| CRRT technique | 521 | ||
| Access line | 522 | ||
| Hemofilter and tubing | 522 | ||
| Anticoagulation | 522 | ||
| Replacement and dialysate fluids | 522 | ||
| CRRT prescription | 522 | ||
| CRRT circuit ECMO | 522 | ||
| CRRT challenges in neonates and the future | 523 | ||
| Intermittent Hemodialysis for AKI in Neonates | 523 | ||
| RRT for neonates with hyperammonemia | 524 | ||
| Supplementary data | 525 | ||
| References | 525 | ||
| Neonatal Hypertension | 529 | ||
| Key points | 529 | ||
| Introduction | 529 | ||
| Scope of the problem | 529 | ||
| Measuring blood pressure in a neonate | 530 | ||
| Diagnosis of hypertension | 531 | ||
| Etiology of hypertension | 531 | ||
| Clinical investigation | 531 | ||
| Treatment | 534 | ||
| Surgical interventions | 538 | ||
| Outcomes | 538 | ||
| Summary | 538 | ||
| References | 539 | ||
| Neonatal Polycystic Kidney Disease | 543 | ||
| Key points | 543 | ||
| Introduction | 543 | ||
| Hereditary PKD | 544 | ||
| Background | 544 | ||
| ARPKD | 544 | ||
| Frequency | 545 | ||
| Clinical manifestations | 545 | ||
| Diagnostic testing | 545 | ||
| Ultrasonography | 545 | ||
| Radiography | 545 | ||
| Magnetic resonance imaging (MRI) and computed tomography (CT) scans | 546 | ||
| Genetic testing | 547 | ||
| Treatment | 547 | ||
| Mortality/Morbidity | 548 | ||
| Autosomal Dominant Polycystic Kidney Disease | 548 | ||
| Frequency | 548 | ||
| Clinical manifestations | 548 | ||
| Diagnostic testing | 550 | ||
| Ultrasonography | 550 | ||
| MRI and CT scans | 550 | ||
| Genetic testing | 550 | ||
| Treatment | 551 | ||
| Mortality/Morbidity | 551 | ||
| Nonhereditary PKD | 552 | ||
| MCDK | 552 | ||
| Frequency | 552 | ||
| Clinical manifestations | 552 | ||
| Diagnostic testing and treatment | 553 | ||
| Mortality/Morbidity | 555 | ||
| Obstructive Cystic Dysplasia | 555 | ||
| Simple Renal Cyst | 556 | ||
| Complex Renal Cyst | 556 | ||
| References | 557 | ||
| Long-Term Renal Consequences of Preterm Birth | 561 | ||
| Key points | 561 | ||
| Clinical scenario 1 | 561 | ||
| Chorioamnionitis | 562 | ||
| Antenatal Steroids | 562 | ||
| Preterm Birth | 563 | ||
| Clinical scenario 1 (continued) | 563 | ||
| Nephrotoxic Medications | 564 | ||
| Growth Restriction | 564 | ||
| Clinical scenario 2 | 565 | ||
| Maternal Disease | 565 | ||
| Diabetes | 565 | ||
| Preeclampsia | 566 | ||
| Clinical scenario 2 (continued) | 566 | ||
| Obesity After Growth Restriction | 566 | ||
| Long-Term Consequences of Preterm Birth on the Kidney | 567 | ||
| Summary | 568 | ||
| References | 568 | ||
| Electrolyte Disorders | 575 | ||
| Key points | 575 | ||
| Introduction | 575 | ||
| Basics of Renal Water and Electrolyte Handling | 576 | ||
| The Special Circumstances of the Neonatal Kidney | 576 | ||
| Dysnatremias | 577 | ||
| Hyponatremia | 577 | ||
| How to Assess the Cause of True Hyponatremia | 577 | ||
| Treatment of Hyponatremia | 579 | ||
| Hypernatremia | 580 | ||
| Treatment | 580 | ||
| Dyskalemias | 580 | ||
| Internal Potassium Balance | 581 | ||
| Hypokalemia | 582 | ||
| Clinical Manifestations | 582 | ||
| Clinical Assessment | 582 | ||
| Treatment | 583 | ||
| Hyperkalemia | 584 | ||
| Treatment | 584 | ||
| Inherited disorders associated with electrolyte abnormalities | 584 | ||
| Bartter Syndrome | 584 | ||
| Pseudohypoaldosteronism Type 1 | 587 | ||
| References | 587 | ||
| Hematuria in the Newborn | 591 | ||
| Key points | 591 | ||
| Introduction | 591 | ||
| Incidence | 591 | ||
| Definition | 591 | ||
| Etiology | 592 | ||
| History | 592 | ||
| Physical Examination | 592 | ||
| Laboratory | 593 | ||
| Imaging | 593 | ||
| Disorders associated with newborn hematuria | 594 | ||
| Trauma | 594 | ||
| Acute Tubular Necrosis and Cortical Necrosis | 595 | ||
| Structural Abnormalities | 595 | ||
| Glomerulonephritis | 596 | ||
| Nephrocalcinosis and Nephrolithiasis | 596 | ||
| Thrombotic Event | 597 | ||
| Bleeding Disorders | 599 | ||
| Infectious | 600 | ||
| Medications | 600 | ||
| Summary | 600 | ||
| References | 600 | ||
| Nephrotic and Nephritic Syndrome in the Newborn | 605 | ||
| Key points | 605 | ||
| Introduction | 605 | ||
| Diagnosis of congenital nephrotic syndrome | 606 | ||
| Congenital nephrotic syndrome of the Finnish type (NPHS1) | 607 | ||
| Congenital nephrotic syndrome resulting from podocin mutations (NPHS2) | 609 | ||
| Diffuse mesangial sclerosis caused by WT1 mutations | 610 | ||
| Pierson syndrome (LAMB2) | 610 | ||
| Other genetic causes of CNS | 611 | ||
| Nongenetic causes of CNS | 611 | ||
| Evaluation of an infant with nephrotic syndrome | 611 | ||
| Management of an infant with nephrotic syndrome | 611 | ||
| Complications of nephrotic syndrome | 612 | ||
| Diagnosis of nephritic syndrome | 613 | ||
| Hemolytic uremic syndrome in the neonate | 613 | ||
| Antenatal membranous glomerulonephritis resulting from maternal antibody transfer | 613 | ||
| Lupus nephritis | 614 | ||
| Evaluation of an infant with nephritic syndrome | 614 | ||
| Management of neonatal nephritic syndrome | 614 | ||
| References | 614 | ||
| Renal Teratogens | 619 | ||
| Key points | 619 | ||
| Introduction | 619 | ||
| Overview of nephrogenesis | 620 | ||
| The renin-angiotensin system during development | 623 | ||
| Known or suspected nephroteratogenic drug classes | 623 | ||
| ACE Inhibitors and ARBs | 623 | ||
| Nonsteroidal Antiinflammatory Drugs (Selective/Nonselective) | 624 | ||
| Corticosteroids | 625 | ||
| Cancer Chemotherapeutics | 625 | ||
| Immunosuppressives | 626 | ||
| Aminoglycosides/Other Antibiotics | 626 | ||
| Renal Effects of Selected General Teratogens | 627 | ||
| Summary/Discussion | 627 | ||
| Recommendations | 628 | ||
| Acknowledgments | 629 | ||
| References | 629 | ||
| Diagnosis and Management of Urinary Tract Infection and Vesicoureteral Reflux in the Neonate | 633 | ||
| Key points | 633 | ||
| Epidemiology and risk factors | 633 | ||
| Vesicoureteral reflux | 634 | ||
| VUR and renal scarring | 635 | ||
| Causative organisms for UTI | 635 | ||
| Clinical presentation | 635 | ||
| Diagnosis of UTI | 636 | ||
| Urinalysis and Culture | 636 | ||
| Inflammatory Markers | 637 | ||
| Renal imaging after UTI in neonate | 637 | ||
| Renal Ultrasound | 637 | ||
| Voiding Cystourethrogram | 638 | ||
| Renal Scan | 638 | ||
| Treatment | 638 | ||
| Treatment of UTI | 638 | ||
| Management of VUR | 639 | ||
| Antimicrobial prophylaxis | 639 | ||
| Follow-up | 640 | ||
| References | 640 | ||
| Lower Urinary Tract Obstruction in the Fetus and Neonate | 643 | ||
| Key points | 643 | ||
| Introduction | 643 | ||
| Epidemiology and introduction of LUTO | 644 | ||
| PUV | 644 | ||
| Urethral Atresia | 645 | ||
| PBS | 645 | ||
| Anterior Urethral Obstruction | 646 | ||
| Obstructing Ureterocele | 646 | ||
| Mimics of LUTO | 646 | ||
| Voluntary Termination of Pregnancy | 647 | ||
| Antenatal suspicion of LUTO | 647 | ||
| Timing | 647 | ||
| Amniotic Fluid Volume | 647 | ||
| Renal Appearance | 648 | ||
| Bladder Appearance | 648 | ||
| Urinary Extravasation | 649 | ||
| Neonatal diagnosis and management | 649 | ||
| Standard Work-up | 649 | ||
| PUV | 650 | ||
| UA | 651 | ||
| PBS | 651 | ||
| Long-term outcome of LUTO | 651 | ||
| Antenatal intervention | 652 | ||
| Preservation of Renal Function | 652 | ||
| Renal Function in LUTO Survivors | 653 | ||
| Pulmonary Survival | 653 | ||
| Percutaneous Shunting for LUTO Trial | 653 | ||
| Summary | 654 | ||
| References | 654 | ||
| Hydronephrosis | 661 | ||
| Key points | 661 | ||
| Introduction | 661 | ||
| Prenatal diagnosis and management | 662 | ||
| Defining ANH | 662 | ||
| Anterior-Posterior Diameter | 662 | ||
| Differential Diagnosis | 663 | ||
| Prognosis | 663 | ||
| Grading and severity of ANH | 663 | ||
| Renal parenychmal assessment | 665 | ||
| Amniotic fluid level | 665 | ||
| Additional features | 666 | ||
| Prenatal Management | 666 | ||
| Elective termination | 666 | ||
| Expectant management | 668 | ||
| Early delivery | 668 | ||
| Fetal intervention | 668 | ||
| Postnatal evaluation and management | 669 | ||
| Evaluation | 670 | ||
| Renal and bladder ultrasound | 670 | ||
| Grading of hydronephrosis on RBUS | 670 | ||
| Which patients need evaluation? | 671 | ||
| Optimal timing of RBUS | 671 | ||
| VCUG | 671 | ||
| Diuretic renal scintigraphy | 672 | ||
| Which patients with ANH need DRS? | 672 | ||
| Magnetic resonance urogram | 672 | ||
| Evaluation of Obstruction | 673 | ||
| Which Patients Require Surgery for Obstruction | 673 | ||
| Continuous Antibiotic Prophylaxis | 674 | ||
| Summary | 674 | ||
| References | 674 | ||
| Upper Urinary Tract Anomalies and Perinatal Renal Tumors | 679 | ||
| Key points | 679 | ||
| Renal embryology | 679 | ||
| Unilateral renal agenesis | 680 | ||
| Incidence, Diagnosis, and Associated Anomalies | 680 | ||
| Long-Term Outcomes | 682 | ||
| Anomalies of ascent | 683 | ||
| Simple Renal Ectopia | 683 | ||
| Anomalies of form and fusion | 684 | ||
| Crossed Renal Ectopia with and Without Fusion | 684 | ||
| Horseshoe kidney | 684 | ||
| Incidence, Diagnosis, and Associated Anomalies | 684 | ||
| Renal hypoplasia and dysplasia | 685 | ||
| Renal Hypoplasia | 685 | ||
| Renal Dysplasia | 685 | ||
| Neonatal renal tumors | 687 | ||
| Incidence, Diagnosis, and Associated Syndromes | 687 | ||
| CMN | 687 | ||
| WT | 688 | ||
| Rhabdoid Tumor of the Kidney | 689 | ||
| Clear Cell Sarcoma of the Kidney | 689 | ||
| Neuroblastoma | 689 | ||
| Prenatally Diagnosed Adrenal Mass | 689 | ||
| Congenital Neuroblastomas: Special Considerations | 690 | ||
| References | 690 | ||
| Disorders of the Bladder and Cloacal Anomaly | 695 | ||
| Key points | 695 | ||
| Introduction | 695 | ||
| Urachal anomalies | 696 | ||
| Patient History/Physical Examination | 696 | ||
| Imaging/Additional Testing | 696 | ||
| Management | 697 | ||
| Summary | 697 | ||
| Bladder exstrophy | 697 | ||
| Patient History/Physical Examination | 698 | ||
| Imaging/Additional Testing | 699 | ||
| Management | 699 | ||
| Summary | 699 | ||
| Cloacal exstrophy | 700 | ||
| Patient History/Physical Examination | 701 | ||
| Imaging/Additional Testing | 701 | ||
| Management | 701 | ||
| Summary | 703 | ||
| Persistent cloaca | 703 | ||
| Patient History/Physical Examination | 703 | ||
| Imaging/Additional Testing | 704 | ||
| Management | 704 | ||
| Summary | 704 | ||
| References | 705 | ||
| Neuropathic Bladder in the Neonate | 725 | ||
| Key points | 725 | ||
| Introduction | 725 | ||
| Bladder evaluation | 727 | ||
| Therapeutic options | 729 | ||
| References | 731 | ||
| Index | 735 |