- Clinical science
Congenital anomalies of the kidneys and urinary tract (CAKUT) are one of the most common malformations diagnosed in newborns. Even though most cases are initially asymptomatic, up to 50% of children with end-stage renal disease have an underlying CAKUT. For this reason, early identification of these malformations is essential in order to prevent renal damage. The pathogenesis of CAKUT is multifactorial; both specific genes and environmental factors (e.g., in utero exposure to ACE inhibitors) have been implicated in the development of CAKUT.
- Most CAKUT are incidental findings with no clinical significance.
- CAKUT are considered clinically significant if they can lead to , , , , or .
- Signs that an underlying clinically significant CAKUT may be present include:
- Ultrasound imaging of the kidneys and bladder
- Voiding cystourethrogram
- Intravenous pyelogram: detects anatomic abnormalities; has largely been replaced by ultrasound and CT urography
- CT scan: detects anatomic abnormalities; can complement renal ultrasound if findings on ultrasound are equivocal
- Downward displacement of the kidney due to reduced perirenal fat (thin individuals, anorexia nervosa)
- Hypermobility of the kidney
- Renal ultrasound in upright and supine position
- Intravenous pyelogram in upright and supine position
- Conservative: abdominal muscle training and stabilization with abdominal wall binders
- Surgical: laparoscopic nephropexy
The differential diagnoses listed here are not exhaustive.
|Duplex kidney|| |
|Renal agenesis|| || |
|Renal aplasia|| |
|Renal hypoplasia|| |
|Renal dystopia/renal ectopia|| |
|Horseshoe kidney|| |
|Bifid collecting system|| |
|Ectopic ureter|| |
- The majority of cases do not require treatment.
- If there is vesicoureteral reflux → antibiotic prophylaxis (see )
- If there is vesicoureteral reflux and recurrent cystitis or pyelonephritis → surgical correction
- Laparoscopic nephrectomy may be indicated in cases with recurrent pyelonephritis and loss of kidney function.