Relação entre ectopia renal e risco de ITU

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Relação entre ectopia renal e risco de ITU

Mensagem  Renato Gomes em Seg Jan 07, 2013 8:29 pm

Segue um trecho do UpToDate que discorre sobre ectopia renal e anormalidades de fusão:

RENAL ECTOPY — Renal
ectopy occurs when the kidney does not normally ascend to the
retroperitoneal renal fossa (level of the second lumbar vertebra).
Simple congenital ectopy refers to a kidney that lies on the correct
side of the body but lies in an abnormal position. Kidneys that cross
the midline are referred to as crossed renal ectopy. Crossed renal
ectopy can occur with and without fusion to the contralateral kidney.

Ectopic
kidneys that do not ascend above the pelvic brim are commonly called
pelvic kidneys. Rarely, the ectopic kidney is found in the thorax. Bilateral renal ectopy has also been reported but is a rare occurrence.
The
ectopic kidney fails to rotate normally resulting in a shift of the
renal axis so that the renal pelvis is directed anteriorly rather than
medially. The blood supply of the ectopic kidney is variable and may
come from the iliac arteries, aorta, and at times, the hypogastric and
middle sacral arteries.
The incidence of renal ectopy is reported
as 1 in 1000 autopsies. A similar rate was reported in a study of 13,705
fetuses with antenatal ultrasounds performed in a tertiary center in
Turkey.
However, a study that screened 132,686 Taiwanese schoolchildren (6 to
15 years of age) found a lower incidence of 1 in 5000 children.
In this study, 30 cases of ectopic kidneys were detected by a "quick"
screening renal ultrasound in 20 boys and 10 girls. Further imaging
located the ectopic kidney in the lower lumbar region of 21 children,
and in the pelvis and the thorax of five and two other children,
respectively. The kidney crossed the midline in a further two children.
This study may have underestimated the incidence of renal ectopy because
of limitations of the screening technique used.
CLINICAL FINDINGS OF RENAL ECTOPY — The
majority of patients with renal ectopy are asymptomatic. The diagnosis
is often made coincidentally during routine antenatal or postnatal
ultrasonography. This was illustrated in a case series of 99 children
with renal ectopy, of which 79 were asymptomatic at the time of
diagnosis
. The diagnosis was made by either antenatal or postnatal ultrasonography.
In
a fetus with normal amniotic fluid volume, the most likely cause of an
absent kidney in the renal fossa is an ectopic kidney as demonstrated in
the previously mentioned retrospective review of 13,705 fetuses who had
antenatal ultrasounds.
Of 40 cases with an empty renal fossa identified, the underlying cause
in 24 patients was renal ectopia, and unilateral renal agenesis and
horseshoe kidney in 13 and 2, respectively. Crossed fused renal ectopy
was detected in one patient. Thus, a finding of an empty renal fossa
should direct the ultrasonographer to search for an ectopic kidney.
In
patients diagnosed symptomatically, findings at presentation are
generally related to associated complications, such as urinary tract
infection
, obstruction, and renal calculi. Symptoms include abdominal
pain, fever, hematuria, or incontinence from an ectopic ureter. On
examination, an abdominal mass may be palpable or hypertension detected.
In
the previously mentioned case series of 99 patients, at presentation,
12 of the 20 patients with symptomatic renal ectopy had signs of urinary
tract infection
, four had abdominal pain, two had a palpable abdominal
mass, one had hematuria and one was incontinent.
The
ectopic kidney generally has decreased function. As illustrated in the
case series of 99 patients, decreased renal function was detected by
9mTc-dimercaptosuccinic acid (DMSA) renal scan in 74 of 82 cases of
simple unilateral renal ectopy.
Rarely
in female patients, persistent urinary incontinence characterized by
continuous dampness of their underwear can be secondary to a small
ectopic pelvic kidney.
Renal sonogram may not be sensitive enough to identify the tiny ectopic
kidney, which may be associated with compensatory hypertrophy of the
normal contralateral kidney. A high clinical suspicion should initiate
evaluation with a DMSA scan and/or magnetic resonance imaging urogram to
look for a dilated ureter and associated ectopic renal nubbin.
Laparoscopic removal will resolve the incontinence.
Other anomalies — A
high incidence of other urological abnormalities has been associated
with renal ectopy. Vesicoureteral reflux (VUR) is the most common
. The following urological abnormalities were noted in the case series of 99 patients:

  • VUR
    occurred in 20 percent of crossed renal ectopy, 30 percent of simple
    renal ectopy, and 70 percent in bilateral simple renal ectopy.

  • Other genitourinary abnormalities included:


  • Contralateral renal dysplasia in four cases; three with multicystic dysplasia and one with renal agenesis
  • Cryptorchidism in five cases
  • Hypospadias in five cases
  • Hydronephrosis in three ectopic and eight contralateral kidneys; in one ectopic kidney, ureteropelvic obstruction was detected.


--> A fonte não deixa claro se há um risco significativamente aumentado de desenvolver ITU sendo portador de uma ectopia renal, mas mostra que há grande prevalência de anormalidades urológicas, como Refluxo Vesicoureteral, o que por si só é fator de risco para tais processos infecciosos.

Renato Gomes

Mensagens : 7
Data de inscrição : 22/12/2012
Idade : 27

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