Birth anomalies occur in about 6% of children. Routine Ultrasound examination of the pregnant mothers largely accounts for the higher incidence of anomalies detected in the babies. Environmental and lifestyle factors also could be responsible. Among the anomalies that require surgical attention, congenital kidney anomalies or defects are one of the most common varieties. I will discuss some of them today. Hydronephrosis or swelling of the kidneys occurs in about 2% of children.
Urine flow obstruction anomalies: The junction of the kidney’s urine collecting system (renal pelvis) and the tube draining urine into the urinary bladder (ureter) is called Uretero-Pelvic Junction. This junction and the upper ureter, if they do not work or relax properly, it results in obstruction to flow of urine and swelling of the kidney, called as Uretero-Pelvic Junction Obstruction Hydronephrosis. This is one of the most common problems in children. Due to this obstruction, back pressure changes occur resulting in permanent damage to kidney unless treated surgically. If both kidneys are affected, this may result in kidney failure. This is a curable condition by operation unless there is a delay.
Kidney rotation and fixation anomalies: They are also common and may require treatment if there is any compromise of drainage.
Structural anomalies: Horse-Shoe kidney is an anomaly where the kidneys are fused in the midline at their lower poles and create problems like pain, mass effect or pressure on ureters resulting in obstruction. Awareness of this entity at the time of any operation in the tummy is essential so that no inadvertent damage is caused.
Agenesis, multicystic dysplastic kidney, cystic disease of kidneys: They also are not uncommon. Each anomaly requires appropriate management depending on the complications.
Ureter anomalies: Megaureter (dilatation of the ureter resulting in loss of urine propelling capacity), Vesicoureteric reflux (backflow of urine from the bladder into kidneys), Vesico-Ureteric Junction Obstruction are some of the commonly encountered urological abnormalities in children.
Kidney cancerous tumors: Particularly Congenital mesoblastic nephroma or nephroblastomatosis in the first few months or Wilms tumor in the bigger children are quite common.
Each of the above anomalies needs to be treated appropriately for the well being of the child.