American Medical Association Family Medical Guide - American Medical Association [206]
Diagnosis
Doctors often identify renal dysplasia during an ultrasound scan before birth. In older children, doctors sometimes detect the possibility of renal dysplasia during a physical examination while taking the child’s blood pressure. The diagnosis can be confirmed by an ultrasound scan or a radionuclide scan (see page 114).
Treatment
A child with renal dysplasia may not require treatment because a person can live with only one working kidney. However, if the disorder causes health problems, the doctor may recommend surgical removal of the affected kidney. If both kidneys are affected, the doctor will probably recommend a kidney transplant.
Wilms’ Tumor
Wilms’ tumor is a rare, life-threatening cancer in which a malignant growth forms in one of the kidneys. The disorder usually affects children under age 5, boys twice as often as girls. The disorder tends to run in families. Prompt treatment is needed to prevent the cancerous cells from spreading to other parts of the body, such as the lungs, liver, brain, or the other kidney.
Symptoms
The main symptom of Wilms’ tumor is a hard lump that can be felt in the child’s abdomen. Other symptoms may include a slight fever, loss of appetite, constipation, nausea, vomiting, and weight loss. A child with Wilms’ tumor may also have the blood disorder anemia (see page 610), which can cause weakness and fatigue, and he or she may develop high blood pressure (see page 574). If your child has any of these symptoms, see your doctor right away.
Diagnosis and Treatment
To diagnose Wilms’ tumor, the doctor will ask about your child’s symptoms and perform a physical examination. The doctor will order a CT scan (see page 112) or MRI (see page 113) to locate and evaluate the tumor and to determine if the cancer has spread. He or she may order a biopsy (a microscopic examination of tissue from the tumor) to confirm the diagnosis.
If Wilms’ tumor is diagnosed, surgery will be performed to remove the affected kidney and prevent the cancer from spreading. The remaining kidney is able to take over the work of the one that is removed. The doctor will prescribe anticancer medication and, in some cases, radiation therapy to destroy any remaining cancer cells.
Undescended Testicles
In boys, the testicles develop inside the abdomen from the same embryonic tissue that becomes the ovaries in girls. In most boys, both testicles descend through the abdominal wall and into the scrotum (the pouch of skin that surrounds the testicles) about a month before birth. In a small number of boys, for reasons that are not known, one testicle or, less frequently, both testicles do not descend into the scrotum by birth. In these cases, the testicle or testicles usually descend by 1 year of age. If the testicles do not descend by age 1, surgery is necessary to bring them down into the scrotum. If the condition is not corrected, the child has an increased risk of being infertile and of developing testicular cancer (see page 824) in either testicle after puberty. For these reasons, early treatment is essential.
Symptoms
Undescended testicles do not cause pain or interfere with urination. Some boys who have an undescended testicle may also have an inguinal hernia (see page 763). If either or both of your son’s testicles have not descended by age 1, see the child’s doctor.
Undescended testicles
In some boys, a testicle may fail to descend from the abdomen into the scrotum before birth. An undescended testicle can be in the abdomen (abdominal), the groin area (inguinal), the upper thigh (femoral), or just above the pubic bone (prepubic) or penis (penile). Although an undescended testicle usually descends on its own by the time a boy is 1 year old, surgery may be performed to move the testicle into the scrotum if it does not descend on its own.
Diagnosis and Treatment
A diagnosis of undescended testicles is based on the results