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YR5 Specialties > Paeds RENAL > Flashcards

Paeds RENAL Flashcards

1
Q

How does UTI present in an infant as compared to a child?

A

Infant: fever, vomiting, lethargy, poor feeding, jaundice, septicaemia

Children: dysuria, frequency, abdo pain, lethargy, anorexia, haematuria

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2
Q

How should UTI be investigated?

A

URINE DIP
Nitrite stick test: very specific
Leucocyte esterase: less specific than nitrites
Urine MC+S: diagnostic
Only do imaging if recurrent/ atypical UTI

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3
Q

Recall the different UTI management for different age groups

A

<3m: admit, IV Abx then switch to oral prophylaxis: emergency: book urgent USS

> 3m, upper UTI: consider admission with IV Abx, if not, oral Abx: book USS

> 3m, lower UTI: oral Abx as local guidelines for 3d (eg trimethoprim, nitrofurantoin)

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4
Q

How should recurrent UTI be managed in children?

A

Abx prophylaxis

<6 months: USS urgently + MCUG
>3y: USS within 6w

DMSA scan 4-6m later

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5
Q

By what age should children be dry by day?

A

4 years old

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6
Q

By what age should children be dry by day and night?

A

5 years old

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7
Q

What is ‘primary bedwetting’?

A

Bedwetting that has not previously been resolved

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8
Q

How should primary bedwetting be managed in children <5 years old?

A

Reassure parents: often resolves by 5y

Educate: easy access to toilet at night, bladder emptying before bed, positive reward system

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9
Q

How should primary bedwetting be managed in children >5 years old?

A

Infrequent (<2/ week): watch + see approach

Frequent: 1st line: enuresis alarm, pos reward system (eg encourage child to help change sheets)

2nd line: desmopressin (1st line for short-term control like sleepovers + school trips)

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10
Q

How should enuresis with daytime symptoms be managed?

A

Refer to enuresis clinic, community paediatrician

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11
Q

What causes of secondary bedwetting can be managed in primary care?

A

UTI + constipation

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12
Q

What causes of secondary bedwetting should be managed in secondary care?

A

Diabetes
Psychological
LD
Recurrent UTI

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13
Q

What is phimosis?

A

Inability to retract foreskin as it is too ‘tight’

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14
Q

By what age should phimosis only be present in 10% of children who were born with it?

A

4y (it is physiological at birth)

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15
Q

How should phimosis be managed?

A

If <2: reassure + review in 6m - add personal hygiene promotion

If >2: circumcision or topical steroid creams (depending on severity)

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16
Q

What is the name given to pathological phimosis?

A

Balantis Xerotica Obliterans

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17
Q

What are 5 signs and symptoms of BXO?

A

Haematuria
Painful erections
Recurrent UTI
Weak stream
Swelling

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18
Q

What is paraphimosis?

A

Emergency in which foreskin becomes trapped in the retracted position proximal to swollen glans

Restriction of blood flow to head of penis: penis turns dark purple

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19
Q

How should paraphimosis be managed?

A

1st line: adequate analgesia, attempt to reduce foreskin (gently compresswith saline soaked swab)
2nd line: emergency referral to urologist

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20
Q

What is hypospadias?

A

Wrongly positioned meatus ventrally (if dorsal = epispadias)

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21
Q

What are 4 key features of hypospadias?

A

Ventral foramen
Hooded foreskin
Chordee (ventral curvature)
Foreskin not fused ventrally

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22
Q

How should hypospadias be managed?

A

Repair surgery after 3 month:- no Mx required before that

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23
Q

What is balanoposthitis?

A

Inflamed/ purulent discharge from foreskin

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24
Q

How common is balanoposthitis?

A

Single attacks are common

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25
Q

How should balanthoposthitis be managed?

A

Warm baths + Abx (broad spec)
If recurrent (rare): circumcision

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26
Q

What is the mean age for testicular torsion?

A

16y

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27
Q

What is the appendixtestis?

A

Small remnant of Mullerian duct

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28
Q

How does torsion of the appendixtestis present?

A

Similarly to torsion but evolving over a few days

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29
Q

What is the one indication that surgery isn’t needed in suspected testicular torsion?

A

Blue dot seen over superior pole of testes (shows it is torsion of appendixtestis)

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30
Q

Recall the signs and symptoms of torsion?

A

Redness, oedema, N+V

Sudden onset pain in testis or abdomen

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31
Q

How can torsion and epididymitis be differentiated clinically?

A

Prehn’s sign: lifting testes increases pain in torsion but decreases it in epididymitis
Torsion = -ve Prehn’s

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32
Q

What is the surgical management of testicular torsion?

A

Exploratory surgery +/- BL orchidopexy +/- orchidectomy +/- fixation of contralateral testes

33
Q

What is the key window of time in which torsion needs to be fixed?

A

< 6 hours

34
Q

Recall the serum creatinine changes/ measurements for each stage of AKI

A

Stage 1: increase >26 or 1.5-1.9x reference sCr

Stage 2: 2-2.9 x reference sCr

Stage 3: >354mmol increase or >3 x the reference sCr

35
Q

Recall the urinary output values for each stage of AKI

A

Stage 1: <0.5mL/kg/hr, 6-12h

Stage 2: <0.5mls/kg/hr, >12h

Stage 3: <0.3mL/kg/hr, >24h

36
Q

What is the difference in clinical syndrome produced by proliferative vs non-proliferative glomerulonephritis?

A

Proliferative: nephritic syndrome

Non-proliferative: nephrotic syndrome

37
Q

What are the 3 types of non-proliferative glomerulonephritis?

A

Focal segmental
Membranous glomerulonephritis
Minimal change disease

38
Q

What are the 3 types of proliferative glomerulonephritis?

A

IgA nephropathy
Membranoproliferative glomerulonephritis
Post-infectious (post strep)

39
Q

What can focal segmental glomerulonephritis be secondary to?

A

Obesity
HIV

40
Q

What can membranous glomerulonephritis be secondary to?

A

SLE
Drugs

41
Q

Which type of glomerulonephritis is most common in children?

A

Minimal change disease

42
Q

Recall the triad of symptoms seen in IgA nephropathy

A

Petechiae
Abdo pain
Nephritic syndrome

43
Q

What are the triad of symptoms in nephrotic syndrome?

A

Low albumin
Peripheral oedema
Proteinuria

44
Q

What are the signs and symptoms of nephrotic syndrome?

A

1st = peri-orbital oedema (often misdiagnosed as allergy)

2nd = other features of oedema (delayed) - eg leg swelling, features of underlying dx

45
Q

What % of nephrotic syndrome is steroid-sensitive?

A

80-95%

46
Q

How quickly does steroid-sensitive nephrotic syndrome respond to treatment?

A

<6 weeks

47
Q

How should the nephrotic syndrome be investigated?

A

Urine tests: dipstick, urea, urine MC+S, urinary sodium
FBC, U+Es,ESR, creatinine, albumin

Complement (C3,C4) (SLE?)

Anti-streptolysin O (recent strep throat)
HBV/HCV

48
Q

If podocyte fusion is seen on microscopy, what is this indicative of?

A

Minimal change disease

49
Q

What are the 3 main complications of nephrotic syndrome?

A

Risk of thrombosis
Risk of infection
Hypercholesterolaemia

50
Q

How does the nephrotic syndrome cause hypercholesterolaemia?

A

Loss of albumin
Less oncotic pressure
Hepatic cholesterol synthesis

51
Q

What are the 2 most common causes of Acute renal failure in children?

A

HUS + ATN

52
Q

What is the triad of features that characterises the HUS?

A

Low RBC
Low platelets
AKI

53
Q

What is the most common cause of ATN in children?

A

Organ failure following cardiac surgery

54
Q

Recall the signs and symptoms of acute renal failure in children

A

Oligo/anuria
Oedema (feet, legs, abdo, weight gain)
Brown discoularisation of urine
Fatigue, lethargy, N+V

55
Q

What is the key treatent for prerenal fialure?

A

Fluid replacement + circulatory support

56
Q

What is the key treatment for intrinsic renal failure?

A

High calorie, normal protein feed: to decrease catabolism, uraemia + hyperkalaemia

57
Q

How should postrenal ARF be managed in children?

A

Assess site of obstruction: relief may be obtained by nephrostomy/ Catheter

58
Q

What is the most important investigation to do in ARF children?

A

Renal USS

59
Q

What woud be seen on USS In CKD?

A

Small kidneys

60
Q

What would be seen on USS in AKI?

A

Large, bright kidneys with loss of cortical medullary differentiation

61
Q

In what age group is minimal change disease most common?

A

2-4 years old

62
Q

In what age group is focal segmental glomerulonephritis most common?

A

Older children

63
Q

How does minimal change disease affect renal function?

A

Renal function will be normal

64
Q

How does FSGN affect renal funcion?

A

Impairs renal function –> HTN

65
Q

In which age group is membranous nephropathy more common?

A

Adults

66
Q

What is another name for IgA vasculitis?

A

Henoch-Shonlein purpura

67
Q

Which vessels does IgA vasculitis affect?

A

Small vessels

68
Q

What is the usual cause of IgA vasculitis?

A

Usually preceded by an URTI by 2-3 days

69
Q

What is the pathophysiolgy of IgA vasculitis?

A

IgA + IgG complex, deposit in organs, activating complement

70
Q

Recall the signs and symptoms of IgA vasculitis?

A

100% = purpuric rash sparing trunk: looks a bit like HUS

60-80% = arthralgia + periarticular oedema: joint pain + swelling

60% = abdo pain: can cause intussusecption

20-60% = glomerulonephritis (within 3m of onset = 97%) with nephritic syndrome

71
Q

What should be the first investigations ordered in IgA vasculitis?

A

FBC, clotting screen, urine dip and U+Es
Urinalysis to rule out meningococcal sepsis

72
Q

How should IgA vasculitis be managed?

A

Most cases resolve spontaneously within 4w
For joint pain: NSAIDs
If scrotal involvement/ severe oedema/ severe abdo pain: oral prednisolone
If renal involvement: IV corticosteroids

73
Q

What is another name given to nephroblastoma?

A

Wilm’s tumour

74
Q

In what age group is nephroblastoma most common?

A

<5 years old

75
Q

Recall 2 common symptoms and signs of nephroblastoma

A

Asymptomatic abdo mass
Painless haematuria

76
Q

Recall 4 less common signs and symptoms of nephroblastoma

A

Abdo pain
Anaemia (from haemorrhage into the mass)
Anorexia
HTN

77
Q

When is a biopsy indicated in suspected nephroblastoma?

A

Never: may worsen the condition

78
Q

What investigations should be done in suspected nephroblastoma?

A

US
SCT/MRI

79
Q

How is nephroblastoma managed?

A

Nephrectomy + chemotherapy (+ neoadjuvant radiotherapy if advanced disease)
80% cure rate

YR5 Specialties (27 decks)

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