Nephrology Flashcards
You want to obtain urine for a urine culture. How will you get it?
Clean catch urine. This is the same as midstream urine with the additional step of cleaning the genital area before urination and then starting the urinate before filling the cup.
What would you expect to see on a urine dipstick of a UTI patient?
White cells (leukocytes) and Nitrites (maybe blood). Note that urine dipstick in babies isnt the most reliable
A 4 month baby is present at clinic with their mom with irritability and poor feeding. What would you ask their mother to make sure this is a UTI? (predisposing factors)
Predisposing factors:
Reduced fluid intake
previous UTI infection
Dysfunctional pattern of voiding
constipation
Poor perineal hygiene
Vulvitis (if girl) inflammation of labia minora
Anatomical abnormalities (Vesicoureteric reflux, duplex kidneys…)
30% of children with a UTI have what?
How would you diagnose this?
Vesicoureteric reflux
MCUG Micturating cystourethrogram
A 1 month baby is present at clinic with their mom with irritability and poor feeding. On examination you notice vulvitis. What is your full management plan including investigations
0-6 month old with UTI
Admitted to hospital, urine dipstick, urine culture/microscopy/sensitivity
Given IV antibiotics: (<2 months) Triple therapy of amoxicillin + Gentamicin + Cefotaxime
Renal USS during and after admission at the OPD
ONLY IF POSITIVE FINDINGS ON Renal USS
MCUG after 6 weeks
DMSA scan after 4-6 months
A 1 year old baby is present at clinic with their mother with reduced appetite, irritability and fever. Their mother notices that they are in pain when urinating and will only urinate small amounts. What is your full management plan with investigations in a well vs unwell child
6 months - 2 years
Well: No admission and Oral antibiotics (Cephalexin or nitro or co-amoxiclav or trimethoprim) + Renal USS OPD
Unwell: Admission, urine dipstick, urine culture/microscopy/sensitivity, and empiric IV antibiotics (Co-amoxiclav +Gentamicin) + USS during and after admission
A 6 year old presents to the emergency department with their mother. They look well but tell you it hurts when they urinate and they feel like they have to go urgently during the consultation. When asked if this happened before, his mom says that it occurred 3 times in the past 2 years. What is your full workup?
> 2 years
They are well => no admission + oral antibiotics (Cephalexin or nitro or co-amoxiclav or trimethoprim)
Since it is a recurrent infection, Renal USS needs to be used
A 6 year old presents to the emergency department with their mother. They look unwell with fever and nausea and tell you it hurts when they urinate and they feel like they have to go urgently during the consultation. When asked if this happened before, his mom says that it occurred 3 times in the past 2 years. What is your full workup?
> 2 years
They are unwell => admission + urine dipstick + urine culture/microscopy/sensitivity + IV antibiotics (Co-amoxiclav and Gentamicin) + Renal USS
What is MCUG, what does it detect, and how is it performed?
Micturating cystourethrogram detects vesicoureteric reflux. This involves sedating the patient and putting in a urinary catheter which is used to inject a contrast in. That is then scanned to show vesicoureteric reflux
What does a DMSA scan detect? How does it work?
Detects renal scarring. It is an isotope based scan. This involves sedating the patient and putting in a urinary catheter which is used to inject a contrast in. The contrast is absorbed by renal cells that arent scarred. That is then scanned to show renal scarring
What does a Mag 3 renogram detect? How does it work?
Detects obstruction. It is an isotope based scan. This involves sedating the patient and putting in a urinary catheter which is used to inject a contrast in. This is taken up by renal cells. That is then scanned to show dynamic images which can reflect both GFR and renal emptying => can show obstruction
How is Vesicoureteric reflux graded?
It is graded based on the MCUG scan which can grade the reflux based on the extent of reflux and dilatation of the ureters and kidney itself
When should you conduct invasive procedures such as MCUG?
1) Present unwell in <6 months
2) Structural abnormality on Renal USS
3) Recurrent UTIs
What is Phimosis?
Phimosis is when the foreskin cannot be retracted in boys
What organism is most common in boys with phimosis? What is a significant complication of that organism?
Proteus which is an ammonia splitting organism => kidney stones => obstruction and infection
