Renal and urology

Question 1

Describe the presentation of UTI in infants

Answer 1

In infants, symptoms are non specific:

• Fever (this may be the only symptom)
• Irritability
• Poor feeding

Question 2

Describe the initial investigation of suspected UTI

Answer 2

Urine dip and MCS

Question 3

A child with a confirmed UTI may require further investigation…

What are the criteria for further investigation?

Give some examples of further investigation which may be required

Answer 3

Only children with atypical or recurrent UTIs require further investigation

Further investigation may include:

• US scan
• MCUG (micturating cystourethrogram)
• DMSA scan

Question 4

Describe the management of UTI in…

a) Infants < 3 months
b) Children with cystitis/lower UTI

Answer 4

a) Immediate referral to hospital for IV antibiotic therapy and septic screen
b) Short course of oral antibiotics, e.g. 3 days of trimethoprim or nitrofurantoin

Question 5

Describe the classic triad of nephrotic syndrome

Answer 5

• Heavy proteinuria
• Low albumin
• Oedema

Question 6

What is the most common cause of nephrotic syndrome?

Answer 6

Minimal change disease

Question 7

Describe the medical management of nephrotic syndrome

Answer 7

Prednisolone

Question 8

Describe the pathophysiology of haemolytic uraemic syndrome

Answer 8

Thrombosis in small blood vessels throughout the body (usually triggered by a bacterial toxin called the shiga toxin so typically occurs following episode of gastroenteritis)

Question 9

Describe the classic triad of haemolytic uraemic syndrome

Answer 9

• Acute kidney injury
• Haemolytic anaemia
• Thrombocytopenia (haematuria)

Question 10

Describe the management of haemolytic uraemic syndrome

Answer 10

Treatment is mainly supportive, e.g. fluids, blood transfusion/dialysis if required

Question 11

What is Wilms’ tumour?

What are the 2 typical features of Wilms’ tumour?

Answer 11

Nephroblastoma

Features:

• Painless abdominal mass (most common presentation)
• Painless haematuria

Question 12

Describe the management of Wilms’ tumour?

Answer 12

• Nephrectomy

- Chemo/radiotherapy

Question 13

In most cases undescended testes will descend by (…?) months

If they have not descended by (…?) months, referral to paediatric urology is indicated

Answer 13

3-6 months

6 months

Question 14

What is hypospadias?

Answer 14

The urethral meatus is abnormally displaced to the ventral (underside) of the penis

Question 15

Is it more common for hypospadias to be nearer to the glans penis or nearer to the scrotum?

Answer 15

Nearer to the glans penis