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ΩΩ 3a Bateman - Paeds > Renal and urinary > Flashcards

Renal and urinary Flashcards

1
Q

Who are UTIs more common in?

A

<3 months boys >3 months girls

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2
Q

What is the presentation of a UTI?

A

Infants: poor feeding, vomiting, irritability

Younger children: abdominal pain, fever, dysuria

Older children: dysuria, frequency, haematuria

Features which may suggest an upper UTI include: temperature > 38ºC, loin pain/tenderness

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3
Q

What features favour an atypical UTI?

A
  1. Seriously ill
  2. Poor urine flow
  3. Abdominal or bladder mass
  4. Raised creatinine
  5. Septicaemia
  6. Failure to respond to treatment with suitable antibiotics within 48 hours
  7. Infection with non-E. coli organisms.
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4
Q

What is the management of a UTI?

A

Infants less than 3 months old
Referral immediately to a paediatrician

Children aged more than 3 months old with an upper UTI
Cephalosporin or co-amoxiclav should be given for 7-10 days

Children aged more than 3 months old with a lower UTI Trimethoprim, nitrofurantoin, cephalosporin or amoxicillin

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5
Q

What is nocturnal enuresis?

A

Bed wetting at night

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6
Q

What are the causes of nocturnal enuresis?

A
  1. Hormonal problems
  2. Bladder problems
  3. Genetics
  4. Sleep problems
  5. Caffeine
  6. Psychological problems

Medical conditions

  1. Diabetes
  2. Urinary tract abnormalities
  3. Constipation
  4. Urinary tract infections (UTIs).
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7
Q

What are the different types of nocturnal enuresis?

A

Someone with primary nocturnal enuresis has wet the bed since he or she was a baby. This is the most common type of enuresis.

Secondary enuresis is a condition that develops at least 6 months — or even several years — after a person has learned to control their bladder.

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8
Q

What is the management of nocturnal enuresis?

A
  1. Look for possible underlying causes/triggers
  2. Advise on fluid intake, diet and toileting behaviour
  3. Reward systems (e.g. Star charts)
  4. An enuresis alarm is first-line for children under the age of 7 years
  5. Desmopressin may be used first-line for children over the age 7 years

Desmopressin also used for short term use

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9
Q

What is nephrotic syndrome?

A

Nephrotic syndrome is a kidney disorder that causes your body to pass too much protein in your urine.

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10
Q

What are the causes of nephrotic syndrome?

A

Diabetic kidney disease

Minimal change disease

Congenital nephrotic syndrome

Membranous nephropathy

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11
Q

What are the symptoms of nephrotic syndrome?

A
  1. Severe swelling (edema), particularly around your eyes and in your ankles and feet
  2. Foamy urine, a result of excess protein in your urine
  3. Weight gain due to fluid retention
  4. Fatigue
  5. Loss of appetite
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12
Q

What is the triad of diagnosis for nephrotic syndrome?

A

Proteinuria (> 1 g/m^2 per 24 hours)

Hypoalbuminaemia (< 25 g/l)

Oedema

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13
Q

What is the cause of minimal change disease?

A
  1. idiopathic, but in around 10-20% a cause is found:
  2. drugs: NSAIDs, rifampicin
  3. Hodgkin’s lymphoma, thymoma
  4. infectious mononucleosis
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14
Q

What is the treatment for nephrotic syndrome?

A
  1. Oral corticosteroids
  2. Diuretics
  3. ACE Inhibitors
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15
Q

What is hypospadius?

A

Hypospadias is a congenital abnormality of the penis which occurs in approximately 3/1,000 male infants

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16
Q

what are the symptoms of hypospadius?

A
  1. A ventral urethral meatus
  2. A hooded prepuce
  3. Chordee (ventral curvature of the penis) in more severe forms
  4. The urethral meatus may open more proximally in the more severe variants. However, 75% of the openings are distally located.
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17
Q

What is the treatment for hypospadius?

A

Corrective surgery is performed before 2 years of age.

  1. It is essential that the child is not circumcised prior to the surgery as the foreskin may be used in the corrective procedure.
  2. In boys with very distal disease no treatment may be needed.
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18
Q

What is vescicoureteric reflux?

A

Vesicoureteric reflux (VUR) is the abnormal backflow of urine from the bladder into the ureter and kidney

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19
Q

What is the pathophysiology of vescicoureteric reflux?

A
  1. Ureters are displaced laterally, entering the bladder in a more perpendicular fashion than at an angle
  2. Therefore shortened intramural course of ureter
  3. Vesicoureteric junction cannot therefore function adequately
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20
Q

What are the different grades of vescicoureteric reflux?

A

I Reflux into the ureter only, no dilatation

II Reflux into the renal pelvis on micturition, no dilatation

III Mild/moderate dilatation of the ureter, renal pelvis and calyces

IV Dilation of the renal pelvis and calyces with moderate ureteral tortuosity

V Gross dilatation of the ureter, pelvis and calyces with ureteral tortuosity

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21
Q

How is vescicoureteric reflux diagnosed?

A
  1. Micturating cystourethrogram
  2. DMSA scan may also be performed to look for renal scarring
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22
Q

What is Henoch-Schonlein purpura?

A

IgA mediated small vessel vasculitis

HSP is usually seen in children following an infection

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23
Q

What are the symptoms of Henoch-Schonlein purpura?

A

Palpable purpuric rash (with localized oedema)
over buttocks and extensor surfaces of arms and legs

Abdominal pain

Polyarthritis

  • *Features of IgA nephropathy may occur**
    e. g. haematuria, renal failure
24
Q

What is the treatment of Henoch-Schonlein purpura?

A
  1. Analgesia for arthralgia
  2. Treatment of nephropathy is generally supportive
  3. There is inconsistent evidence for the use of steroids and immunosuppressants
25
Q

WHAT IS PYELONEPHRITIS?

A

Infection of the renal parenchyma and soft tissues of renal pelvis /upper ureter

26
Q

What is the epidemology of pyelonephritis?

A

Predominantly affects

women <35

27
Q

What are the symptoms of pyelonephritis?

A

Classical triad

Loin pain

Fever

Pyuria

28
Q

What is the most causative organism in pyelonephritis?

A

E. coli

29
Q

What are the investigations for pyelonephritis?

A

Mainly clinical

  1. Urinalysis
  2. Bloods including cultures
  3. X-ray - stone in upper tract
30
Q

What is the treatment for pyelonephritis?

A

Cefalexin - can give in pregnant women and children too

OR

Ciprofloxacin

OR

Co-amoxiclav

Surgery if needed

31
Q

What are the pyelonephritis complications?

A
  1. Sepsis
  2. Renal abscess
  3. Progression to chronic pyelonephritis
32
Q

WHAT IS POST=STREPTOCOCCAL GLOMERULONEPHRITIS?

A

Post streptococcal glomerulonephritis characteristically occurs 7 to 14 days after infection with group A beta haemolytic streptococcus, usually after a sore throat.

33
Q

What is the causative organism for post-steptococcal glomerulonephritis?

A

Strep pyogenes

34
Q

What are the clinical features of post streptococcal glomerulonephritis?

A

Often asymptomatic

Features include:

  1. General
    headache
    malaise
  2. Visible haematuria - pepsi coloured
  3. Proteinuria
    this may result in oedema
  4. Hypertension
  5. Oliguria
  6. Bloods:
    low C3
    raised ASO titre
35
Q

What are the investigations for post streptococcal glomerulonephritis?

A

Renal biopsy features

  1. Endothelial proliferation with neutrophils
  2. Electron microscopy: subepithelial ‘humps’ caused by lumpy immune complex deposits
  3. Immunofluorescence: granular or ‘starry sky’ appearance
36
Q

What is the management for post-streptococcal glomerulonephritis?

A
  1. Throat swab to measure antistreptolysin
  2. Supportive measures
    Fluid restriction
    Diet high in carbohydraters
37
Q

WHAT IS ALPORT SYNDROME?

A

Alport’s syndrome is a hereditary disease of basement membranes which is characterised by sensorineural deafness and renal failure

38
Q

What is the inheritence pattern of alport’s syndrome?

A

X-linked dominant pattern

39
Q

What are the clinical features of Alport syndrome?

A
  1. Kidneys - Microscopic haematuria and progressive renal failure
  2. Ears - Bilateral sensorineural deafness
  3. Eyes - Lenticonus: protrusion of the lens surface into the anterior chamber and retinitis pigmentosa
40
Q

What are the investigations for Alport syndrome?

A
  1. Molecular genetic testing
  2. Renal biopsy
    Electron microscopy: characteristic finding is of the longitudinal splitting of the lamina densa of the glomerular basement membrane, resulting in a ‘basket-weave’ appearance
41
Q

What is the management of Alport syndrome?

A

No treatment is curative

  1. Blood pressure control
  2. Support treatment of renal failure
  3. Renal dialysis and transplant
42
Q

WHAT ARE THE SYMPTOMS OF SLE IN THE KIDNEYS?

A
  1. Haematruia
  2. Proteinuria
43
Q

WHAT IS A HORSESHOE KIDNEY?

A

Horseshoe kidneys is a congenital condition of the kidneys which produces a characteristic IVP picture where the upper poles are further from the midline than the lower poles.

44
Q

What are the clinical feautres of horseshoe kidneys?

A
  1. This congenital abnormality may result in hydronephrosis due to PUJ obstruction
45
Q

What is the treatment for horseshoe kidney?

A

Pyeloplasty

46
Q

WHAT IS INFANTILE POLYCYSTIC KIDNEY DISEASE?

WHAT CHROMOSOME DOES IT AFFECT?

A

Autosomal recessive condition with the presence of numerous renal cysts throughout the cortex and medulla

Bilateral condition

Chromosome 6

47
Q

What are the clinical features of infantile polycystic disease?

A
  1. Nomrally presents on ultrasound in pregnancy
  2. Mass in abdomen
  3. Poor renal function
48
Q

What is the management of infantile polycystic kidney disease?

A
  1. Managaing complication of CKD and portal hypertension
  2. Most children die in infancy or childhood
49
Q

WHAT IS THE TRIAD OF HAEMOLYTIC URAEMIC SYNDROME?

A
  1. AKI
  2. Microangiopathic haemolytic anaemia
  3. Thrombocytopenia
50
Q

What are the cuases of haemolytic uraemic syndrome?

A
  1. Shiga toxin-producing Escherichia coli (STEC)
  2. Pneumococcal infection
51
Q

What are the clinical features of haemolytic uraemic syndrome?

A
  1. Most common following diarrhoeal illness
  2. Blood in stool
  3. AKI - Haematuria
  4. Dehydration
  5. Thrombocytopenia
52
Q

What are the investigations for haemolytic uraemic syndrome?

A
  1. Stool culture
    looking for evidence of STEC infection
    PCR for Shiga toxins
  2. Full blood count: anaemia, thrombocytopaenia, fragmented blood film
  3. U&E: acute kidney injury
53
Q

What is the management for haemolytic uraemic syndrome?

A
  1. Treatment is supportive e.g. Fluids, blood transfusion and dialysis if required
  2. VOLUME PLASMAPHERESIS
  3. There is no role for antibiotics
  4. Eculizumab can be useful
54
Q

WHAT IS PHIMOSIS?

A

Non-retractile foreskin

55
Q

What is the management of phimosis before 2 years of age?

A

In children less than 2 years of age, phimosis (a non-retractable foreskin) is normal and will most likely resolve with time

ΩΩ 3a Bateman - Paeds (19 decks)

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