Renal

Question 1

What are the conditions for a diagnosis of acute pyelonephritis to be made?

Answer 1

Either
A temp above 38 degrees
Loin pain or tenderness

Question 2

What do nitrites show on urine dip?

Answer 2

Bacteria break down nitrates to nitrites so their presence indicates bacteria

Question 3

What do leukocytes on urine dip indicate?

Answer 3

Leukocytes indicate infection or inflammation
Nitrites are a better indication of bacterial infection so if there are nitrites but no leukocytes then treat as an infection

Question 4

What management should a child under 3 months witha fever recieve?

Answer 4

IV antibiotics e.g. ceftriaxone

Septic screen and lumbar puncture should be considered

Question 5

When should children be investigated further for utis?

Answer 5

If under 6 months should have an abdominal ultrasound within 6 weeks
Children with recurrent utis within 6 weeks
Children with atypical uti during the illness

Question 6

When should dmsa scans be used?

Answer 6

In children with recurrent or atypical utis

DMSA scans show the renal uptake so will show areas of scarring

Question 7

How is vesico-uteric reflux investigated?

Answer 7

a micturating cystourethrogram

This involves catheterisation and using contrast medium to image the urinary system

Question 8

How is vesico-uteric reflex managed?

Answer 8

Avoiding constipation
avoid excessively full bladder
prophylactic antibiotics
Surgical input from paediatric urology

Question 9

What age is vulvovaginitis most common?

Answer 9

Girls 3-10 due to the thin skin and mucosa being more prone to colonisation
This usually resolves after puberty as oestrogen is protective

Question 10

What are the exacerbating factors for vulvovaginitis?

Answer 10

Wet nappies
Strong chemicals
Threadworms
Poor toilet hygiene 
Tight clothing trapping moisture

Question 11

What are the oresenting features of volvovaginitis?

Answer 11

Erythema
Itching
Discharge
Dysuria
Dipstick may show leukocytes

Question 12

What is the management of vulvovaginitis?

Answer 12

General advice regarding risk factors

In severe cases oestrogen cream can be given

Question 13

What age is nephrotic syndrome most common in children?

Answer 13

Between 2-5

Question 14

What are the triad of features in nephrotic syndrome?

Answer 14

Proteinuria
Low albumin
Oedema

Question 15

What is the most common cause of nephrotic syndrome in children?

Answer 15

Minimal change disease
Hyline casts on unrinalysis
Managed with corticosteroids

Question 16

What are the secondary causes of nephrotic syndrome in children?

Answer 16

Intrinisic kidney disease:
-Focal segmental glomerulosclerosis
-Membranoproliferative glumerulonephritis
Systemic illness:
-Henoch-schonlein purpura
-Diabetes
-Infection

Question 17

What is the general management of nephrotic syndrome?

Answer 17

High dose steroids e.g. prednisolone
Low salt diet
Diuretics may be used for oedema
Albumin infusions for hypoalbuminaemia
Phrophylactic antibiotics in severe cases

Question 18

What are the complications of nephrotic syndrome?

Answer 18

Hypovolaemia as fluid moves into the interstitium and intracellular spaces
Thrombosis as anticlotting proteins are lost
Infection as immunoglobulins are lost through the kidneys
Acute or chronic renal failure

Question 19

What are the 2 most common causes of nephritis in children?

Answer 19

Post streptococcal glomerulonephritis
buergers disease (IgA nephropathy)

Question 20

What is the pathophysiology of post streptococcal glomerulonephritis? How is it investigated?

Answer 20

Following a strep pyogenes tonsillitis there is deposition of immune complexes in the glomeruli causing damage to the kidneys
A positive throat swab and antistreptolysin antibody titres are diagnostic

Question 21

What is the pathophysiology of berguers disease?

Answer 21

IgA deposition in the nephrons

This is linked to HSP and will show IgA deposits on biopsy

Question 22

What is the management of nephritis in children?

Answer 22

Mainly supportive treatment
Can use antihypertensives if hypertension present
Can use immunosupressants such as steroids or cyclophosphamide in IgA nephropathy

Question 23

What is the pathophysiology of haemolytic ureamic syndrome?

Answer 23

This is when there are thrombi in the small blood vessels

this is usually triggered by the shiga toxin which is released by e coli and shigella

Question 24

What are the triad of features in haemolytic ureamic syndrome?

Answer 24

small vessel thrombosis caused by the shiga toxin leads to:
Ureamia - due to AKI and lack of urea secretion
Anamiea - due to haemolysis
Thrombocytopenia - due to the thrombosis

Question 25

What are the symptoms of haemolytic ureamic syndrome?

Answer 25

Symptoms typically start 5 days after onset of diahorrea due to an e coli gastroenteritis:

• Reduced urine output
• Haematuira or dark urine
• Abdo pain
• Lethargy
• Oedema
• Hypertension
• Bruising

Question 26

What is the management of haemolytic ureamic syndrome?

Answer 26

It is a medical emergency with 10% mortality
The anagement is mainly supportive
Urgent referral for dialysis if required
Antihypertensives if required
Careful fluid maintenance balance
Transfusion if required

Question 27

What age do most children stop nighttime enuresis?

Answer 27

3-4 years

Question 28

What are the causes of nocturnal enuresis?

Answer 28

Normal development
Bladder overactivity
Drinking too much
Psychological stress
Failure to wake
Constipation/UTI

Question 29

What is the management of nocturnal enuresis?

Answer 29

useful to keep a 2 week diary to track intake, tioleting and bedwetting episodes, helps rule out medical causes
If under 5 reassure that will probably resolve by itself
Lifestyle changes: reduced fluid intake in the evenings, pass urine before bed and ensure easy access to a toilet
Encouragement and reinforcement of agreed behaviours e.g. star chart
Treat underlying causes e.g. constipation
Enuresis alarm
Pharmacoloigcal treatment e.g. desmopressin

Question 30

What is secondary nocturnal enuresis and what are the causes?

Answer 30

This is when the child has previously been dry for 6 months and starts wetting the bed again
This inidicates an underlying illness:
-UTi
-Diabetes
-Constipation
-Psychosocial problems
-Maltreatment
also consider safeguarding

Question 31

What are the pharmacological options for nocturnal enuresis?

Answer 31

Desmopressin - ADH analogue taken at night

Oxybutinin - anticholinergic medication helpful in overactive bladder urge incontinence