Ch 18 - Kidney & Urinary tract disorders Flashcards Preview

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Flashcards in Ch 18 - Kidney & Urinary tract disorders Deck (51):
1

Renal Agenesis (absence of both kidneys): features (1 syndrome - 5 features)

So lack of kidneys > no urine > oligohydramnios (because most of amniotic fluid is made up of fetal urine)
F - Oligohydramnios results in Potter Syndrome (fatal) - fetal compression, low set ears, beaked nose, prominent epicanthic folds, pulmonary hypoplasia causing resp failure, limb deformities > infants may be still born/ die soon after due to resp failure

2

Multicystic dysplastic kidney: cause, features (1), management (1)

Cause - failure of union of ureteric bud (forms ureter, pelvis, calyces, collecting duct) with nephrogenic mesenchyme - so get a non-functioning structure with large fluid-filled cysts and no renal tissue or connection with bladder.
M - half involute by 2 yr so no treatment required, nephrectomy is done only if still very large/ or causing HTN

3

Polycystic kidney disease: autosomal dominant features (5), autosomal recessive PKD feature (1)

ADPKD - discrete cysts of varying size within normal renal parenchyma, HTN, haematuria, enlarged kidneys, extra renal - e.g. hepatic cysts
ARPKD - diffuse bilateral enlargement of both kidneys

4

What is horseshoe kidney?

Fusion of both kidneys at lower poles; predisposes to infection/ obstruction

5

Duplex anomalies: cause (1) 2 examples

Premature ureteric bud division
Duplex ureters - abnormal drainage: ureter from lower pole refluxes, upper pole drains ectopically into urethra/vagina/ may prolapse into bladder, may obstruct urine flow
Duplex pelvis

6

What is bladder extrophy?

When there is failure of fusion of infraumbilical structures - basically the bladder mucosa is exposed (kinda like gastroschisis)

7

Absence musculature syndrome: what is it?

Absence/ def in anterior abdo wall muscles > megacystic megaureters + crytorchidism (undescended testicle)

8

Urine flow obstruction: can be unilateral (2) or bilateral (2) Give 2 places for each where the obstruction would be
Consequences (2)

Obstruction to urine flow leads to dilatation of urinary tract proximal to obstruction.
Unilateral can be at: pelvicoureteric junction (PUJ) or Vesicoureteric junction (VUJ)
Bilateral can be at: Bladder neck or urethra (this will cause hydroureters & hydro nephrosis)
Consequences - Dysplastic kidneys (small + poor function) & if v. severe Potter syndrome

9

Dysuria alone: differentials 2 Male & 2 Female

M - cystitis/balanitis (uncircumsized)
F - Cystitiis/ vulvitis

10

UTI predisposition: infecting organisms (4)

UTIs are usually result of bowel flora entering UT via urethra - except in newborn where its most likely haematogenous.
E. Coli - commonest organism, Klebsiella, Pseudomonas, Proteus, E. Faecalis

11

UTI predisposition: Antenatally diagnosed renal or urinary tract abnormality

increases risk of infection

12

UTI predisposition: incomplete bladder emptying (4)

Contributing factors in some children are:
infrequent voiding > bladder enlargement
Vulvitis
Incomplete micturition
Obstruction from loaded rectum
Neuropathic bladder
vesicoureteric reflux

13

UTI predisposition: VUR - definition, complications (4)

VUJ developmental abnormality (the ureters are displaced laterally and enter directly into bladder rahter than at an angle) > tends to resolve with age
C - Mild reflux into ureters, reflux during bladder filling, intrarenal reflux (into collecting ducts - high risk of scarring), predisposition to UTI/ hydronephrosis

14

UTI suscpicioun: investigations (2)

USS
MCUG - micturating cystourethrogram
DMSA - to check for renal scarring 3 months post UTI

15

UTI suscpicion/ confirmed management:
1) infant 3 months and children with acute pyelonephritis/ upper UTI - features (3), management (1)
3) Cystitis/lower UTI - feature (1), management (1)

1) Refer to hospital! IV Cefotaxime until temp settles > oral AB
2) F - bacteriuria + fever/ loin pain, M - PO co-amoxiclav 7-10 days or IV Cefotaxime for 3 days then oral AB for a week
3) Dysuria only, M - 3 day course of Nitrofurantoin/ tripethoprim/ ceftriaxone/ amoxicillin

16

Prevention of UTIs (4)

Aim is to washout organisms that ascend into bladder from the perineum
High fluid intake
Regular voiding
Ensure complete voiding - double micturition (encourage child to try a second time to empty bladder)
Lactobacillus acidophillus; probiotic colonizes the gut & reduces the number of pathogenic organisms (that may invade)

17

Primary nocturnal enuresis: definition, causes (3)

D - involuntary voiding of urine at least 3/7 in child

18

Secondary (onset) nocturnal enuresis: definition (1), causes (3), Ix (3)

D - child had previously achieved night time dryness
C - Emotional upset (most common), > , constipation, Diabetes
Ix - Urine dipstick, early morning urine osm/ water deprivation test, USS

19

Management of nocturnal enuresis (3)

1st line: Reward systems - star charts: give for agreed behaviour rather than dry nights e.g. if they go to toilet before bed
2nd line: enuresis alarm 7 yrs old

20

Daytime enuresis: causes (4), Ix (3), management (4)

Causes:
detrusor instability (sudden urgent urge to void induced by sudden bladder contractions)
Bladder neck weakness
Neuropathic bladder - enlarged and fails to empty properly, associated with spinda bifida
UTI
Constipation
Ectopic ureter - causes constant dribbling and always damp child
Ix - urine sample microscopy, culture, USS, urodynamic studies
M - Bladder training, pelvic floor exercises, Oxybutynin (anti-cholinergic)

21

Proteinuria: causes (4)

Orthostatic - common postural proteinuria
Minimal change disease
GN
HTN

22

Nephrotic syndrome: triad, causes (3)

Proteinuria (hypoalbuminaemia)+ hyperlipidaemia + oedema
Causes - unknown, but some cases secondary to HSP, SLE, minimal change disease

23

Nephrotic syndrome features (3), Ix (3)

F - periorbital oedema, ascites, dyspnoea
Ix - dipstick, U & C, albumin, complement levels

24

Steroid sensitive nephrotic syndrome: Features (3), management (1), Complications (2)

F - proteinuria resolves with steroids, does not progress to renal failure, precipitated by resp infection
M - oral steroids
C - hypovolaemia, infection, hypercholesterolaemia

25

Management of steroid resistent Nephrotic syndrome: (3)

Refer to nephrologist Diuretics, Salt restriction, ACEI

26

Congenital nephrotic syndrome: feature (1), Complication (1), Managment (1)

F - presents in 1st 3 months of life
C - hypoalbuminaemia
M - unilateral nephrectomy + dialysis

27

Haematuria: characteristics if glomerular (3), if lower UT (3)

Glomerular - Brown, deformed RBCs, casts, proteinuria
UT - red, no proteinuria, unusual in kids

28

Haematuria causes: non glomerular (3), glomerular (3)

Non glomerular: infection (by far most common), trauma, stones, bleeding disorders
Glomerular: GN, IgA nephropathy, familial nephritis e.g. Alport syndrome

29

4 causes of acute nephritis

Post infectious/strep GN
HSP or other vasculitides
IgA nephropathy
Anti-GBM (v. rare)

30

Post-infectious/strep GN: definition, Ix (2)

D - causes a diffuse proliferative GN following a strep sore throat/ skin infection
Ix - Raised ASO + low C3 levels

31

HSP features (3)

Preceded by URTI (peak in winter months) palpable rash on buttocks, arthralgia, joint swelling, abdo pain

32

Alport syndrome features (2)

Most common familial nephritis (X-linked)
Nerve deafness + ocular defects

33

Vasculitides that affect the kidney: (3)

HSP most common, but aslo polyarteritis nodosa, Wegner granulomatosis

34

HTN causes (6)

Renal disease: renal parenchymal disease, PKD, RAS
Hyperthyroidism, Phaeo, Cushing, CAH

35

HTN features in kids (4)

headache
vomiting
convulsions
facial palsy
FTT
HF

36

Renal masses causes: unilateral (3) bilateral (3)

Wilm's tumour
Multicystic kidney
obstructed hydronephrosis
Bilat:
ARPKD
ADPKD
tuberous sclerosis

37

Predisposing causes of Renal calculi in children (3)

Uncommon in childhood so when they occur need to figure out the predisposing factor:
UTI
structural anomalies of UT
Metabolic abnormalities

38

Renal calculi are either phosphate or Calcium containing, give examples of what would cause these types of stones (1, 2)

Phosphate - most common; occur with infection - commonly Proteus
Calcium containing - idiopathic hypercalciuria, distal renal tubular acidosis,

39

Features of renal calculi (3), management (4)

F - haematuria, loin pain, UTI, structural anomaly
M - spontaneous passing, high fluid intake, surgery, correction of anomaly, lithotripsy

40

Renal tubular disorders: Fanconi syndrome - general description, features (4)

Abnormalities of renal tubular function may occur at any point along nephron. Fanconi is generalized proximal tubular dysfunction - excessive loss of AAs, glucose, phosphate, Bicarb, sodium, calcium, urate.
F - polydispia + polyuria; salt depletion & dehydration; hyperchloraemic metabolic acidosis; rickets; FTT

41

Refer to Lissaeurs pg 342 for image of specific transport defects, but basically there can be a defect at any point & depending on that the substance that should have been reabsorbed/secreted will not. Give some examples (4)

Glycosuria
Cystinuria - renal calculi
Pseudohypoparathyroidism - due to increased phosphate reabsorption; obesity, depressed nasal bridge & short fing
RTA II - due to reduced bicarb reabsorption; metabolic acidosis + alkaline urine + growth failure
Bartter syndrome: due to reduced chloride reabsorption; hypokalaemia + hyponatremia + hypochloraemia + metabolic alkalosis

42

AKI causes: pre-renal (2) causes

Hypovolaemia - gastroenteritis, burns sepsis, haemorrhage
Circulatory failure
(pre renal causes most common)

43

Renal causes of AKI: vascular (2), tubular (2), glomerular (1), interstitial (2)

Vascular: vasculitides, HUS, renal vein thrombosis
Tubular: ATN, ischaemic, obstructive
glomerular: GN
Interstitial: pyelonephritis, interstitial nephritis

44

Post renal causes of AKI (2)

Obstruction:
Congenital - post urethral valves
acquired - blocked urinary catheter

45

Management of pre-renal failure(1) renal failure: if metabolic acidosis (1), hyperphosphataemia (2), hyperkalaemia (3)

Pre-renal - fluid replacement
Renal failure - 2 most common causes are HUS & ATN
metabolic acidosis - Sodium bicarb
Hyperphosphataemia - CaCO3 + dietary restriction
Hyperkalaemia - calcium gluconate if see ECG changes, glucose + insulin

46

Management of post-renal failure (2)

Nephrostomy after correction of electrolyte abnormalities

47

Indications for dialysis in renal failure: (4)

If conservative management fails
severe hypo/hypernatremia
HTN
pulmonary oedem
severe acidosis

48

HUS: cause (1), features (3), Management (1)

C - secondary to E. Coli O157 due to uncooked beef
F - Triad of renal failure + MAHA + TTP
M - dialysis

49

CKD causes (3)

Very uncommon in children
Most commonly caused by structural malformations
GN
Systemic disease

50

CKD features (5)

anorexia
FTT
polyuria/polydipsia
incidential finding of proteinuria
HTN
unexplained normocytic normochromic anaemia

51

Management of CKD: diet (2), prevention of renal osteodystrophy (2), control acidosis and fluid balance (2), hormonal abnormalities (1)

Diet - cal supplements, NGT
Prevention of renal osteodystrophy - 2dary HPT develops > osteitis fibrosa cystica + osteomalacia > phosphate restriction via diet, CaCO3,
Acidosis - salt supplements + HCO3 + fluid
Hormonal abnormalities - get GH resistance - give recombinant HGH