Ch 18 - Kidney & Urinary tract disorders Flashcards
(51 cards)
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
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
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
What is horseshoe kidney?
Fusion of both kidneys at lower poles; predisposes to infection/ obstruction
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
What is bladder extrophy?
When there is failure of fusion of infraumbilical structures - basically the bladder mucosa is exposed (kinda like gastroschisis)
Absence musculature syndrome: what is it?
Absence/ def in anterior abdo wall muscles > megacystic megaureters + crytorchidism (undescended testicle)
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
Dysuria alone: differentials 2 Male & 2 Female
M - cystitis/balanitis (uncircumsized)
F - Cystitiis/ vulvitis
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
UTI predisposition: Antenatally diagnosed renal or urinary tract abnormality
increases risk of infection
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
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
UTI suscpicioun: investigations (2)
USS
MCUG - micturating cystourethrogram
DMSA - to check for renal scarring 3 months post UTI
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
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)
Primary nocturnal enuresis: definition, causes (3)
D - involuntary voiding of urine at least 3/7 in child
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
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
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)
Proteinuria: causes (4)
Orthostatic - common postural proteinuria
Minimal change disease
GN
HTN
Nephrotic syndrome: triad, causes (3)
Proteinuria (hypoalbuminaemia)+ hyperlipidaemia + oedema
Causes - unknown, but some cases secondary to HSP, SLE, minimal change disease
Nephrotic syndrome features (3), Ix (3)
F - periorbital oedema, ascites, dyspnoea
Ix - dipstick, U & C, albumin, complement levels
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
