Ch 18 - Kidney & Urinary tract disorders Flashcards Preview

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

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)

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
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


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


Management of steroid resistent Nephrotic syndrome: (3)

Refer to nephrologist Diuretics, Salt restriction, ACEI


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

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


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

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


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


4 causes of acute nephritis

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


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