Nephrology

Question 1

Differential for offensive smelling urine

Answer 1

Dehydration most likely

UTI

Question 2

Presentation of UTI

Answer 2

Fever
Poor feeding
Vomiting
Crying
Frequency
Offensive smelling urine

Question 3

How to obtain a urine sample

Answer 3

Sterile pot
Non absorbent pad in nappy - specimen will be contaminated
Bag over genitalia

Question 4

Investigations for suspected UTI

Answer 4

Dipstick

If at least 1 of either leu or nit are positive on dipstick do urine microscopy, culture and sensitivity

Question 5

Treatment of UTI

Answer 5

5-7 days antibiotics
IV piperacillin and tazobactum if febrile then switch to oral cefalexin
Prophylactic trimethoprim

Question 6

Benefits of prophylactic trimethoprim in children

Answer 6

Lowers risk of UTI if abnormal urinary tract

Prevents renal scarring

Question 7

Grades of hydronephrosis

Answer 7

1: slightly enlarged major calyces
2: enlarged major calyces and renal pelvis within renal border
3: enlarged minor calyces, major calyces and renal pelvis outside of renal border
4: grade 3 with loss of renal parenchyma

Question 8

What is the process of a micturating cystourethrogram

Answer 8

Catheterise
Fill the bladder with contrast
Take X-ray images during micturation

Question 9

Grades of vesicoureteric reflux

Answer 9

1: reflux into ureter
2: reflux into ureter and renal pelvis without hydronephrosis
3: reflux into the ureter and renal pelvis with mild hydronephrosis
4: moderate hydronephrosis with twisting of the ureter
5. Severe hydronephrosis with twisting of the ureter and loss of renal parenchyma

Question 10

What does a micturating cystourethrogram detect

Answer 10

Abnormal urinary tract e.g vesicoureteric reflux

Question 11

Risks associated with vesicoureteric reflux

Answer 11

Recurrent UTI
Renal scarring
Hypertension

Question 12

How is vesicoureteric reflux often detected

Answer 12

Fetal anomaly scan - ask in history of UTI about fetal scans

Question 13

Management of vesicoureteric reflux

Answer 13

DMSA isotope scan 6 months after UTI - detects renal scarring
Education of parents/carers to get prompt treatment of UTI
Prophylactic trimethoprim until continent
Follow up clinics
If still present when developed continence, consider cystoscopic deflux

Question 14

Triad of symptoms in nephrotic syndrome

Answer 14

Oedema
Proteinuria
Oliguria
(Hypercholesterolaemia)

Question 15

Fluid management of nephrotic syndrome with generalised oedema

Answer 15

IV albumin as normal saline/hartmanns/dextrose will go straight to extravascular compartment

Question 16

Management of nephrotic syndrome

Answer 16

Check immunity to chicken pox as immunocompromised - prophylactic aciclovir
Fluids/albumin
Oral prednisolone
Home monitoring of proteinuria

Question 17

Dose of prednisolone or nephrotic syndrome

Answer 17

First 4 weeks: 60mg/sq m

Next 4 weeks: 40mg/sq m on alternate days

Question 18

Definition of remission of nephrotic syndrome

Answer 18

Urine protein neg/trace for 3 consecutive days

Question 19

Definition of relapse in nephrotic syndrome

Answer 19

Urine protein + or more for 3 consecutive days

Question 20

Definition of frequent relapse in nephrotic syndrome

Answer 20

2 or more relapses in 6 months
OR
4 or more relapses in 1 year

Question 21

Definition of steroid dependence in nephrotic syndrome

Answer 21

Child relapses whilst on steroids or within 2 weeks of stopping steroids

Question 22

Describe the most common pathophysiology of nephrotic syndrome in children

Answer 22

Minimal change glomerulonephritis

Electron microscopy shows widened filtration slits

Question 23

Presentation of nephritic syndrome

Answer 23

Haematuria
Generalised oedema
Poor feeding
Reduced urine output 
Recent strep infection?

Question 24

Investigations for nephritic syndrome

Answer 24

BO
Urine dipstick - protein and blood
Renal USS
Blood test - C3 + 4, ASOT

Question 25

What is ASOT

Answer 25

Antistreptolysin O test | for post strep glomerulonephritis

Question 26

Management of nephritic syndrome

Answer 26

Furosemide | Assess AKI risk using RIFLE criteria

Question 27

Causes to nephritic syndrome

Answer 27

``` Post infectious glomerulonephritis Henoch-Schonlein purpura nephritis SLE nephritis ANCA vasculitis IgA nephropathy Anti glomerular basement membrane disease Membranoproliferative glomerulonephritis ```

Question 28

Calculation for correction of % dehydration

Answer 28

Fluids (ml) = % dehydration x 10 x weight (kg)

Question 29

Maintenance fluids for children

Answer 29

First 10kg: 100ml/kg Second 10kg: 50ml/kg Subsequent kg: 20ml/kg

Question 30

Causes of paediatric hydronephrosis

Answer 30

Posterior urethral valves Ureteric kinks Vesicoureteric reflux

Question 31

Management of posterior urethral valves

Answer 31

Immediate surgery after birth to relieve obstruction DMSA scan to assess renal damage Follow up for ESRD - urine dipstick, US kidneys and bladder, BP