Nephrology and Urogenital Flashcards
(48 cards)
Give 2 reasons why UTIs in childhood is important?`
- 50% will have __
- pyelonephritis may __ predisposing to__
- up to 50% will have a structural abnormality of their urinary tract
- pyelonephritis may damage the growing kidney by forming a scar, p.disposes to HT and progressive CKD of bilateral
UTI symptoms vary with age.
Infants: symptoms are __..what can occur rapidly
(the classical symptoms are more common with increasing age)
- non-specific, +/- fever, vomiting, lethargy/irritable, poor feeding, jaundice, offensive urine, febrile seizure
- septicaemia can occur rapidly
Dysuria alone is often due to cystitis or ___ in girls or ____ in uncircumcised boys. What dipstick test is positive in both these conditions?
-vulvitis
-balanitis
Leukocyte will be postivie
If both leukocyte and nitrites are present on a dipstick regard and treat as UTI, if only one is positive what should you do?
- diagnosis depends on urine culture
- start Abx only if there is clinical evidence of UTI
Name 3 methods of urine sample collection in the young?
- “clean-catch” sample into pot when nappy removed
- adhesive plastic bag on perineum after careful washing
- urethral catheter (if need sample urgently)
- suprapubic aspiration (for severely ill, needing urgently)
What amount of CFU (colony-forming units) in a bacterial culture strongly suggest UTI
more than 10^5 CFU
What test should all infants with an unexplained fever >38degrees have done?
A urine sample tested
Name 3 common organisms causing UTIs and name one seen more commonly in boys from its presence under the prepuce.
- E.coli
- klebsiella
- Pseudomonas
- Strep. Faecalis
- Proteus
Name some contributing factors to incomplete bladder emptying in children:
- infrequent voiding –> bladder enlargement
- vulvitis, vesicoureteric reflux (VUR)
- incomplete micturition w residual volumes post micturition
- obstruction by a loaded rectum
- neuropathic bladder
Vesicoureteric reflux (VUR) is when the ureters are displaced ___ and enter __ into bladder (not at an __) It is __.
- laterally, directly (angle)
- familial
What association with VUR when urine flows back from renal pelvis to CDs can lead to severe renal scarring if UTIs occur.
-intrarenal reflux
Give 3 reasons why VUR-associated ureteric dilatation is importantly bad.
- if urine returns from ureters to bladder post-void, you get incomplete emptying and predisposition for infection
- pyelonephritis may develop esp with intrarenal reflux
- bladder voiding pressure is transmitted to the renal papillae which may contribute to renal damage if voiding pressures are high
VUR impacts on kidney mean infection can __ renal tissue leaving a __ of shrunken poorly functioning kidney ( __ ____). If scars are bilat and severe progressive ___ may develop. Also ~10% risk of childhood/early adult ___.
- destroy
- scar
- (reflux nephropathy)
- CKD
- hypertension
We do not need to investigate all children w UTIs only those with atypical UTIs, name some features that come under atypical UTIs:
e.g. non-ecoli organisms..
- seriously ill/septicaemia
- poor urine flow
- abdo/bladder mass
- raised creatinine
- not responding to abx in 48hrs
If a child with a UTI is found to be atypical and requiring investigation, what is the first line next step?
Ultrasound of kidneys and urinary tract
If urethral obstruction is identified as a probable cause for atypical UTIs in a boy with an abnormal bladder, what investigation should be carried out?
Clue: 4letters
MCUG: Micturating Cystourethrogram
What is the basis of UTI treatment in the following ages:
<3months
>3moths and children w pylonephritis
children with cystitis/lower UTI
<3mn: hospital for IV Abx (e.g. co-amoxiclav)
children: oral abx e.g. trimethoprim or IV abx followed by oral
lower UTI: oral abx short course
How can you try to prevent UTIs in children?
e.g. lactobacillus acidophilus probiotic
- high fluid intake
- regular voiding and/or double voiding
- treat/prevent constipation as it arises
- good perineal hygiene
In children with recurrent UTI/scarring/reflux what follow up should be arranged?
e.g. regular renal growth and function assessments if there are bilat defects bc of risk of CKD
- dipstick urine in any non-specific illness with MC&S
- long-term low dose abx prophylaxis
- circumcision
- anti-VUR surgery if scarring progresses with ongoing VUR
- check BP annually if renal defects present
- urinalysis to check for proteinuria as sign of CKD
What is a DMSA scan (it is used in the investigation of UTIs in young children <3yrs to look at the kidney’s and how they contribute to functioning;
Dimercaptosuccinic Acid scan
Nephrotic Syndrome = heavy proteinuria leading to low ____ and ____.
Cause often unknown but suggest 2 systemic things it can be secondary to.
- low plasma albumin, and oedema
- 2dry to: Henloch-Schonlien Purpura, SLE, infection like malaria, allergens like bee sting
Give 3 clinical signs of nephrotic syndrome:
NB: infection e.g. peritonitis, septic arthritis or sepsis can occur, why?
- periorbital oedema 1st sign (often on waking)
- scrotal, vulval/leg/ankle oedema
- ascites
- SOB due to pleural effusions + abdo distension
- infection due to loss of protective Igs in the urine
In 90% children with nephrotic syndrome, what does is resolve with and hence won’t progress to CKD
NB: children more commonly 1-10yrs, Asian, male, often precipitated by resp tract infection
how will these children be generally?
On biopsy due to findings on EM, what is this disease called?
Steroid therapy (‘steroid-sensitive nephrotic syndrome)
- associated with atopy
- well (normal BP, normal complement level, normal renal function)
- fusion of podocytes so called minimal change disease
Give 3 complications of nephrotic syndrome:
clue: one issue correlates inversely with serum albumin, cause unknown, hyper______
- hypovolaemia (c/o abdo pain and feel faint, give saline or albumin)
- thrombosis due to urinary losses of antithrombin III, increased viscosity and steroid therapy
- infection esp. capsulated bacterial e.g. pneumococcus (give flu and pneumococcal vaccine)
- hypercholesterolaemia
