Nephrology and Urology Flashcards
(20 cards)
Describe alport syndrome
Glomerular basement membrane disease
Collagen 4 abnormalities, X linked dominant inheritance
Renal; haematuria (micro and macro), proteinuria, hypertension
Deafness; high tone sensorineural loss
Renal failure in early adult life
Eye changes; lectinous, macular changes in retina
What are the most common presenting signs for UTI in neonates vs children?
Neonates; fever, vomiting, lethargy, irritability
Children;
- preverbal; fever, abdo pain, tenderness, vomiting, poor feeding, lethargy
- verbal; abdo loin pain/tenderness, fever, malaise, vomiting
How is a diagnosis of UTI aided in children? (LAB)
Dipstix;
- leucocyte esterase activity, nitrates
- unreliable under 2
Microscopy;
- pyuria, bacteruria
Culture >10^5 colony forming units = E.Coli
What is a concern regarding UTIs in children?
Vesico-ureteric reflux
5 grades; high grade/bilateral
What is renal dysplasia?
Kidneys are present and functioning but development is abnormal
Can be unilateral/bilateral
Who to investigate if suspect UTI?
Upper tract symptoms
Younger
Recurrent
What are some investigations for UTI? (IMAGING)
Ultrasound; structure
DMSA; isotope scan for scarring and function
Micturating cysto-urethrogram (MAG3 scan); dynamic
What is UTI treatment?
Lower; 3 days oral antibiotic
Upper tract/pyelonephritis
- antibiotics for 7-10 days (oral if systemically well)
- no role for routinge prophylaxis
Prevention, fluids, hygiene, constipation
Manage voiding dysfunction
How can paediatric urological problems present?
Systemic; fever, vomiting, FTT, anaemia, hypertension, renal failure
Local; pain, urine changes, abnormal voiding, mass, visible abnorms
Describe hernia presentation in paeds
More common in boys
Most indirect
increased risk with prematurity
Management;
- <1yr urgent referral, repair (no place for observation)
- > 1yr elective referral and repair
- incarcerated; reduce and repair on same admission
Describe hydrocele
Scrotal swelling
Very common in newborns
Painless; increases with crying, straining, evening
Bluish colour
Management; conservative until 5yr old
Describe cryptorchidism
Any testis that cannot be manipulated into bottom half of scrotum
non-descent
Types; true, retractile, ectopic, (ascending testis)
What are indications for orchidopexy?
Fertility
- 1% loss germ cells/month undescent
Malignancy
Trauma
Torsion
Cosmetic
Describe circumcision
Removal of foreskin
indications
- absolute; balanitis xerotica obliterans (BXO)
-relative; balanoprosthitis, religious, UTI
How long do you have to recover testis?
6-8hours
What are differentials for the acute scrotum?
Torsion testis
Torsion appendix testis
Epididymitis
What does MAG3 show?
Drainage, function, reflux
Indicated in imaging for UTI
What foes DMSA show?
function, scarring
What is the management for VUR?
Conservative; voiding advice, constipation, fluids
Antibiotic prophylaxis
STING (injection sugar based medication) - mild/moderate with symptoms
Ureteric reimplantation
Describe hypospadias
urethral meatus on ventral aspect of penis
Anterior (50%), middle (30%), posterior (20%)
may have ambiguous genitalia
US if severe
DO NOT CIRCUMCISE
One or two stage procedure to correct
