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Flashcards in nephrology + genitourinary Deck (61):
1

what % of boys and girls get UTI before 6 years old

3-7% girls, 1-2% boys

2

complications pyelonephritis

damage growing kidney by forming a scar- hypertension and chronic renal failure

3

features UTI in infants

non specific- fever, vomiting, lethargy, poor feeding, jaundice, septicaemia, offensive urine, febrile convulsions

4

features UTI in children

dysuria and frequency, abdominal pain or loin tendernessm fever +- rigors, lethargy, d +v, haematuria, offensive urine, febrile convulsion, recurring enuresis

5

what differentiates pyelonephritis from cystitis

fever and systemic involvement

6

what is the best way to get a urine sample in infant

clean catch

7

what should you do with urine culture if

culture immediately. or refrigerate

8

what is the mode of infection in infant

haematogenous (older- bacteria from the gut flora)

9

commonest organisms UTI

e coli. others- klebsiella, proteus, pseudomonas, strep faecalis

10

what is vesicoureteric reflux

anomaly vesicoureteric junction. ureters displaced laterally, directly enter into bladder rather than at an angle (backward flow urine from bladder to kidneys)

11

what is mild VUR

reflex of urine into ureter only. on micturition

12

what is severe VUR

gross dilatation ureter, renal pelvis and calyces. reflux during bladder filling and voiding. assoc with intrarenal reflux

13

what has a high risk of causing scarring to the kidneys

intrarenal reflux

14

if bilateral scarring of kidneys what can occur

chronic renal failure. risk of HTN

15

when is investigation necessary in UTI

atypical or recurrent UTIs. septicaemia, poor urine flow, abdominal mass, incr creat, failure to respond to antibiotics within 48h. infection with non e coli organisms

16

investigations in UTI

ultrasound, DMSA (99Tc), MCUG (micturating cystourethrogam), MAG3 renogram, AXR

17

what is the best investigation for excluding reflux

MCUG

18

which scan is best for dynamic scan

MAG3

19

what can be done in first UTI

ultrasound

20

treatment UTI infant

cefotaxime. or amoxicillin + gentamicin

21

treatment lower UTI

trimethoprim 3 days. nitrofurantoin

22

treastment upper UT/ acute pyelonephritis

co amoxiclav for 7-10d or IV cefotaxime 2-4 days then oral for 7-10d

23

what can be used as prophylaxis

trimethoprim

24

what can enuresis be due to

lack of attention to bladder sensation, detrusor instability, bladder neck weakness, neuropathic bladder, UTI, constipation, ectopic ureter

25

presentation ectopic ureter

girls who are dry at night but wet on getting up

26

investigations enuresis

urine sample, US, urodynamic studies, X ray, MRI

27

treatment enuresis

desmopressin. enuresis alarm

28

causes secondary enuresis

when lose previously achieved urinary continence- emotional upset, UTI, polyuria- DM, sickle cell

29

what is nephrotic syndrome

proteinuria, low albumin, oedema

30

signs nephrotic syndrome

periorbital oedema, scrotal or vulval leg or ankle oedema, ascites, breathless- effusion

31

investigations nephrotic syndrome

urine protein, FBC, ESR, U&Es, creat, albumin, complement, urine microscopy and culture, urinary Na, antistrepsolysin O or anti DNAase B titres and throat swab, hep B and C screen

32

what tests can detect group A strep

anti DNAase b titre, with anti strepsolysin O

33

what is steroid sensitive nephrotic syndrome

85-90% children with NS respond to corticosteroids. dont progress to renal failure. often precipitated by resp infections

34

features of steroid sensitive NS

age 1-10y, no macroscopic haematuria, normal bp, normal complement, normal renal function

35

management steroid sensitive NS

oral prednisolone 60mg/m/d reduce to 40 after 4 weeks then alternate days for 4 weeks then stop.

36

if steroid sensitive NS doesn't respond to corticosteroids or atypical what should be done

renal biopsy

37

what is the most common NS in children

minimal change disease

38

is minimal change disease responsive to steroid treatment

yes

39

complication of minimal change disease

hypovolaemia, low urinary Na, thrombosis, infection, hypercholesterolaemia

40

what can you treat hypovolaemia with in minimal change disease

IV albumin (colloid)

41

causes of steroid resistant NS

focal segmental glomerulonephritis, mesangiocapillary glomerulonephritis, membranous nephropathy

42

treatment focal segmental glomerulonephritis

cyclophosphamide, ciclosporin, tacrolimus, rituximab

43

associations membranous nephropathy

may precede SLE. associated with hep B. most remit spontaneously within 5 years

44

treatment oedema

diuretics, salt restriction, ACEi, NSAIDs

45

most common cause haematuria

UTI

46

signs glomerular haematuria

brown urine, deformed red cells and casts, proteinuria

47

signs lower UT haematuria

red. beginning or end of stream

48

when to do renal biopsy in haematuria

significant proteinuria, abnormal renal function, recurrent macroscopic haematuria, complement levels abnormal

49

non glomerular causes haematuria

trauma, stones, sickle cell, hypercalcuria, bleeding disorders, infection, renal vein thrombosis, tumours

50

glomerular causes haematuria

acute and chronic glomerulonephritis, IgA nephropathy, thin basement membrane disease, familial nephritis

51

investigations haematuria

urine microscopy and culture, protein and calcium excretion, US, U&Es, creat, Ca, PO4, albumin, FBC, platelets, clotting, sickle cell screen

52

if suspect alports what can you test

hearing

53

what is henoch schlonein purpura

acute immune complex mediated vasculitis

54

what precedes the purpura in HSP

URTI

55

symptoms HSP

purpura, arthritis/arthralgia, abdominal pain. renal involvement- glomerulonephritis, haematuria, proteinuria. intussusception, GI petechiae- haematemesis and malaena

56

presentation HSP

symmetrical rash over buttocks, extensor surfaces of arms and legs, ankles. trunk spared. usually have a fever. 3-10y. male : female 2:1

57

tests in HSP

ESR incr, IgA incr, proteinuria, ASO titres incr, U&E, BP.

58

complications HSP

massive GI bleeds, haemoptysis, acute renal failure

59

what is AKI characterised by

rapid rise in creat and development oliguria/anuria

60

what is haemolytic uraemic syndrome

acute microangiopathic haemolytic anaemia, thrombocytopaenia, renal failure + endothelial damage to glomerular capillaries.

61

what is typical HUS associated with

diarrhoea. more freq in summer months, typically occurs children