nephrology + genitourinary

Question 1

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

Answer 1

3-7% girls, 1-2% boys

Question 2

complications pyelonephritis

Answer 2

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

Question 3

features UTI in infants

Answer 3

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

Question 4

features UTI in children

Answer 4

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

Question 5

what differentiates pyelonephritis from cystitis

Answer 5

fever and systemic involvement

Question 6

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

Answer 6

clean catch

Question 7

what should you do with urine culture if

Answer 7

culture immediately. or refrigerate

Question 8

what is the mode of infection in infant

Answer 8

haematogenous (older- bacteria from the gut flora)

Question 9

commonest organisms UTI

Answer 9

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

Question 10

what is vesicoureteric reflux

Answer 10

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

Question 11

what is mild VUR

Answer 11

reflex of urine into ureter only. on micturition

Question 12

what is severe VUR

Answer 12

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

Question 13

what has a high risk of causing scarring to the kidneys

Answer 13

intrarenal reflux

Question 14

if bilateral scarring of kidneys what can occur

Answer 14

chronic renal failure. risk of HTN

Question 15

when is investigation necessary in UTI

Answer 15

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

Question 16

investigations in UTI

Answer 16

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

Question 17

what is the best investigation for excluding reflux

Answer 17

MCUG

Question 18

which scan is best for dynamic scan

Answer 18

MAG3

Question 19

what can be done in first UTI

Answer 19

ultrasound

Question 20

treatment UTI infant

Answer 20

cefotaxime. or amoxicillin + gentamicin

Question 21

treatment lower UTI

Answer 21

trimethoprim 3 days. nitrofurantoin

Question 22

treastment upper UT/ acute pyelonephritis

Answer 22

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

Question 23

what can be used as prophylaxis

Answer 23

trimethoprim

Question 24

what can enuresis be due to

Answer 24

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

Question 25

presentation ectopic ureter

Answer 25

girls who are dry at night but wet on getting up

Question 26

investigations enuresis

Answer 26

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

Question 27

treatment enuresis

Answer 27

desmopressin. enuresis alarm

Question 28

causes secondary enuresis

Answer 28

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

Question 29

what is nephrotic syndrome

Answer 29

proteinuria, low albumin, oedema

Question 30

signs nephrotic syndrome

Answer 30

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

Question 31

investigations nephrotic syndrome

Answer 31

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

Question 32

what tests can detect group A strep

Answer 32

anti DNAase b titre, with anti strepsolysin O

Question 33

what is steroid sensitive nephrotic syndrome

Answer 33

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

Question 34

features of steroid sensitive NS

Answer 34

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

Question 35

management steroid sensitive NS

Answer 35

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

Question 36

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

Answer 36

renal biopsy

Question 37

what is the most common NS in children

Answer 37

minimal change disease

Question 38

is minimal change disease responsive to steroid treatment

Answer 38

yes

Question 39

complication of minimal change disease

Answer 39

hypovolaemia, low urinary Na, thrombosis, infection, hypercholesterolaemia

Question 40

what can you treat hypovolaemia with in minimal change disease

Answer 40

IV albumin (colloid)

Question 41

causes of steroid resistant NS

Answer 41

focal segmental glomerulonephritis, mesangiocapillary glomerulonephritis, membranous nephropathy

Question 42

treatment focal segmental glomerulonephritis

Answer 42

cyclophosphamide, ciclosporin, tacrolimus, rituximab

Question 43

associations membranous nephropathy

Answer 43

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

Question 44

treatment oedema

Answer 44

diuretics, salt restriction, ACEi, NSAIDs

Question 45

most common cause haematuria

Answer 45

UTI

Question 46

signs glomerular haematuria

Answer 46

brown urine, deformed red cells and casts, proteinuria

Question 47

signs lower UT haematuria

Answer 47

red. beginning or end of stream

Question 48

when to do renal biopsy in haematuria

Answer 48

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

Question 49

non glomerular causes haematuria

Answer 49

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

Question 50

glomerular causes haematuria

Answer 50

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

Question 51

investigations haematuria

Answer 51

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

Question 52

if suspect alports what can you test

Answer 52

hearing

Question 53

what is henoch schlonein purpura

Answer 53

acute immune complex mediated vasculitis

Question 54

what precedes the purpura in HSP

Answer 54

URTI

Question 55

symptoms HSP

Answer 55

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

Question 56

presentation HSP

Answer 56

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

Question 57

tests in HSP

Answer 57

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

Question 58

complications HSP

Answer 58

massive GI bleeds, haemoptysis, acute renal failure

Question 59

what is AKI characterised by

Answer 59

rapid rise in creat and development oliguria/anuria

Question 60

what is haemolytic uraemic syndrome

Answer 60

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

Question 61

what is typical HUS associated with

Answer 61

diarrhoea. more freq in summer months, typically occurs children