Nephrology + Urinary System Flashcards
(26 cards)
What is nocturnal enuresis?
Intermittent incontinence of urine during sleep after 5 years of age (bed wetting).
What is the difference between monosymptomatic enuresis and non-monosymptomatic enuresis (NMNE)?
Monosymptomatic enuresis: enuresis with no other lower urinate tract symptoms
Non-monosymptomatic enuresis: enuresis with other, mainly daytime, lower urinary tract symptoms
What are important symptoms suggestive of underlying bladder dysfunction (overactive bladder/NMNE)?
- Leakage of urine during the day
- Drops of urine in the underpants (before or after voiding)
- Very wet underpants
- Hx of daytime incontinence over the years of 3 and a half
What are symptoms suggestive of dysfunctional voiding?
- Voiding postponement
- Holding maneuvers observed
- The need to push in order to urinate
- Interrupted urinary stream, or several voids, one after the other
What are examples of secondary causes of nocturnal enuresis?
- UTI (most common)
- DM
- Severe psychological trauma
- Spina bifida occulta or cystica
What is enuresis (esp. NMNE) associated with constipation usually indicate?
Dysfunctional elimination syndrome
What drug can be given to children to treat nocturnal polyuria?
Desmopressin
What is recommend as first line treatment in treating monosymptomatic enuresis?
Alarms (behavioral therapy)
What can be used with combination with rest Detrusor muscle over activity?
Oxybutynin
Is UTI more common in girls or boys?
Girls (due to their short urethra)
What is the most common renal anomaly that is associated with UTI?
VUR
What is the most common presentation of UTI?
Unexplained fever
What is the most common microorganism that causes UTI?
E. Coli
What are the signs and symptoms of UTI according to age?
Neonates with UTI:
Jaundice, fever, FTT, poor feeding, vomiting and irritability (non-specific symptoms)
Infants (1m) to 2 years:
Fever, poor feeding, vomiting, strong-smelling urine, irritability and abdominal urinate (may masquerade a GI illness)
2-6 years:
Fever, vomiting, abdominal pain, strong-smelling urine, enuresis and urinary symptoms like dysuria, urgency and frequency (more specific symptoms)
What are the factors that distinguish between an upper UTI (pyelonephritis) and a lower UTI (cystitis)?
Pyelonephritis (upper UTI):
Febrile UTI + flank abdominal pain + loin pain/tenderness
Cystitis (lower UTI):
Dysuria, frequency and hematuria (may be present) = NO SYSTEMIC FEATURES
What is checked in the urine dipstick test of a suspected case of UTI?
Leukocytes
Leukocyte esterase
Nitrites
What is the definitive diagnosis method for UTI?
Urine culture
What is the best and most accurate method of collection of urine sample?
Suprapubic sample
What method of collection of urine sample is used after infancy?
Midstream urine
What are the commonest organisms that cause UTI?
E. Coli (most common)
Proteus ~associated with stones
Pseudomonas ~hospital acquired
Klebsiella pneumonia
What are characteristics of atypical UTI?
- Seriously ill
- Poor urine flow (think of obstruction like PUV)
- Abdominal or bladder mass
- Raised creatinine
- Septicemia
- Failure to respond to treatment with Abx (within 48 hrs)
- Infection with non-E. Coli organisms
What is recurrent UTI?
Two or more episodes of UTI
Does PUV occur in females?
NO
What are important investigations for atypical or recurrent UTIs?
- Renal US
- Voiding cysrourethrogram (VCUG) / micturating cystourethrogram (MCUG) ~to diagnose PUV and reflux
- DMSA scan (to diagnose renal scarring)
