Paediatric Nephrology/Urology

Question 1

How do you investigate a child under 6 months with their first UTI? (Not atypical or recurrent, responds well to treatment)

Answer 1

Abdominal ultrasound within 6 weeks

Question 2

How do you investigate a child over 6 months with a recurrent UTI?

Answer 2

Abdominal ultrasound within 6 weeks

DMSA scan within 4-6 months

Question 3

How do you investigate a child over 6 months with an atypical UTI?

Answer 3

Ultrasound during illness

DMSA 4-6 months after illness

Question 4

How do you investigate a child under 6 months with a recurrent UTI?

Answer 4

Ultrasound during illness

DMSA 4-6 months after illness

MCUG

Question 5

`How do you investigate a child under 6 months with an atypical UTI?

Answer 5

Ultrasound during illness

DMSA 4-6 months after illness

MCUG

Question 6

What is classed as an atypical UTI?

Answer 6

Seriously ill

poor urine flow

abdominal or bladder mass

raised creatinine

septicaemia

failure to respond to treatment with suitable antibiotics within 48 hours

infection with non-E. coli organisms

Question 7

How does nephrotic syndrome present in children?

Answer 7

Frothy urine

Generalised oedema - peripheral, ascites, periorbital, pulmonary

Pallor

Low serum albumin

High urine protein

Oedema

Question 8

What blood results are seen in nephrotic syndrome?

Answer 8

Low serum albumin

Increased cholesterol and lipids

Question 9

What is the main complication of nephrotic syndrome?

Answer 9

Hypercoagulability causes increased risk of DVT and PE

Question 10

What is the most common cause of nephrotic syndrome in children?

Answer 10

Minimal change disease

Question 11

How is minimal change disease managed?

Answer 11

Oral prednisolone

If steroid resistant -> ACEi/immunnosuppresants

Question 12

What is the first line treatment for nocturnal enuresis after all lifestyle measures have been trialled?

Answer 12

Under 7 -> enuresis alarm

Over 7 -> desmopressin

Question 13

Which type of polycystic kidney disease presents in neonates?

Answer 13

Autosomal recessive PKD

Question 14

What are features of autosomal recessive PKD?

Answer 14

Can be seen on antenatal scans with:

enlargement of collecting ducts

Oligohydramnios

Pulmonary hypoplasia (due to oligohydramnios)

Potter syndrome

Congenital liver fibrosis

Question 15

What is a Wilm’s tumour and how does it present?

Answer 15

Specific type of tumour which affects the kidney in children

Mass in abdomen

Abdominal pain

Haematuria

Lethargy

Weight loss

Fever

Question 16

How is a Wilm’s tumour diagnosed?

Answer 16

Abdominal ultrasound

Use MRI/CT to stage

Question 17

How is a Wilm’s tumour treated?

Answer 17

Nephrectomy

Question 18

What is a posterior urethral valve?

Answer 18

Tissue at the proximal end of the urethra, causing obstruction of urine outflow and build up in the bladder

Leads to back flow to the kidney (Hydronephrosis)

Question 19

How does a posterior urethral valve present?

Answer 19

Presents antenatally with oligohydramnios and pulmonary hypoplasia

Question 20

How do you manage a neonate with undescended testes?

Answer 20

Watch and wait - most will descend by 3-6 months

If not descended by 6 months - referral needed

Question 21

What is hypospadias? How is it treated?

Answer 21

Congenital abnormality of the penis

Urethra is displaced towards the scrotum

Treated with corrective surgery at 12 months age

Question 22

What is a hydrocele and how does it present? When are they normal?

Answer 22

Collection of fluid within the tunica vaginalis

Soft, smooth non-tender swelling

Transilluminates

Common in newborn males

Should absorb by 2 years of age