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CCC > Paediatrics: Renal + urinary > Flashcards

Paediatrics: Renal + urinary Flashcards

1
Q

What is the difference between primary and secondary enuresis? How do the RFs vary?

A

Primary - delayed maturation of bladder control mechanisms (urinary continence previously never achieved)

  • RF: Paternal FHx, B>F

Secondary - loss of previously established bladder continence (previously achieved urinary continence for at least 6 months)

  • RF: Typically psychological, domestic abuse, bullying, emotional stress, UTI and other pathology
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2
Q

What is the definition of enuresis

A

Loss of bladder control during the day or night for girls > 5yo or boys > 6yo

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3
Q

Definition of nocturnal enuresis

A

Loss of bladder control at least twice weekly in children age > 5yo

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4
Q

What are the possible mechanisms behind nocturnal enuresis

A
  • Lack of attention to bladder sensation
  • Physiological: detrusor muscle dysfunction, bladder neck weakness, neuropathic bladder (common in spinal bifida)
  • Pathological causes: UTI, ectopic ureter, constipation
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5
Q

What are the features of detrusor instability

A

Sudden, urgent urge to void (uncontrollable), bladder contractions

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6
Q

What are the features of a neuropathic bladder

A
  1. Bladder enlarged (thick wall –> bladder does not empty fully)
  2. Abnormal leg reflexes and gait
  3. Loss of sensation to dermatomes S2-4
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7
Q

What are the features of ectopic bladder

A
  1. Constant dribbling
  2. Child always damp
  3. Girls - dry during night, wet on getting up (due to bladder pooling and change in position causes urine to release through ectopic ureter often in vagina)
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8
Q

What are the possible investigations for enuresis?

A
  1. Urine dip
  2. Urine MSC
  3. USS pevis
  4. Cystoscopy
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9
Q

What are the treatment options for enuresis under 5s?

A

Reasure + educate (10% of 5 year olds, 5% of 10 year oldS)

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10
Q

What are the treatment options for enuresis under 7s?

A
  1. Start chart for drinking and voiding - immediate, achievable, consistent, encouragement, rewards, no punishment (1st line)
  2. Enuresis alarm
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11
Q

What are the treatment options for enuresis over 7s who have already tried the star chart?

A
  1. Desmopressin + fluid reduction 1 hr before bed - only for short term use like sleep overs
  2. Imipramine (2nd line) - more SE, higher risk of OD
  3. Oxybutynin (bladder instability)
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12
Q

What is the main cause of UTIs in children

A

E.Coli (90%)

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13
Q

What is the criteria for UTI

A

Clinically suggestive symptoms with significant culture of 10^5 organisms

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14
Q

With which type of organisms are urinary tract stones most common

A

Proteus

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15
Q

Which UTI organism suggests an abnormal urinary tract

A

Pseudomonas

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16
Q

What are symptoms of a UTI in an infant

A

D+V, not eating, FTT, crying, irritable, fever, febrile convulsion, prolonged neonatal jaundice

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17
Q

What are symptoms of a UTI in a child

A

Frequency, dysuria, vomiting, fever + riggers, irritable, LoA, cloudy urine, abdo/loin pain/ache, recurrence of enuresis, haematuria,

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18
Q

What are the symptoms of a LUTI

A

^Frequency, dribbling, abdominal pain/ache (mild), enuresis

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19
Q

What are the investigations for a child < 6months with an (a) typical UTI and (b) atypical/recurrent UTI after recovering from UTI

A

Typical - USS

atypical - USS during acute phase and 6 weeks later, DMSA, MCUG

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20
Q

What are the investigations for a child between 6months and 3 years with an (a) typical UTI and (b) atypical/recurrent UTI after recovering from UTI

A

Typical - nothing

Atypical - USS and DMSA

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21
Q

What are the investigations for a child > 6 months with an (a) typical UTI and (b) atypical/recurrent UTI after recovering from UTI

A

Typical - nothing

Atypical - USS (DMSA if recurrent or clinically indicated)

22
Q

What features would may find on a urine dip in a UTI patient

A
  1. Leukocytes (infection)
  2. Nitrites (bacteria)
  3. Blood
23
Q

What is the Mx of a UTI in a child < 3 months

A
  1. Hospitalisation
  2. IV Abx
  3. Care under specialist with Abx
24
Q

What is the MX of a UTI in a child > 3 months with a LUTI or cystitis

A
  1. PO Trimethoprime, Nitrofurantoin or cefradine (3 day)
25
Q

What is the MX of a UTI in a child > 3 months with a UUTI or pyelonephritis

A 
1st line - PO cephalosporin or co-amoxiclav (7d)
2nd line (if PO not tolerated) - IV ceftriaxone or cefotaxime (2-4d) then PO ( 10d)
26
Q

What are some self management tips you can give parents for their child to prevent UTIs

A
  1. Encourage regular voiding and drinking
  2. Cotton or nylon underwear
  3. Good hygiene - wiping, washing perineum
27
Q

What is the mot common structural abnormality a/w UTIs and what is the possible complications and investigations

A

Vesicouteric reflux (VUR) - graded 1-5
Ix - MCUG, DMSA
complication - VUR + UTI –> high level of scarring –> renal failure

28
Q

What are the features of an atypical UTI

A
  1. Non E-coli organism
  2. Symptoms not improving in 48hrs of Abs
  3. Abdominal mass
  4. Sepsis
  5. ^creatinine and deranged U+Es
  6. Poor urine flow
  7. Seriously ill
29
Q

What is the most common glomerular and non-glomerular cause of haematuria in children

A 
glomerular = glomerulonephritis 
n-glomerular = UTI
30
Q

What is haemolytic uraemia syndrome?

A

It is a syndrome of microangiopathic haemolytic anaemia, thrombocytopoenia and acute renal failure

31
Q

What are the two forms of HUS? How do they differ?

A

Sporadic (D-HUS) - related to familial

Atypical/Epidemic (D+HUS) - related to E.Coli 0157 infection causing bloody diarrhoea

32
Q

What are some of the symptoms of HUS?

A

Pancreas - Type 1DM, Pancreatitis

Gut - Bloody diarrhoea, rectal prolapse

33
Q

What are the investigations for HUS?

A

Blood film: haemolysis, anaemia, thrombocytopenia

Bloods: High WCC, Low platelets

34
Q

What is the management for HUS patients?

A
  1. Hospitilisation
  2. Supportive treatment - O2, Fluid balance
  3. Eculizumab
35
Q

What is the most common cause of AKI in children?

A

Haemolytic uraemia syndrome

36
Q

What is nephrotic syndrome?

A

Damage to kidneys causing leakage of proteins into urine (proteinuria)

37
Q

What is the main secondary cause of nephrotic syndrome?

Can you name two other causes?

A

Minimal change disease (85%)

Others include membranous glomerulonephritis, focal segment glomerulosclerosis

38
Q

What are the symptoms of nephrotic syndrome?

A 
1. Classic: 
Facial oedema - begins periorbitally (puffy eyes) and then spreads to other areas e.g. scrotum 
Abdominal pain or discomfort 
Oliguria 
Frothy urine 
Diarrhoea 
Anorexia
  1. Late:
    Ascites
    Pleural effusion
39
Q

What are the key investigations for nephrotic syndrome?

A
  1. Urine:
    - Dip = +++protein
    - MSC
    - Protein:CR > 200mg/mmol
    - Na < 10 mmol/l (hypovolaemia)
    - Haematuria suggests a cause other than MCD
  2. Blood:
    - Serum Albumin < 20g/L
40
Q

What is the management ladder for nephrotic syndrome

A
  1. Hospitalise
  2. Diuretics - Furosemide or spironolactone (reduce fluid overload)
  3. Limit fluid intake
  4. Steroids - prednisone (95% nephrotic syndromes are steroid sensitive, induce remission)
  5. Prophylactic Abx
41
Q

Define glomerulonephritis. What are the two forms?

A

Inflammation of renal glomeruli

  1. Proliferative (nephritic) - increase in number of cells –> haematuria, HTN + RBC casts
  2. Non-proliferative (nephrotic) - no increase in cells –> proteinuria
42
Q

What are the main causes of nephrotic and nephritic syndrome?

A

Nephrotic - MCD (85%), Membraneproliferative glomerulonephritis, Focal segment glomerulosclerosis

Nephritic - Streptococcus

43
Q

What are the symptoms of nephritic syndrome

A

URTI (prodrome)

Haematuria (nephritic), Proteinuria (nephrotic) HTN, oedema, oliguria

44
Q

What are the symptoms of nephrotic syndrome

A

Proteinuria, oedema (facial and scrotal), oliguria, frothy urine, abdominal pain/discomfort, anorexia, diarrhoea

45
Q

What is the investigation ladder for glomerulonephritis

A
  1. Urine:
    - Dip = +++Protein +Blood + Nitrites (bacterial infection)
    - Microscopy - red cell casts
  2. Throat swab - Strep (esp if nephritic synd)
  3. USS kidney (urgent)
46
Q

What is the management for Glomerulonephritis?

A
  1. Admission - due to HTN, worsening renal function and fluid overload
  2. Oliguria? start fluid management - Diuretic (furosemide), limit fluid intake
  3. HTN due to overload - CCB + Tamsulosin
  4. Infection? - penicilin
47
Q

What are the possible complications arising from glomerulonephritis? and how are they treated?

A
  1. Hypocalcaemia - IV Magnesium Sulphate
  2. Hyperkalaemia - Calcium gluconate
  3. HTN - Tamsulosin + CCB
  4. Seizures - Diazepam or Lorazepam
  5. Acidosis
48
Q

What is hypospadias and how does it present?

A

A congenital disorder in boys where they fail to complete “foetal urethral tubularisation”

  1. Ventral urethral meatus - external opening of urethre is incorrectly placed
  2. Chordee (ventral bending penis)
  3. Hooded dorsal foreskin - foreskin fails to fuse ventrally
49
Q

What is the treatment for hypospadias

A

1.Corrective surgery within 2 years

50
Q

In which demographic is nephrotic syndrome most common

A

Indians, Boys

51
Q

At what time of year is HUS most common?

A

Summer and Autumn

CCC (7 decks)

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