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Paeds GU Flashcards

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1
Q

How would you define a UTI?

+ diagnostic numbers

A

Growth of bacteria in the urinary tract

10*5 organisms/ml grown on culture of appropriate sample

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2
Q

What are the common organisms that cause UTI in children?

A

Proteus
E coli
Pseudomonas
Klebsiella

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3
Q

What are predisposing factors for a UTI in children?

A

Incomplete bladder emptying
- Infrequent emptying, hurried micturition
- Obstruction by rectum due to constipation
Vesicoureteric reflux
Poor hygiene eg wiping back to front

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4
Q

How might a child present with an upper UTI?

A 
Fever, septicaemic illness + meningitis in infancy
General malaise
Vomiting
Loin / abdo pain in an older child
Failure to thrive + jaundice in infancy
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5
Q

How might a child present with a lower UTI?

A 
Dysuria
Urinary frequency / urgency
Incontinence
Lower abdo pain
Haematuria
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6
Q

How do you diagnose a UTI?

A

Urine sample
Urinalysis

10*5 organisms/ml grown on culture = diagnostic ting

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7
Q

How would you get a urine sample in a child?

A

MSU - clean catch
Suprapubic aspirate
Catheter
Bag sample / pad sample if need be

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8
Q

What would you look for in a child’s urine if you suspect a UTI?

A 
Visual inspection - is it cloudy or dark or whatever
Protein
Nitrites
Leucocyte esterase
MC&S
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9
Q

What antibiotics would you give to acutely treat an upper UTI?

A

Ciprofloxacin or co-amoxiclav

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10
Q

What antibiotics would you give to acutely treat a lower UTI?

A

trimethoprim / nitrofurantoin / cephalosporin / amoxicillin - based on local guidelines + results of culture

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11
Q

As well as antibiotics, how would you manage a child with a UTI?

A

Pain relief
Fluids

Later - give scans to see if there’s any underlying abnormality

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12
Q

What methods of imaging would you do for a child with a UTI to see if there’s an underlying abnormality?

A

USS
Micturating cystourethrogram
DMSA (radionuclitide scan)

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13
Q

What would you be looking for on a renal USS in a child with UTI?

A

Obstruction

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14
Q

What would you be looking for on a micturating cystourethrogram in a child with a UTI?

A

Retrograde flow of urine from bladder into ureters

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15
Q

What would you be looking for on a DMSA scan in a child with a UTI?

A

Renal scarring

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16
Q

What are the complications of UTI in childhood?

A

Renal scarring leading to:

  • Hypertension
  • Impaired GFR (so CKD in the future ????)
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17
Q

What is a complication of UTI caused by proteus?

A

Phosphate renal stones - more in boys

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18
Q

What would UTI caused by pseudomonas indicate?

A

Structural abnormality

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19
Q

What are the atypical organisms that cause UTI?

A

Anything other than E coli - so pseudomonas, proteus, klebsiella

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20
Q

What are the indications for further investigation in a child with UTI?

A 
Poor flow
Bladder mass
Raised CK
Not responding to abx
Atypical organism - not E coli
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21
Q

How would you routinely follow up a child who had a UTI?

A

Check BP annually
Proteinuria for CKD
Reflux surgery if progression of scarring
Abx prophylaxis - trimethoprim

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22
Q

What are the 3 features of nephrotic syndrome?

A

Heavy proteinuria 1g/m2/24 hours
Hypoalbuminaemia <25g/L
Oedema

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23
Q

Where would you look for evidence of oedema in a child with nephrotic syndrome?

A 
Peri-orbital on waking = earliest sign
Scrotal
Leg and ankle
Pleural effusion so breathlessness
Ascites
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24
Q

What is commonly the earliest sign of nephrotic syndrome?

Study These Flashcards
A

Periorbital oedema on waking

25
What are the causes of nephrotic syndrome?
``` Minimal change disease Focal segmental glomerulosclerosis Membranoproliferative glomerulonephritis Membranous glomerulonephritis Infections - malaria Allergens eg bee stings ```
26
What are the types of nephrotic syndrome?
Steroid resistant | Steroid sensitive
27
What are the features that indicate steroid-sensitive nephrotic syndrome?
Minimal change disease essentially ``` Normal BP No blood in urine Normal renal function No features to suggest nephritis Responds to steroids (DUH) Histology shows minimal change Normal complement Age 1-10 ```
28
What are the features that indicate steroid-resistant nephrotic syndrome?
Other diseases not minimal change disease ``` Elevated BP Haematuria Impaired renal function Features to suggest nephritis Failure to respond to steroids (DUH) Histology shows pathology ie glomerulonephropathy, basement membrane abnormality ```
29
What tests would you do to investigate a child with suspected nephrotic syndrome?
``` Urine dipstick - protein, no nitrites, may be RBCs Urine MC&S FBC ESR U&E Creatinine Albumin C3 + C4 (complement levels) Urinary sodium Hep B / C screen Malaria screen if recent foreign travel ```
30
How do you treat nephrotic syndrome? | first line
PREDNISOLOOOOOOONE 60mg/m2 for 4 weeks Then 40mg/m2 alternate days for 4 weeks
31
Other than steroids, how would you manage a child with steroid responsive nephrotic syndrome?
Salt and water moderation Diuretics Penicillin V VZV, measles and pneumococcal immunisation
32
How would you treat steroid resistant nephrotic syndrome?
``` Refer to nephrology And treat the oedema: - Salt restriction - Diuretics - ACEi - NSAIDs - reduce the proteinuria ```
33
What are the complications of nephrotic syndrome?
Hypovolaemia Thrombosis (because pissing out antithrombin 3) Infection Hypercholesterolaemia
34
Which organism causes post-strep glomerulonephritis?
strep (no shit sherlock) | Group A beta-haemolytic strep (same bitchin thing as rheumatic fever)
35
CASE A child presents with swollen testicles, breathlessness, red blood in his urine and a fever. A week ago he had a sore throat. What are the differential diagnoses?
``` Nephrotic syndrome (probs steroid resistant to be picky) Post-strep glomerulonephritis ```
36
Which investigations would you perform for a child with suspected post-strep glomerulonephritis?
``` FBC U&E Immunology Throat / skin swabs for the initial infection Urinalysis ```
37
What would you see on urinalysis of a patient with post-strep glomerulonephritis?
Increased protein Increased protein:creatinine ratio Haematuria (macroscopic) RBC casts
38
How would you manage a child with post-strep glomerulonephritis?
``` Fluid balance Diuretics Correction of electrolyte imbalance Dialysis (uncommonly needed) Penicillin to treat the strep infection ```
39
What is Alport syndrome?
Congenital Glomerulonephritis CKD (end-stage) Hearing loss
40
What are the symptoms of HSP?
Rash Arthralgia + periarticular oedema Colicky abdo pain Glomerulonephritis
41
Describe the rash in HSP
Non-blanching Symmetrical On buttocks, extensors of arms and legs, ankles Sparing of the trunk Palpable Initially urticarial - then goes to maculopapular and purpuric
42
What is haemolytic uraemic syndrome?
Triad of: - Microangiopathic haemolytic anaemia - Acute renal failure (uraemia) - Thrombocytopaenia
43
What is the most common cause of HUS?
E coli O157:H7 From farm animals or uncooked beef
44
What are the causes of HUS?
``` E coli O157:H7 Tumours Pregnancy The pill Cyclosporins SLE HIV ```
45
How would you investigate a patient with suspected HUS?
FBC - shows the anaemia and the thrombocytopaenia U&E - shows acute renal failure Stool culture
46
How would you manage a patient with HUS?
Supportive: Fluids Blood transfusion Dialysis if required
47
What is atypical HUS?
Without the bloody diarrhoeal prodrome | Or cerebral involvement
48
How would you treat atypical HUS?
Plasma exchange | Plasma infusion
49
What are the causes of proteinuria?
Transient - febrile illness or after exercise | Persistent - nephrotic syndrome basically
50
What is the definition of daytime enuresis?
Lack of bladder control during the day in a child old enough to be continent of urine
51
At what age should children be continent of urine?
3-5 years
52
What are the causes of daytime enuresis?
``` Lack of attention to bladder sensation (don't respond to a full bladder) Detrusor instability Neuropathic bladder Bladder neck weakness Constipation UTI Ectopic ureter ```
53
How would you treat a child with daytime enuresis?
``` Star charts Bladder training / pelvic floor exercises Enuresis alarm (if lack of attention to bladder sensation) Treat constipation ```
54
What is secondary enuresis?
Urinary incontinence in a child who has previously achieved continence
55
What are the causes of secondary enuresis?
Emotional upset UTI Diabetes Renal concentrating disorders - sickle cell, chronic renal failure
56
What is nocturnal enuresis?
Bed-wetting | Genetically determined delay in sphincter competence
57
How would you manage a child with nocturnal enuresis?
Explain that it is normal + stop parents from punishing Star charts Enuresis alarm
58
What pharmacological treatment would you use for nocturnal enuresis?
Desmopressin

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