Paeds - renal tings

Question 1

Postnatal management of congenital renal anomalies

Answer 1

1. ABX prophylaxis
2. USS - if bilateral hydronephrosis is seen, do MCUG
3. Repeat USS in 2-3 months if first one is normal

Question 2

Wtf is an MCUG

Answer 2

Micturating Cystourethrogram

Inject a die into the bladder via catheter.
Take images whilst child is urinating

Question 3

3 most common organisms in a UTI in children

Answer 3

E. Coli
Proteus (boys)
Pseudomonas (structural problem)

Question 4

which UTI is more common in boys

Answer 4

Proteus

Question 5

which UTI is most common in children with a structural abnormality

Answer 5

Pseudomonas

Question 6

Signs of atypical UTI

Answer 6

• Septicaemia
• No improvement after 48h of starting abx
• Pelvic/renal mass
• Reduced UO
• High serum Cr

Question 7

Ddx for UTI? give 3

Answer 7

Vulvovaginitis
Balanitis
Sexual abuse!!!!!

Question 8

which 1 urine dip result is most specific for UTI - leukocytes or nitrites?

Answer 8

Nitrites

Question 9

When would you order a USS for a typical UTI?

Answer 9

any child <6 months. do a USS 6 weeks later

Question 10

In a child with RECURRENT UTIs, which 2 investigations are always ordered?
which extra Ix would you do in a child under 6 months?

Answer 10

USS + DMSA

if <6 mnths, also do MCUG

Question 11

management of a child <3 months with a lower UTI?

Answer 11

Admit and IV abx

Question 12

Mx of child with upper UTI and >3months

Answer 12

7-10 days oral Abx = cipro/coamoxiclav

• consider specialist referral

Question 13

Mx of child with lower UTI and >3 months

Answer 13

Oral trimethoprim for 3 days

Question 14

what IS vesicoureteric reflux

Answer 14

Where ureters enter directly into bladder and not at an angle

• Either congenital OR acquired after recurrent infection/urethral obstruction/neuropathic bladder

Question 15

Complications of vesicoureteric reflux

Answer 15

Renal scarring, HTN, recurrent UTIs

Question 16

Ddx for secondary enuresis

Answer 16

UTI
DM
emotional upset

Question 17

First Sx of nephrotic syndrome

Answer 17

Periorbital oedema

Question 18

Is proteinuria always a problem?

Answer 18

Nah can occur in a febrile illness

• worry if it’s persistent

Question 19

How is nephrotic syndrome classified in children?

Answer 19

Steroid resistant or non-resistant

Question 20

What Ix are done to exclude Post strep GN as a cause of nephrotic sydnrome

Answer 20

ASO titre

Anti-DNAse B

Question 21

Initial mx of nephrotic syndrome

Answer 21

Steroids: oral pred

Question 22

If a child with nephrotic syndrome, doesn’t respond to oral prednisolone what do you do next?

Answer 22

Renal biopsy

Question 23

How do you assess for hypovolemia in a child with nephrotic syndrome?
How is the hypovolemia managed?

Answer 23

Urinary sodium - if it is low, then child is hypovolemic

Treat child with IV albumin

Question 24

What is a child with nephrotic syndrome at risk of? therefore how can this be prevented?

Answer 24

Thrombosis
Infection
Hypovolemia
Hypercholesterolemia

Question 25

Prognosis of nephrotic syndrome

Answer 25

90% respond to steroids - the rest are at risk of ESRF

Question 26

3 causes of steroid resistant nephrotic syndrome? which one is most common?

Answer 26

1. Focal segmental glomerulosclerosis - most common 2. Membranous nephropathy 3. Mesangiocapillary GN

Question 27

Useful investigation in a child with nephrotic syndrome and a recent travel Hx?

Answer 27

Malaria - thick and thin blood film or rapid Ag test

Question 28

Glomerular causes of haematuria

Answer 28

Post-strep GN IgA nephropathy Vasculitis: HSP!! , wegener's, SLE

Question 29

In a child with rash and haematuria = list 3 Ddx?

Answer 29

Vasculitides: HSP = number 1 SLE Wegeners

Question 30

In a child with brown blood in urine, name some useful Ix

Answer 30

SLE screen (ANAs - dsDNA, sm, histone) ASO titre/antiDNAse B ESR, complement levels

Question 31

Top 3 causes of acute glomerulonephritis

Answer 31

IgA nephropathy Post strep GN HSP

Question 32

Manifestations of acute glomerulonephritis

Answer 32

Haematuria Proteinuria Oedema Hypertension --> SEIZURES

Question 33

Clinical features of HSP

Answer 33

Preceding URTI - Rash on buttocks (trunk spared) - Glomerulonephritis - Joint pain - Abdo pain

Question 34

Management of HSP - when would you admit?

Answer 34

Admit if abdo pain/renal probs - Supportive - NSAIDs for pain BUT careful if renal involvement - Renal specialist review

Question 35

Histology of IgA nephropathy

Answer 35

mesangial IgA deposition

Question 36

Number one cause of renal stones in a child

Answer 36

Proteus infection, esp in boys!

Question 37

What urine dip result would be suggestive of renal stones

Answer 37

pH>7

Question 38

tx of renal stones

Answer 38

Treat the cause (eg proteus) | Lithotripsy

Question 39

Best imaging for renal stones

Answer 39

USS

Question 40

Most common renal cause of AKI

Answer 40

HUS