Paeds Written - Urology/Nephrology Flashcards
(45 cards)
Important complications of Nephrotic syndrome
Thrombosis - loss of AT-III in urine creates hyper coagulable state
Infections - loss of immunoglobulin in urine, esp Neisseria, Haemophilus, Streptococcus
Hypercholesterolaemia - loss of albumin in urine –> reduced oncotic pressure –> drives hepatic cholesterol synthesis
Diagnostic features of Nephrotic syndrome
Proteinuria (>3.5g per 24 hours)
(Peripheral) oedema
Hypoalbuminaemia (<25g/L)
Treatment of nephrotic syndrome
High dose oral predisolone
4-6 weeks (tapered from 4 weeks)
Some will not respond (steroid resistant type)- need specialised renal biopsy + specialist care
Most common cause of nephrotic syndrome (in kids)?
Minimal change disease
Microscopy findings in minimal change disease
Light microscopy - normal
Electron microscopy - podacyte effacement (fusion)
Diagnostic features of Nephritic syndrome
Haematuria
Proteinuria
HTN
Key Ix/histology findings in Focal segmental GN
Segmental scarring
Foot process fusion
Key Ix/histology findings in Membranous GN
Widespread thickening
Granular deposits of Ig & complement
Presentation of Henoch-Schonlein purpura
Purpuric rash / petechiae
Abdo pain
Nephritic syndrome - haematuria, proteinuria, HTN
+ arthritis / joint swelling
Risk factor/ trigger for Henoch-Schonlein purpura?
Recent URTI
Presents 2-3 days later
NOTE: if longer than this, instead thing Post-infectious/Strep GN
Treatment options in Henoch-Schonlein purpura
Symptomatic
- NSAIDs for joint pain
- Oral prednisolone if scrotal involvement, severe oedema or severe abdo pain
IV corticosteroids +/- transplant if renal involvement
Key features of HUS
Anaemia (haemolytic - MAHA)
Thrombocytopenia
AKI
Trigger / cause of HUS?
Haemorrhagic E.coli O157:H7 strain
Produces shiga toxin –> bloody, infectious diarrhoea + HUS
Indications for dialysis in AKI
Refractory hyper K
Refractory fluid overload
Metabolic acidosis
Uraemic Sx - encephalopathy, nausea, pruritus, pericarditis, malaise
Pulmonary oedema (from Path notes) Dialysable drug intoxication – e.g., antifreeze, aspirin, lithium
When does Acute tubular necrosis occur in children?
Usually in context of multi organ failure in ICU OR post-cardiac surgery
Average age of day + nighttime continence?
3-4 years
Types of nocturnal enuresis
Primary = never achieved continence
- with or without daytime Sx
Secondary = achieved continence for at least 6 months prior to Sx
Treatment options for primary nocturnal enuresis WITHOUT daytime Sx
Below 5 years old - no Tx needed
Conservative measures/advice
- empty bladder regularly during day + before sleep
- Lifting + waking
Reward system
- use for behaviour e.g. using toilet
- NOT for dry nights
Enuresis alarm
- 1st line for most children
Desmopressin - ADH hormone analogue short term control needed e.g. camp, sleepover - OR failed enuresis alarm Tx - OR alarm not acceptable to family
Oxybutynin
- Anticholinergic
- not to be used in primary care
Things to exclude in child with enuresis?
Abdo exam –> constipation, UTI?
Urine dip –> UTI? DM?
Lower limb Neuro & spine exam –> NTD? (rare cause)
Spot check BP –> renal disease?
Management of secondary bedwetting?
UTI or constipation –> treat in primary care
Other –> refer as needed
- diabetes
- recurrent UTI
- psych problems
- family issues
- developmental, attention or learning difficulties
Treatment of suspected testicular torsion
Supportive: analgesia, sedation, anti-emetics
Urgent urological referral
Exploratory surgery
+/- bilateral orchiopexy
+/- orchidectomy
+/- fixation of contralateral testes - reduces risk of future torsion
Presentation of Torsion of Appendix testes (Hydatid of Morgagni)
Onset of pain over few days
+/- blue dot seen over superior pole of testes
Risk factors for testicular torsion
Undescended testes
‘Clapper bell’ testes - testes free hanging on spermatic cord
Post-pubertal (mean 16 yo)
Prehn’s sign?
Lifting testes
= MORE pain in testicular torsion
= LESS pain in epididymitis
