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Specialties > Paeds Written - Urology/Nephrology > Flashcards

Paeds Written - Urology/Nephrology Flashcards

1
Q

Important complications of Nephrotic syndrome

A

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

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2
Q

Diagnostic features of Nephrotic syndrome

A

Proteinuria (>3.5g per 24 hours)

(Peripheral) oedema

Hypoalbuminaemia (<25g/L)

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3
Q

Treatment of nephrotic syndrome

A

High dose oral predisolone
4-6 weeks (tapered from 4 weeks)

Some will not respond (steroid resistant type)- need specialised renal biopsy + specialist care

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4
Q

Most common cause of nephrotic syndrome (in kids)?

A

Minimal change disease

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5
Q

Microscopy findings in minimal change disease

A

Light microscopy - normal

Electron microscopy - podacyte effacement (fusion)

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6
Q

Diagnostic features of Nephritic syndrome

A

Haematuria
Proteinuria
HTN

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7
Q

Key Ix/histology findings in Focal segmental GN

A

Segmental scarring

Foot process fusion

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8
Q

Key Ix/histology findings in Membranous GN

A

Widespread thickening

Granular deposits of Ig & complement

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9
Q

Presentation of Henoch-Schonlein purpura

A

Purpuric rash / petechiae

Abdo pain

Nephritic syndrome - haematuria, proteinuria, HTN

+ arthritis / joint swelling

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10
Q

Risk factor/ trigger for Henoch-Schonlein purpura?

A

Recent URTI
Presents 2-3 days later

NOTE: if longer than this, instead thing Post-infectious/Strep GN

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11
Q

Treatment options in Henoch-Schonlein purpura

A

Symptomatic

  • NSAIDs for joint pain
  • Oral prednisolone if scrotal involvement, severe oedema or severe abdo pain

IV corticosteroids +/- transplant if renal involvement

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12
Q

Key features of HUS

A

Anaemia (haemolytic - MAHA)
Thrombocytopenia
AKI

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13
Q

Trigger / cause of HUS?

A

Haemorrhagic E.coli O157:H7 strain

Produces shiga toxin –> bloody, infectious diarrhoea + HUS

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14
Q

Indications for dialysis in AKI

A

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
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15
Q

When does Acute tubular necrosis occur in children?

A

Usually in context of multi organ failure in ICU OR post-cardiac surgery

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16
Q

Average age of day + nighttime continence?

A

3-4 years

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17
Q

Types of nocturnal enuresis

A

Primary = never achieved continence
- with or without daytime Sx

Secondary = achieved continence for at least 6 months prior to Sx

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18
Q

Treatment options for primary nocturnal enuresis WITHOUT daytime Sx

A

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
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19
Q

Things to exclude in child with enuresis?

A

Abdo exam –> constipation, UTI?

Urine dip –> UTI? DM?

Lower limb Neuro & spine exam –> NTD? (rare cause)

Spot check BP –> renal disease?

20
Q

Management of secondary bedwetting?

A

UTI or constipation –> treat in primary care

Other –> refer as needed

  • diabetes
  • recurrent UTI
  • psych problems
  • family issues
  • developmental, attention or learning difficulties
21
Q

Treatment of suspected testicular torsion

A

Supportive: analgesia, sedation, anti-emetics

Urgent urological referral

Exploratory surgery
+/- bilateral orchiopexy
+/- orchidectomy
+/- fixation of contralateral testes - reduces risk of future torsion

22
Q

Presentation of Torsion of Appendix testes (Hydatid of Morgagni)

A

Onset of pain over few days

+/- blue dot seen over superior pole of testes

23
Q

Risk factors for testicular torsion

A

Undescended testes
‘Clapper bell’ testes - testes free hanging on spermatic cord
Post-pubertal (mean 16 yo)

24
Q

Prehn’s sign?

A

Lifting testes
= MORE pain in testicular torsion
= LESS pain in epididymitis

25
Q

Unilateral undescended testis - treatment?

A

Review at 3 months

If still undescended –> referral to urology (should be seen by 6 months)

26
Q

Definitive Tx for undescended testes?

A

Orchidopexy

Should be completed by 12 months old

27
Q

Features of ascending/upper UTI in child?

A

Fever >38
Loin pain, tenderness
Rigors

28
Q

Abx regimen for simple UTI?

A

If > 3months = Oral Abx 3 days

Usually trimethoprim

29
Q

Treatment of UTI in <3month old?

A

Immediately refer to Paeds

30
Q

Upper UTI tx?

A

consider admission

If not admitted –> 7-10 days oral Abx
- cephalosporin or co-amoxiclav

31
Q

Additional imaging requirements for child under 6 months with UTI

A

< 6 months simple UTI = outpatient USS within 6 weeks (+ MCUG if abnormal)

< 6 months atypical or recurrent UTI = inpatient USS + Outpatient DMSA and MCUG

32
Q

Additional imaging for child with UTI (6 months - 3 years old)

A

Simple UTI = none

Atypical or recurrent = outpatient USS + DMSA

Dilation on USS, poor urine flow, non-E.coli, family Hx vesicoureteric reflux = outpatient USS + DMSA + MCUG

33
Q

Additional imaging requirements for child >3 years with UTI

A

Simple = none

Atypical = inpatient USS

Recurrent = Outpatient USS + DMSA in 4-6 months

34
Q

Pathophysiology of vesicoureteric reflux

A

Ureters displaced laterally so enter bladder at more perpendicular angle
Creates shortened intramural course for ureters + prevents vesicoureteric junction functioning adequately
Incompetence of valvular mechanism –> reflux of urine to kidneys

35
Q

Grading of Vesicoureteric reflux

A

Grade I = reflux into ureter only, no dilatation

Grade 2 = reflux into renal pelvis on micturition, no dilatation

Grade 3 = mild-moderate dilatation of ureter, renal pelvis & calyces

Grade 4 = dilatation of renal pelvis & calyces with moderate ureteral tortuosity

Grade 5 = gross dilatation of ureter, pelvis & calyces with ureteral totuosity

36
Q

Additional Imaging & purpose in Vesicoureteric reflux

A

Micturating/voiding cystography (MCUG) - allows grading of reflux

Dimercaptosuccinic acid (DMSA) scan - detects renal parenchymal scarring from reflux

37
Q

Features of Reflux nephropathy

A 
Chronic pyelonephritis (secondary to vesicoureteric reflux)
HTN - renal scars release renin
38
Q

Treatment options for vesicoureteric reflux

A

Monitoring/surveillance of renal growth?

Prophlactic Abx
Surgery (if severe)

39
Q

What is phimosis?

A

Inability to retract foreskin

40
Q

Causes/types of phimosis

A

Physiological

  • by 1yo, 50% affected
  • by 4yo, 10%
  • by 17yo, 1%
  • Can cause increased risk of infection + issues with urination & sex if persists to puberty

Pathological = Balanitis xerotica obliterans

  • causes scarring of foreskin
  • rare before 5yo
41
Q

Treatment options for phimosis

A 
<2yo = reassurance + review in 6 months
>2yo = topical steroid cream OR circumcision (depends on severity)
42
Q

Wilm’s tumour associations

A

Beckwith-Wiedemann syndrome
WAGR syndrome
Hemihypertrophy

43
Q

Abdominal mass in child - what is the approach?

A

If unexplained –> Paeds review within 48 hours

Could be Wilm’s tumour

44
Q

Genetics of Wilm’s tumour

A

1/3 of cases have WT1 gene (Chr 11) loss of function mutation

45
Q

Clinical features of nephroblastoma

A

Aka Wilm’s tumour

Abdominal mass
Painless haematuria
Flank pain
Anorexia
Fever

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