Renal Flashcards
what is enuresis
the involuntary emptying of the bladder
at least twice a week
> 5/6 years old
when is enuresis more common?
at night
nocturnal enuresis although daytime is possible too
what is the definition in age groups
over 5 in girls and over 6 in boys
below that is somewhat considered normal
what factors influence primary enuresis
family history
male more comon
15% of 5 year olds
underlying cause not identified
secondary enuresis
UTI organic cause previous continence for at least six months detrusor instability abuse DM spina bifida stress
history and things to ask for enuresis
bed time routine
fluid intake- before bed, sugar drinks, caffeine
history of enuresis
stressful events at ohm e
voiding habits- how often, will they tell if need to go
assess pattern and type of consumption
management enuresis
avoid drinks before bed bedtime routine avoid sugary drinks after 4pm remind and ask if need toilet alarm <7 year olds rewards charts
medication management enuresis
- oxybulnin for detrusor instability
1st line desopressin (if over 7)
imipraime
what is a urinary tract infection
infection running from renal pelvis to urethra
who is UTI more common in
boys in infancy but otherwise females
what are key defining symptoms of uTI
dysuria
frequency
positive culture
can be characterised by lown pain
other symptoms of UTI in kids
vomiting poor feeding failure to thrive prolonged neonatal jaundice diarrhoea haematuria febrile convulsions
examination for UTI
check height and graph centiles blood pressure abdominal masses genitalia and spine for congenital abnormalities lower limb exam for neuropathic bladder
diagnosis OF UTI
try to distinguish between upper and lower uTI
ask aboutt stream I boys and family history
dipstick -leucocytes and nitrates
clean catch
management OF UTI
increase fluid intake if not enough
antibiotics
if < 3 months - refer to paeds
3 more and over - antibiotics
what are diagnostic methods can be used in uTI
DMSA- to look for scarring
MGUS is under 6 months -insertion of dye to watch flow pattern-often reveals back flow
vesicuteric reflux management
prophylaxis antibiotics, 1/3 recur within 1 year
which antibiotics can be used ion UTI
depending on upper or lower UTI
upper 7-10days orally or 2-4 iv then 10 days orally
Lower antibiotics for 3 days
which antibiotics in UTI
under 3 months of age -refer
under 1 month old who present with a fever
children 1–3 months old who appear unwell or present with abnormal white blood cell counts.
–> cephalosporin cefotaxime or ceftriaxone) + against listeria (such as ampicillin or amoxicillin).
over 3 months of age with cystitis
a 3-day course
include trimethoprim, nitrofurantoin, a cephalosporin or amoxicillin as options.
reassessed if they are still feeling unwell 24–48 hours later after Rx
over 3 months of age
acute pyelonephritis s
cephalosporin or co-amoxiclav for 7–10 days
referral to a paediatric specialist should be considered. OR
cefotaxime or ceftriaxone IV first 2–4 days + oral for 10 days.
when is an urgent USS done in UTI
raised creatinine poor urine output abdo mass spesis infections with non ecoli
what is haemturia
blood in urine
may be visible to the naked eye
or microscopic
presentation of haematuria
macroscopic -alarm to child or family
incidental on dipstick or bloods
family screening or routine analysis
causes of haematuria
most common= UTI trauma acute glomeruloneprhtisis hypercalcuria stones tumours congenital abnormalities drugs -rifampicin bleeding disorders betTROOT pCKD alport syndrome -deafness igA nephropathy - hence scholein syndrome renal vein thrombosis
examination for haematuria
urine dipstick abdo exam bp Rashes pain swelling (joints)
investigations haematuria
calcium:creatinine ratio < 0.7mmol
protein: creatinine
bloods
microscopy
USS
urinalysis
cystoscopy
management haematuria
treat cause
paediatric nephrology if complex such as reduced renal function or proteinuria
if no resolution after 6 months monitor and re-assess
what is haemolytic uremic syndrome?
the commonest cause of AKI in children in Europe and uSA
Hemolytic-uremic syndrome (HUS) is a disease characterized by a triad of hemolytic anemia acute kidney failure (uremia), and a low platelet coun
what is an important thing aboutt hUS
medical emergency
two forms of recognised hUS
atypical/sporadiac -not diarrhoea associated
-familal
most common cause of HUS
ecoli 0157
clinical features of uSS
blood diarrhoea rectal prolapse haemorrhic colitis bowel wall necrosis and perforation glucose intolerance pancreatitis liver-jaundice
what is nephrotic syndrome
combo of proteinuria
hypoalbumnia
oedema
hyperlipidema
how many cases of nephrotic syndrome
who
2 per 100,000 < 6 year old onset
female to male 1:2
increased incidence in Indian. subcontinent
primary and secondary causes of nephrotic syndrome
congenital infantile
minimimal change disease (85% cases cause), goal segmental glomerulosclerosis, membranous glomerulonephritis
classification tree of three types nephrotic sx
SS steroid sensitive
SD steroid dependent
SR steroid resistant
examination for Nephrotic
height weight bP
peripheral perfusion
Ix for nephroti
dipstick proteinuria +++ HAEMTURIA-microscopy culture protein : creatinine ratio !!!!!!!!!! bloods_. albumin < 25g/l ue lipids varicella zoster
