Renal

Question 1

What are the classical symptoms of UTI?

Answer 1

dysuria, frequency and loin pain

Question 2

Besides the classical symptoms of UTI, what are some symptoms of UTI?

Answer 2

fever, vomiting, lethargy or irritability, poor feeding, jaundice, septicaemia, recurrence of enuresis, offensive cloudy urine

Question 3

How would you diagnose typical UTI?

Answer 3

MSU

SPA

‘Clean-catch’ sample into waiting clean pot (recommended method)

Analysis of urine - visual inspection, dipstick - nitries and leucocyte esterase, urine culture

Question 4

How would you interpret dipstick results for nitrite and leucocytes?

Answer 4

Nitrite +ve = useful as very likely to indicate UTI,

Leucocyte +ve = MAY be present in children with UTI but also with febrile illness w/o UTIs

Nitrite positive and Leucocyte positive = regard as UTI

Nitrite negative and Leucocyte positive = only start abx if clinical signs or if positive culture

Nitrite positive and Leucocyte Negative = start abx

Question 5

What are common organisms responsible for UTI?

Answer 5

E.Coli > Klebsiella > Proteus (more common in boys) > Pesudomonas (may indicate structureal abnorm)

Question 6

Management of UTI?

Answer 6

• < 3 months old - refer immediately to a paediatrician
• > 3 months old and upper UTI - consider admission

not admitted oral antibiotics such as cephalosporin or co-amoxiclav should be given for 7-10 days

• > 3 months old and lower UTI - 3 days trimethoprim, nitrofurantoin, cephalosporin or amoxicillin. bring after 24-48 hours if still ill

Question 7

What are some causes of incomplete bladder emptying?

Answer 7

Infrequent voiding

vulvitis

incomplete micturition

constipation

neuropathic bladder

vesicoureteric reflux

Question 8

What is vesicoureteric reflux?

Answer 8

developmental anomaly of vesicoureteric junctions - ureters enter directly into bladder directly, rather than at an angle

Question 9

What is the consequence of severe vesicoureteric reflux?

Answer 9

intrarenal reflux - backflow of urine from renal pelvis into the papillar collecting ducts

Question 10

What are complications of vesicoureteric reflux?

Answer 10

intra-renal reflux

incomplete bladder emptying

pyelonephritis

renal damage and scarring

Question 11

How would you investigate an atypical UTI?

Answer 11

USS kidneys and urinary tract

micturating cystourethrogram

DMSA to look for renal scarring

Question 12

What is an atypical UTI?

Answer 12

seriously ill or septicaemia

poor urine flow

abdominal/bladder mass

raised creatinine

failure to respond to abx with 48 hrs

infection w/ non - E.coli

Question 13

What can be done for UTI prevention?

Answer 13

high fluid intake

regular voiding

ensuring complete bladder emptying (double micturition)

prevention of constipation

good perineal hygience

Question 14

What is daytime enuresis?

Answer 14

lack of bladder control during day in child who’s old enough to be continent (3-5 years old)

Question 15

What can cause daytime enuresis?

Answer 15

lack of attention to bladder sensation (developmental, psychogenic, distracted)

destrusor instability

bladder neck weakness

neuropathic bladder (spina bifida)

UTI

constipation

Question 16

How would you investigate enuresis?

Answer 16

Urine sample MC&S

USS

urodynamic studies

x-ray spine

Question 17

How would you manage enuresis?

Answer 17

< 7 : an enuresis alarm is first-line

> 7 : desmopressin particularly if short-term control is needed or an enuresis alarm has been ineffective/is not acceptable to the family

star charts, bladder training

Question 18

What would you suspect if a child was previously continent but now has loss continence?

Answer 18

emotional upset

UTI

Polyuria (diabetes)

Question 19

What are some causes of proteinuria?

Answer 19

transient (febrile/after exercise)

orthostatic proteinuria

glomerular abnormality (minimal change)

reduced renal mass

hypertension

Question 20

What is Nephrotic Syndrome?

Answer 20

proteinuria (> 1 g/m^2 per 24 hours)

hypoalbuminaemia (< 25 g/l)

oedema

Question 21

How does Neprotic Syndrome present?

Answer 21

Periorbital Oedema

Scrotal, Vulval, Leg and Ankle oedema

Ascites

Breathlessness

Question 22

What investigations would you carry out in suspected nephrotic syndrome?

Answer 22

Urine Dipstick

FBC

U&E

Creatinine

Albumin

Question 23

How would you manage nephrotic syndrome?

Answer 23

corticosteroid therapy

prednisolone - 60mg/m2 then after 4 weeks - 40mg/m2 for 4 weeks

Question 24

What is a complication of nephrotic syndrome?

Answer 24

Hypovolaemia - caused by initial phase of oedema

abdo pain

urinary sodium retention

requires IV albumin

Infection, Thrombosis, Hypercholesteromia

Question 25

What are some causes of nephritis?

Answer 25

post-infection vasculitis (Henoch-schonlein, SLE) IgA nephropathy Goodpastures

Question 26

How would Henoch-Schonlein purpura present?

Answer 26

Purpuric rash over bum and extensor surfaces of arms and legs Fever Polyarthritis Abdominal Pain features of IgA nephropathy may occur e.g. haematuria, renal failure

Question 27

What are some common non-symptomatic features of Henoch-Schonlein?

Answer 27

3-10 years old twice as common in boys peaks during winter months preceded by URTI often

Question 28

Treatment for Henoch-Schonlein?

Answer 28

analgesia for arthralgia | treatment of nephropathy is generally supportive

Question 29

What is an example of familial nephritis?

Answer 29

Alport syndrome X-linked recessive assoc. with deafness and ocular defects

Question 30

How would you define hypertension for children?

Answer 30

BP > than 95th percentile for height, age and sex

Question 31

Causes for hypertension?

Answer 31

``` renal parenchymal disease renal vascular disease coarctation of the aorta phaeochromocytoma congenital adrenal hyperplasia essential or primary hypertension (becomes more common as children become older) ```

Question 32

How does Fanconi syndrome present?

Answer 32

``` type 2 (proximal) renal tubular acidosis polyuria aminoaciduria glycosuria phosphaturia osteomalacia ```

Question 33

What are the commonest causes of AKI in children in the UK?

Answer 33

Haemolytic Uraemic Syndrome Acute tubular necrosis - multisystem failure following cardiac surgery

Question 34

How does Haemolytic Uraemic Syndrome present? What causes it?

Answer 34

acute renal failure microangiopathic haemolytic anaemia thrombocytopenia usually secondary to GI infection with E.coli from farm animals

Question 35

How does HUS present? How would you treat?

Answer 35

bloody diarrhoea AKI intravascular thrombogenesis treatment is supportive e.g. Fluids, blood transfusion and dialysis if required