Renal and Urinary

Question 1

What is nocturnal enuresis

Answer 1

Involuntary discharge of urine during sleep

Question 2

What is the treatment of nocturnal enuresis for those under 5

Answer 2

reassurance and advice should be given on fluid intake, diet, toileting behaviour, and use of reward systems.

Question 3

What medication is first line for nocturnal enuresis

Answer 3

Desmopressin

Question 4

What is the standard management of nocturnal enuresus in children over 5

Answer 4

Reassurance and advice
then Enuresis alarm
then Desmopressin

Question 5

What is the definition of a UTI

Answer 5

Presence of leucocytes and nitrites on Urine dip stick.

Question 6

What are the symptoms of a lower tract UTI/ acute cystitis in a child over 5

Answer 6

•	Dysuria
•	Urinary frequency/ urgency
•	Incontinence
•	Lower abdominal pain
•	haematuria
vulvitis

Question 7

How would you diagnose a UTI

Answer 7

Clean catch urine sample
bag sample
pad sample
catheter
suprapubic aspirate

Question 8

How would you treat an acute UTI in a child

Answer 8

• Antibiotics – cefuroxime in neonates, amoxicillin and gentamycin in infants, then trimethoprim in children
• Fluids
• Analgesia

Question 9

What further investigations could you order for a UTI

Answer 9

: Imaging for underlying abnormality – dependent on age and type of infection
• USS – used to size and drainage of kidneys and bladder, can assess for obstruction - structural abnormality
• Vesicoureteric reflux
-Retrograde flow of urine from bladder into ureter/ pelvicalyceal system/intrarenal
-Severity graded on level of reflux and associated dilatation, clubbing
-Associated with UTI, renal abnormality
• DMSA scan
-radionuclide imaging, used to assess relative renal function and renal scarring

Question 10

What is Pyelonephritis

Answer 10

An infection of the upper urinary tract

Question 11

What are the symptoms of pyelonephritis

Answer 11

•	Fever, septicaemic illness (with meningitis in infancy)
•	General malaise, vomiting
•	Loin/abdominal pain – older child
•	Failure to thrive, jaundice - infancy
foul smelling urine - pus in urine

Question 12

How to diagnose an UTI

Answer 12

Urine sample!!!
•	MSU
•	Suprapubic aspirate (SPA)
•	Catheter
•	“clean” catch/bag sample/ pad sample 
Analysis of urine:
•	Visual inspection
•	Dipstick – nitrites, leucocyte esterase
•	M,C and S

Question 13

What is steroid resistant nephrotic syndrome

Answer 13

when there is still proteinuria over 4 weeks later

Question 14

How to manage steroid resistant nephrotic syndrome

Answer 14

fluid balance, daily weighing and salt restriction

Question 15

What characteristics is nephrotic syndrome identified by

Answer 15

proteinuria, hypoalbuminaemia, hyperlipidaemia and oedema

Question 16

What is the main cause of nephrotic syndrome

Answer 16

minimal change disease

Question 17

What are the clinical features of nephrotic syndrome

Answer 17

facial puffiness, leg and feet swelling, gross scrotal oedema, ascites, pleural effusions

Question 18

What diagnostic tests should be done for nephrotic syndrome

Answer 18

Urine dipstick, 24-hour urine collection to measure protein levels (or protein/creatinine ratio), urine microscopy, blood tests including FBC, clotting, ESR, U&Es, albumin, cholesterol and blood glucose (checking diabetes as a cause). The patient should be weighed regularly.

Question 19

How do you treat steroid sensitive nephrotic disease

Answer 19

•	Standard course of prednisolone for first episode:
o	60mg/m2 for 4 weeks
o	40mg/m2 on alternate days for 4 weeks
•	Other considerations:
o	Na & water moderation
o	Diuretics
o	Pen V
o	Measles & varicella immunity & pneumococcal immunisation

Question 20

What are the different renal causes of AKI

Answer 20

vascular
tubular
glomerular
interstitial

Question 21

What are the vascular causes of AKI

Answer 21

Haemolytic uraemic
syndrome (HUS)
– Vasculitis
– Embolus
– Renal vein thrombosis

Question 22

What is the commonest renal cause of AKI

Answer 22

haemolytic -uraemic syndrome

Question 23

What are the characteristics of glomerulonephritis

Answer 23

haematuria
reduced renal functional 
hypertension
protienuria 
oedema

Question 24

What is the triad of characteristics in haemolytic uraemic syndrome

Answer 24

acute renal failure
Haemolytic anaemia
thrombocytopenia

Question 25

What are the investigations for glomerulonephritis

Answer 25

``` urine dip urine microscopy abdominal imaging throat swab anti-DNase B complement levels renal biopsy if severe ```

Question 26

Management of glomerulonephritis

Answer 26

control of fluid and electrolyte balance use of diuretics and antihypertensives treat underlying cause

Question 27

What would you ask about if you suspected post-streptococcal glomerulonephritis

Answer 27

usually follows a streptococcal sore throat or skin infection

Question 28

What would confirm post-streptococcal glomerulonephritis

Answer 28

Throat swab - culture of organism, raised ASO/anti-DNase B titres and low complement C3 levels

Question 29

how would you treat post-streptococcal glomerulonephritis

Answer 29

oral penicillin

Question 30

What clinical signs may indicate post-streptococcal glomerulonephritis

Answer 30

``` cola coloured urine hypertension headache, vomiting, dizziness and seizures swelling of face and feet proteinuria ```

Question 31

What is haemolytic uraemic syndrome pathophysiology

Answer 31

infection with shigella or e.coli. Toxin causes intravascular thrombogenesis. Platelet activation and aggregation occurs, and RBCs get damaged which causes microangiopathic haemolytic anaemia and damage to the capillary walls. Blood clots and damage to the blood vessels cause acute kidney failure

Question 32

Clinical features of haemolytic uremic syndrome

Answer 32

``` Bloody diarrhoea Vomiting (sometimes) Severe abdominal pain Reduced urine production Tiredness Poor appetite Swelling Bruising ```

Question 33

What is the treatment of haemolytic uraemic syndrome

Answer 33

Dialysis Blood transfusions Medication to reduce high blood pressure Plasma exchange