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3a Child Health > Renal/ Urinary > Flashcards

Renal/ Urinary Flashcards

1
Q

Where are infections of the urinary tract?

A

Urethra, bladder, ureters and kidneys

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2
Q

What is acute pyelonephritis?

A

Infection of the kidneys

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3
Q

What is cystitis?

A

Infection of the bladder

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4
Q

What is the most common cause of a UTI?

A

E coli

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5
Q

What is a cause of UTIs in hospitals with catheters?

A

Klebsiella

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6
Q

What are symptoms of UTI in babies?

A

Very non-specific
Lethargy
Fever
Irritability
Vomiting
Poor feeding
Urinary frequency

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7
Q

What are the symptoms of UTI in older infants and children?

A

Fever
Suprapubic pain
Vomiting
Dysuria
Urinary frequency and incontinence

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8
Q

What is the best investigation for UTI?

A

Clean catch - avoids contamination

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9
Q

What is the management of UTI in under 3 months with a fever?

A

Immediate IV ceftriaxone
Full septic screen
Blood cultures

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10
Q

What is the treatment for over 3 months with upper UTI?

A

Oral cefotaxime/ Co-amoxiclav for 7-10 days

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11
Q

What is the treatment for over 3 months with a lower UTI?

A

Oral trimethoprim/ Nitrofurantoin

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12
Q

What is the investigation needed for recurrent UTI?

A

Abdominal USS within 6 weeks or during

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13
Q

What are some findings on urine dipstick for UTI?

A

Nitrites and leukocytes

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14
Q

At what age do children normally control daytime urination?

A

2 years

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15
Q

At what age do children normally control night time urination?

A

3-4 years

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16
Q

What is primary nocturnal enuresis?

A

Child has never managed to be dry at night consistently

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17
Q

What are some causes of primary nocturnal enuresis?

A

Overactive bladder
Fluid intake - fizzy drinks
Failure to wake - underdeveloped bladder signals
Psychological distress
Chronic constipation, UTI, CP

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18
Q

What is secondary nocturnal enuresis?

A

Bedwetting after keeping dry for at least 6 months
Indicates an underlying problem

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19
Q

What are some causes of secondary nocturnal enuresis?

A

UTI
Constipation
T1DM
New psychosocial problems
Maltreatment

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20
Q

What is stress incontinence?

A

Leakage of urine during high pressure physical exertion such as coughing or laughing?

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21
Q

What is urge incontinence?

A

Overactive bladder that gives little warning before emptying

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22
Q

What are some medications for overactive bladders?

A

Desmopressin - ADH analogue
Oxybutynin - anticholinergic reduces bladder contractility

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23
Q

What is phimosis?

A

Inability to retract foreskin as it is very tight

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24
Q

What causes phimosis?

A

Balantis zerotica obliterans

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25
Q

What is the presentation of phimosis?

A

Penile irritation
Ballooning with urination
Bleeding
Urinary retention
Painful erections
Recurrent infections - balanoposthitis
Paraphimosis - foreskin stuck in retracted position
UTI

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26
Q

What is the management for phimosis?

A

Topical corticosteroids to soften foreskin such as hydrocortisone
Circumcision

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27
Q

What are some symptoms of renal malformation?

A

Failure to thrive
Swollen bladder
Frequent urination and UTI
Night bedwetting
Pain when urinating
Weak urinary stream

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28
Q

What is renal agenesis?

A

One kidney missing

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29
Q

What is renal hypoplasia?

A

One or both kidneys are abnormally small

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30
Q

What is horseshoe kidney?

A

Kidneys are joined to form a single arched kidney

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31
Q

What is horseshoe kidney associated with?

A

Trisomy 18 and turner syndrome

32
Q

What are some complications of horseshoe kidney?

A

Kidney stones
Wilms tumour
Renal cancer
PKD
Hydrocephaly
Spina bifida

33
Q

What are the symptoms of horseshoe kidney?

A

UTI
Restlessness
Flank pain
Chills
Poor weight gain
Decreased urination
Abdominal mass

34
Q

What is polycystic kidney disease?

A

Kidneys are filled with fluid filled cysts which can be recessive or dominant

35
Q

What do poorly perfused kidneys activate?

A

RAAS causing hypertension and fluid retention

36
Q

What are the investigations for polycystic kidney disease?

A

Renal biopsy showing salt and pepper appearance

37
Q

What is a complication of PKD?

A

Berry aneurysm causing SAH

38
Q

What is hypospadias?

A

Urethral meatus is displaced to the underside of the penis towards the scrotum

39
Q

What are some consequences of hypospadias?

A

difficulty urinating when standing
cosmetic appearance differs
Sexual function is not affected

40
Q

What is the management of hypospadias?

A

Mild cases may not require treatment
Surgery after 3-4 months
No circumcision

41
Q

What is vesicoureteric reflux?

A

Retrograde flow of urine from the bladder into the upper urinary tract predisposing patients to upper UTIs due to a developmental anomaly of the vesicoureteric junctions

42
Q

What are the investigations for vesicoureteric reflux?

A

Micrurating cystourethrogram
Indirect cystogram

43
Q

What is the treatment for vesicoureteric reflux?

A

Prophylactic antibiotics
STING
Endoscopic injections
Open surgery

44
Q

What is HUS?

A

Thrombosis in small blood vessels throughout the body triggered by Shiga toxins from E.coli 0157 or Shigella.

45
Q

What is the presentation of HUS?

A

Microangiopathic haemolytic anaemia
AKI
Thrombocytopenia
Fever
Abdominal pain
Lethargy
Pallor
Oliguria
Haematuria

46
Q

What are the investigations for HUS?

A

Schistocytes
Raised creatinine
Raised LDH
Low haptoglobin

47
Q

What is the management for HUS?

A

IV fluids
Blood transfusions
Hamodialysis

48
Q

What is nephritic syndrome?

A

Inflammation of the glomeruli causing reduction in kidney function, haematuria and proteinuria

49
Q

What are the two most common causes of nephritic syndrome?

A

Post-strep and IgA nephropathy

50
Q

What is post-strep glomerulonephritis?

A

Occurs 1-3 weeks after strep infection
Immune complexes get stuck in glomeruli
Leads to acute deterioration and AKI

51
Q

What is IgA nephropathy?

A

IgA deposits in the nephrons causing nephritis

52
Q

What is HSP?

A

IgA deposits in both liver and skin

53
Q

What is the difference between IgA nephropathy and Post strep?

A

IgA is 1-2 days post URTI and post strep is 1-3 weeks later
IgA shows IgA deposits and post strep is IgG
IgA has normal C3 and post strep is low

54
Q

What is the presentation of nephritic syndrome?

A

Oedema
Visible haematuria
Fatigue
Pallor
SOB
Cough

55
Q

What is the diagnosis of nephritic syndrome?

A

Urinalysis - haematuria, proteinuria, RBC casts
Bloods - raised creatinine and urea
Renal biopsy - crescent glomeruli, IgA depositions

56
Q

What is nephrotic syndrome?

A

A group of proteinuria, oedema and hypoalbuminaemia

57
Q

What is the criteria for proteinuria in nephrotic syndrome?

A

Over 3.5g in 24 hours causing frothy urine

58
Q

What does hypoalbuminaemia cause in nephrotic syndrome?

A

Oedema
Fatigue
Dyspnoea

59
Q

What is minimal change disease?

A

Affects glomeruli where T cells release cytokines that damage podocyte foot processes = effacement

60
Q

How do you treat minimal change disease?

A

Corticosteroids such as prednisolone

61
Q

What is focal segmental glomerulosclerosis?

A
  • Chronic pathological process caused by injury to podocytes in the renal glomeruli
  • Cells in glomeruli filter are damaged so proteins leak into urine, build up and cause damage
  • Segments of the nephron are replaced with scar tissue
62
Q

What is the presentation of focal segmental glomerulosclerosis?

A

Generalised oedema
Frothy urine
Pallor
Deranged lipids
High blood pressure
Hypercoaguability

63
Q

What is the treatment for focal segmental glomerulosclerosis?

A

High steroids - prednisolone
Low salt diet
diuretics

64
Q

What are some pre-renal causes of AKI?

A

Hypovolaemia - DKA, gastroenteritis
Nephrotic syndrome
Peripheral vasodilation - sepsis
Drugs - ACEi

65
Q

What are some renal causes of AKI?

A

Acute tubular necrosis
Glomerulonephritis
Bilateral pyelonephritis
HUS

66
Q

What are some post renal causes of AKI?

A

Obstruction
Neurogenic bladder
Tumours
Calculi

67
Q

What are some symptoms of AKI?

A

Haemorrhage
Fever
Rash
Bloody diarrhoea
Severe vomiting
Abdominal pain
No or high urine output
Eye inflammation

68
Q

What is the treatment for AKI?

A

IV fluids
Diuretics
Correct electrolytes
Limit protein to 0.5-1g/kg/day

69
Q

What are some causes of CKD?

A

Congenital - renal dysplasia, prolonged urinary tract obstruction
Hereditary - PKD
Alport syndrome
HUS
SLE
Wilms tumour

70
Q

What are some symptoms of CKD?

A

Failure to thrive
Polyuria and polydipsia
Lethargy
Bone pain
Vomiting
Headache
Malaise
Pale skin
Irritability
Stunted growth

71
Q

What is the treatment of CKD?

A

diuretics
minimum protein and no vitamin A
Avoid high potassium
Control HTN
Dialysis
Kidney transplant

72
Q

What are the two types of dialysis?

A

Peritoneal and haemodialysis

73
Q

Name 3 features of an atypical UTI

A

Poor urine flow
Sepsis
Non E coli organism
Raised creatinine
Failure to respond to antibiotic within 48 hours

74
Q

Name 3 things for UTI prevention

A

Regular voiding
High fluid intake to produce high urine output
Ensuring complete bladder emptying
Prophylactic antibiotics

75
Q

What is the triad of symptoms of HUS?

A

Acute renal failure
Microangiopathic anaemia
Thrombocytopenia

3a Child Health (14 decks)

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