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3a Child Health > Renal/ Urinary > Flashcards

Renal/ Urinary Flashcards

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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
What is the presentation of phimosis?
Penile irritation Ballooning with urination Bleeding Urinary retention Painful erections Recurrent infections - balanoposthitis Paraphimosis - foreskin stuck in retracted position UTI
26
What is the management for phimosis?
Topical corticosteroids to soften foreskin such as hydrocortisone Circumcision
27
What are some symptoms of renal malformation?
Failure to thrive Swollen bladder Frequent urination and UTI Night bedwetting Pain when urinating Weak urinary stream
28
What is renal agenesis?
One kidney missing
29
What is renal hypoplasia?
One or both kidneys are abnormally small
30
What is horseshoe kidney?
Kidneys are joined to form a single arched kidney
31
What is horseshoe kidney associated with?
Trisomy 18 and turner syndrome
32
What are some complications of horseshoe kidney?
Kidney stones Wilms tumour Renal cancer PKD Hydrocephaly Spina bifida
33
What are the symptoms of horseshoe kidney?
UTI Restlessness Flank pain Chills Poor weight gain Decreased urination Abdominal mass
34
What is polycystic kidney disease?
Kidneys are filled with fluid filled cysts which can be recessive or dominant
35
What do poorly perfused kidneys activate?
RAAS causing hypertension and fluid retention
36
What are the investigations for polycystic kidney disease?
Renal biopsy showing salt and pepper appearance
37
What is a complication of PKD?
Berry aneurysm causing SAH
38
What is hypospadias?
Urethral meatus is displaced to the underside of the penis towards the scrotum
39
What are some consequences of hypospadias?
difficulty urinating when standing cosmetic appearance differs Sexual function is not affected
40
What is the management of hypospadias?
Mild cases may not require treatment Surgery after 3-4 months No circumcision
41
What is vesicoureteric reflux?
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
What are the investigations for vesicoureteric reflux?
Micrurating cystourethrogram Indirect cystogram
43
What is the treatment for vesicoureteric reflux?
Prophylactic antibiotics STING Endoscopic injections Open surgery
44
What is HUS?
Thrombosis in small blood vessels throughout the body triggered by Shiga toxins from E.coli 0157 or Shigella.
45
What is the presentation of HUS?
Microangiopathic haemolytic anaemia AKI Thrombocytopenia Fever Abdominal pain Lethargy Pallor Oliguria Haematuria
46
What are the investigations for HUS?
Schistocytes Raised creatinine Raised LDH Low haptoglobin
47
What is the management for HUS?
IV fluids Blood transfusions Hamodialysis
48
What is nephritic syndrome?
Inflammation of the glomeruli causing reduction in kidney function, haematuria and proteinuria
49
What are the two most common causes of nephritic syndrome?
Post-strep and IgA nephropathy
50
What is post-strep glomerulonephritis?
Occurs 1-3 weeks after strep infection Immune complexes get stuck in glomeruli Leads to acute deterioration and AKI
51
What is IgA nephropathy?
IgA deposits in the nephrons causing nephritis
52
What is HSP?
IgA deposits in both liver and skin
53
What is the difference between IgA nephropathy and Post strep?
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
What is the presentation of nephritic syndrome?
Oedema Visible haematuria Fatigue Pallor SOB Cough
55
What is the diagnosis of nephritic syndrome?
Urinalysis - haematuria, proteinuria, RBC casts Bloods - raised creatinine and urea Renal biopsy - crescent glomeruli, IgA depositions
56
What is nephrotic syndrome?
A group of proteinuria, oedema and hypoalbuminaemia
57
What is the criteria for proteinuria in nephrotic syndrome?
Over 3.5g in 24 hours causing frothy urine
58
What does hypoalbuminaemia cause in nephrotic syndrome?
Oedema Fatigue Dyspnoea
59
What is minimal change disease?
Affects glomeruli where T cells release cytokines that damage podocyte foot processes = effacement
60
How do you treat minimal change disease?
Corticosteroids such as prednisolone
61
What is focal segmental glomerulosclerosis?
- 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
What is the presentation of focal segmental glomerulosclerosis?
Generalised oedema Frothy urine Pallor Deranged lipids High blood pressure Hypercoaguability
63
What is the treatment for focal segmental glomerulosclerosis?
High steroids - prednisolone Low salt diet diuretics
64
What are some pre-renal causes of AKI?
Hypovolaemia - DKA, gastroenteritis Nephrotic syndrome Peripheral vasodilation - sepsis Drugs - ACEi
65
What are some renal causes of AKI?
Acute tubular necrosis Glomerulonephritis Bilateral pyelonephritis HUS
66
What are some post renal causes of AKI?
Obstruction Neurogenic bladder Tumours Calculi
67
What are some symptoms of AKI?
Haemorrhage Fever Rash Bloody diarrhoea Severe vomiting Abdominal pain No or high urine output Eye inflammation
68
What is the treatment for AKI?
IV fluids Diuretics Correct electrolytes Limit protein to 0.5-1g/kg/day
69
What are some causes of CKD?
Congenital - renal dysplasia, prolonged urinary tract obstruction Hereditary - PKD Alport syndrome HUS SLE Wilms tumour
70
What are some symptoms of CKD?
Failure to thrive Polyuria and polydipsia Lethargy Bone pain Vomiting Headache Malaise Pale skin Irritability Stunted growth
71
What is the treatment of CKD?
diuretics minimum protein and no vitamin A Avoid high potassium Control HTN Dialysis Kidney transplant
72
What are the two types of dialysis?
Peritoneal and haemodialysis
73
Name 3 features of an atypical UTI
Poor urine flow Sepsis Non E coli organism Raised creatinine Failure to respond to antibiotic within 48 hours
74
Name 3 things for UTI prevention
Regular voiding High fluid intake to produce high urine output Ensuring complete bladder emptying Prophylactic antibiotics
75
What is the triad of symptoms of HUS?
Acute renal failure Microangiopathic anaemia Thrombocytopenia

3a Child Health (14 decks)

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