Renal/ Urinary

Question 1

Causes of primary enuresis

Answer 1

Lack of attention to bladder Detrusor instability Bladder neck weakness Neuropathic bladder UTI Constipation Ectopic ureter

Question 2

Management of enuresis

Answer 2

Star charts, bladder training, pelvic floor exercises Enuresis alarm Anticholinergic drugs (Oxybutinin) Desmopressin for short term (synthetic analogue of ADH)

Question 3

Causes of secondary enuresis

Answer 3

Emotional upset UTI Diabetes Renal concentrating disorder = sickle cell anaemia, renal failure

Question 4

Common causes of UTI

Answer 4

E coli Klebsiella Proteus - common in boys + predisposes to phosphate stone formation Pseudomonas Strep faecalis

Question 5

S+S UTI

Answer 5

Non-specific in infants = fever, vomiting, lethargy, jaundice, sepsis

Question 6

Management of UTI by age

Answer 6

<3 months = admit, IV abx (cefotaxime) Infants >3 months or children with upper UTI = co-amoxiclav for 7-10 dyas Older children with lower UTI = oral trimethoprim 3 days

Question 7

What are the signs of glomerular haematuria?

Answer 7

Brown urine Presence of deformed red cells + casts Accompanied by proteinuria

Question 8

Glomerular causes of haematuria

Answer 8

Glomerulonephritis (usually with proteinuria) IgA nephropathy Familial nephiritis (e.g. Alport syndrome) Thin basement membrane disease)

Question 9

Non-glomerular causes of haematuria

Answer 9

Infection Trauma to genitalia, urinary tract or kidneys. Stones Tumours Sickle cell disease Bleeding disorders Renal vein thrombosis Hypercalciuria

Question 10

What is recurrent haematuria syndrome?

Answer 10

Occurs at time of systemic infection Due to nephritis

Question 11

What are the features of haemolytic uraemic syndrome?

Answer 11

Acute renal failure Microangiopathic haemolytic anaemia Thrombocytopenia

Question 12

Pathology + causes of HUS

Answer 12

Typically secondary to GI infection with E coli producing verocytotoxin Coagulation cascade activated but normal clotting

Question 13

S+S HUS

Answer 13

Prodrome of bloody diarrhoea Abdo pain Fever Vomiting

Question 14

Management of HUS

Answer 14

Peritoneal dialysis Plasma exchange if needed

Question 15

Pathology of nephrotic syndrome

Answer 15

Heavy proteinuria = low albumin + oedema Peak onset 2-5 y/o

Question 16

S+S of nephrotic syndrome

Answer 16

Periorbital oedema Scrotal/ leg/ ankle oedema Ascites SOB

Question 17

Blood results for nephrotic syndrome

Answer 17

Low albumin Raised cholesterol

Question 18

Management of nephrotic syndrome

Answer 18

Prenisolone

Question 19

What features suggest nephrotic syndrome is steroid sensitive?

Answer 19

1-10 y/o No macroscopic haematuria Normal BP Normal complement levels Normal renal function Precipitated by resp infection

Question 20

Causes of steroid resistant nephrotic syndrome?

Answer 20

Glomerulonephritis Membranous nephropathy

Question 21

Pathology of glomerulonephritis

Answer 21

Renal inflammation causing: Haematuria Oliguria HTN Raised creatinine

Question 22

Causes of glomerulonephritis

Answer 22

2-3 weeks after B haemolytic strep throat

Question 23

S+S of glomerulonephritis

Answer 23

Sudden onset illness 2-3 weeks after pharyngitis Coco-cola coloured urine (excess RBC, WBC + proteinuria) Facial oedema Abdo pain Raised BP

Question 24

Causes of acute nephritis

Answer 24

post infection Vasculitis (HSP, SLE etc) IgA nephropathy

Question 25

Pathology of acute nephritis

Answer 25

Increased glomerular cellularity restricts blood flow so there is reduced filtration Leads to reduced urine output + fluid overload HTN Oedema Haematuria + proteinuria

Question 26

HSP pathology

Answer 26

Skin rash Arthralgia Periarticular oedema Abdo pain Glomerulonephritis Due to raised IgA

Question 27

S+S HSP

Answer 27

Symmetrical rash (buttocks, arms, legs and ankles) = urticarial, rapidly becoming maculopapular and pupuric. Joint pain (esp knees and ankles) Periarticular oedema Abdominal pain Haematemesis Malaena Intussusception

Question 28

What is IgA nephropathy?

Answer 28

Episodes of macroscopic haematuria Commonly associated with URTIs

Question 29

What is familial nephritis?

Answer 29

Commonest: Alport syndrome X linked recessive disorder = progresses to renal failure Associated with nerve deafness + ocular defects

Question 30

What are the characteristics of SLE?

Answer 30

Presence of multiple autoantibodies C3 + C4 complements are low Haematuria + proteinuria

Question 31

What is hypospadias?

Answer 31

Urethral opening proximal to normal meatus on ventral surface Correctional surgery needed before 2 y/o

Question 32

What is a hydrocele and how is it managed?

Answer 32

Managed conservatively Illuminates with transillumination Disappears by 1