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Renal & Urology Flashcards

(67 cards)

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1
Q

Symptoms of UTI?

A

fever may be the only symptom

Babies:
fever
lethargy
irritability
poor feeding
vomiting
urinary frequency

Older children:
fever
suprapubic pain/abdo pain
vomiting
dysuria
urinary frequency
incontinence

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2
Q

When to diagnose acute pyelonephritis in children?

A

if temp is > 38
if there is loin pain or tenderness

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3
Q

Mx of UTIs?

A

all children <3 months with fever should start immediate IV antibiotics and have full septic screen

> 3 months:
oral antibiotics if otherwise well
IV if signs of pyelonephritis or sepsis
trimethoprim, nitrofurantoin, cefalexin, amoxicillin

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4
Q

Investigations used in recurrent UTIs?

A

US
DMSA scans
micturating cystourethrogram

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5
Q

When to investigate UTIs further?

A

all children under 6 months should have US 6wks after their first UTI
(or during the illness if recurrent or atypical bacteria)

all children with recurrent UTIs should have US within 6wks

children with atypical UTIs should have US during the illness

DMSA scans 4-6 months after illness in recurrent or atypical UTIs

MCUG in children <6 months with atypical or recurrent UTIs or FHx of VUR

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6
Q

What is a DMSA scan used for?

A

to check for scarring of the the kidneys following UTIs

uses radioactive DMSA and a gamma camera to see the uptake by the kidneys

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7
Q

What is a MCUG used for?

A

to assess for the presence of VUR

catheterise the child, inject contrast and series x-rays to see if there is reflux present

prophylactic ABx usually given for 3 days around the investigation

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8
Q

What is Vesico-ureteric reflux?

A

when urine has a tendence to flow backwards from the bladder up into the ureters
predisposes the patient to UTIs and scarring

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9
Q

Mx of VUR?

A

diagnosed with MCUG
mx depends on severity

avoid constipation
avoid an excessively full bladder
prophylactic ABx
surgical input

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10
Q

Exacerbations of vulvovaginitis?

A

wet nappies
use of chemicals or soaps
tight clothing
poor toilet hygiene
constipation
threadworms
pressure (e.g., horse-riding)
heavily chlorinated pools

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11
Q

Presentation of vulvovaginitis?

A

soreness
itching
erythema
vaginal discharge
dysuria
constipation

v common pre-puberty (no oestrogen)
often urine dipstick will show leukocytes, leading to UTI misdiagnosis)

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12
Q

What is nephrotic syndrome?

A

classic triad:
hypalbuminaemia
proteinuria
oedema

+ deranged lipid profile
HTN
hypercoagulability

most common between 2-5

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13
Q

Causes of nephrotic syndrome?

A

minimal change disease (90%)

secondary to intrinsic kidney disease:
FSGS
membranoproliferative glomerulonephritis
secondary to systemic illness:
HSP
diabetes
infections (HIV, malaria, hepatitis)

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14
Q

What is minimal change disease?

A

the most common cause of nephrotic syndrome in children
presents with oedema, proteinuria and hypoalbuminemia
no clear cause

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15
Q

Investigations in minimal change disease?

A

urinalysis (small molecular weight proteins + hyaline casts)
BP
Bloods
renal biopsy and microscopy usually do not detect any abnormalities

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16
Q

Mx of minimal change disease?

A

corticosteroids (prednisolone)
usually good response
most children make full recovery, however it can recur

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17
Q

Mx of nephrotic syndrome?

A

high dose steroids
low sodium diet
diuretics for oedema
albumin infusions
antibiotic prophylaxis

high dose steroids given for 4wks and then weaned over 8wks

if steroid resistant -> ACEi, immunosuppressants (cyclosporine, tacrolimus, rituximab)

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18
Q

Response to steroids in nephrotic syndrome?

A

80% respond - steroid sensitive
80% of steroid sensitive will relapse and need further steroids - steroid dependent
20% are steroid resistant

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19
Q

Complications of nephrotic syndrome?

A

hypovolaemia (third spacing)
thrombosis
infection (kidneys leak immunoglobulins, immunosuppressant meds)
acute or chronic renal failure
relapse

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20
Q

What is nephritic syndrome?

A

caused by inflammation in the nephrons of the kidneys

classic triad:
red. in kidney function
haematuria
proteinuria (but less than nephrotic syndrome)

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21
Q

Causes of nephritic syndrome?

A

post-streptococcal glomerulonephritis
IgA nephropathy (Berger’s disease)
HSP (overlaps with IgA)

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22
Q

What is post-streptococcal glomerulonephritis?

A

nephritis occurring 1-3wks after b-haemolytic streptococcus infection
(tonsillitis by strep pyogenes)
strep antigens, antibodies and complement gets stuck in the kidneys, causing AKI

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23
Q

Investigations for post-strep GN?

A

Hx of tonsillitis
throat swab
anti-streptolysin O titres

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24
Q

Mx of post-strep GN?

A

supportive care
80% full recovery

others -> worsening of renal function:
antihypertensives
diuretics
depending on complications

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25
What is IgA nephropathy?
aka Berger's disease related to HSP (IgA vasculitis) IgA deposits form in the kidneys, causing nephritis
26
Mx of IgA nephropathy?
supportive treatment immunosuppressants to slow the progression of the disease
27
What is haemolytic uraemic syndrome?
classic triad: microangiopathic haemolytic anaemia AKI thrombocytopenia involves thrombosis of the small vessels caused by the Shiga toxin from either E coli 0157 or shigella infection
28
What increases the risk of HUS?
treating gastroenteritis with Abx or anti-diarrhoeal releases the toxin from E coli 0157 or shigella
29
Presentation of haemolytic uraemic syndrome?
gastroenteritis initially (diarrhoea, which turns bloody after 3 days) HUS symptoms develop about a week later fever abdo pain lethargy pallor (haemolysis) oliguria (AKI) haematuria (AKI) HTN (AKI) bruising (thrombocytopenia) jaundice (haemolysis) confusion (uraemia)
30
Mx of HUS?
stool culture to establish the causative organism medical emergency - admission supportive management with: IV fluids antihypertensives blood transfusions haemodialysis self-limiting and good recovery by most patients with supportive care
31
When do most children gain bladder control?
daytime by 2yrs night time by 3-4yrs
32
What is primary and secondary nocturnal enuresis?
primary -> child has never been dry at night secondary -> child who previously was dry for at least 6 months starts bedwetting again
33
Causes of primary nocturnal enuresis?
normal variation (particularly if FHx) overactive bladder fluid intake failure to wake psychological distress secondary causes (constipation, UTI, learning disability or CP)
34
Mx of primary nocturnal enuresis?
diary Hx and exam reassure parents of patients <5 lifestyle changes encouragement and positive reinforcement avoid punishment or shame treat any underlying cause enuresis alarm pharmacological treatment
35
Causes of secondary nocturnal enuresis?
UTI constipation T1DM new psychosocial problems maltreatment or abuse
36
Mx of secondary nocturnal enuresis?
establish and treat underlying cause always be thinking of abuse
37
Causes of diurnal enuresis?
urge incontinence stress incontinence recurrent UTIs psychosocial problems constipation
38
Pharmacological treatment for enuresis?
initiated by a specialist desmopressin (ADH, taken before bedtime) oxybutynin (anticholinergic - helpful if urge incontinence) imipramine (TCA)
39
What is ARPKD?
AR condition caused by the mutation in the PKHD1 gene on chromosome 6 this gene is responsible for creation and maintenance of the tubules, the epithelial tissue of the kidneys, liver and pancreas presents in neonates, usually picked up antenatally
40
Features of ARPKD?
cystic enlargement of collecting ducts oligohydramnios, pulmonary hypoplasia and Potter syndrome congenital liver fibrosis most patients require dialysis within first few days of life and reach end-stage kidney disease before reaching adulthood
41
What is Potter syndrome?
syndrome caused by lack of amniotic fluid and renal failure in utero presents with dysmorphic features including underdeveloped ear cartilage, low-set ears, flat nasal bridge and skeletal abnormalities
42
Complications of ARPKD?
liver failure (fibrosis) portal HTN progressive renal failure HTN chronic lung disease
43
Prognosis of ARPKD?
poor 1/3 will die in the neonatal period 1/3 will survive to adulthood but with various co-morbidities
44
What is multi-cystic dysplastic kidney disease?
separate condition to ARPKD one kidney is affected and the other is typically normal rarely bilateral -> death cystic kidney often atrophies and disappears before 5
45
What is Wilm's tumour?
nephroblastoma, tumour that affects the kidneys in children, usually <5yrs
46
Presentation of Wilm's tumour?
suspect in any child <5 presenting with abdominal mass abdo pain haematuria lethargy fever HTN weight loss
47
Diagnosis of Wilm's tumour?
US initially biopsy for definitive diagnosis CT/MRI for staging
48
Mx of Wilm's tumour?
nephrectomy adjuvant chemotherapy adjuvant radiotherapy if advanced
49
Prognosis of Wilm's tumour?
good 90% cure rate if early mets worsen prognosis
50
What is a posterior urethral valve?
occurs in newborn boys, where there is tissue at the posterior end of the urethra, causing a bladder outflow obstruction, resulting in hydronephrosis
51
Presentation of posterior urethral valve?
varies in severity difficulty urinating poor stream chronic urinary retention palpable bladder recurrent UTIs impaired kidney function severe cases -> bilateral hydronephrosis and oligohydramnios -> pulmonary hypoplasia
52
Investigations for posterior urethral valve?
severe cases picked up antenatally abdo US -> enlarged, thickened bladder and bilateral hydronephrosis MCUG cystoscopy -> can be used to ablate or remove excess tissue
53
Mx of posterior urethral valve?
mild -> monitoring temporary urinary catheter can be inserted while awaiting definitive management definitive management is ablation or removal, usually during cystoscopy
54
What are undescended testis?
aka cryptorchidism affects 5% boys, when the testis are still in the abdomen at birth
55
Complications of undescended testis remaining undescended?
testicular cancer infertility testicular torsion
56
RFs for undescended testis?
FHx low birth weight SGA prematurity maternal smoking
57
Mx of undescended testis?
watch and wait most cases descend by 3-6 months orchidopexy between 6-12 months
58
What are retractile testis?
normal in pre-puberty testes move out of the scrotum and into the inguinal canal when it is cold or when the cremasteric reflex is activated occasionally may fully retract and then orchidopexy may be required
59
What is hypospadias?
condition affecting males, where the urethral meatus is abnormally displaced to the ventral (underside) side of the penis foreskin is usually developed incorrectly also
60
What is epispadias?
condition affecting males where the urethral meatus is abnormally displaced to the dorsal (top) side of the penis foreskin usually developed incorrectly also
61
Investigations for hypospadias?
usually diagnosed on newborn exam
62
Mx of hypospadias?
no circumcision allowed as foreskin might be needed in surgical intervention mild cases might not need any treatment Sx usually performed at 3-4 months of age
63
Complications of hypospadias?
difficulty during urination cosmetic and psychological concerns sexual dysfunction
64
What is a hydrocele?
a collection of fluid that forms within the tunica vaginalis and surrounds the testes simple - fluid is trapped in tunica vaginalis and usually gets reabsorbed over time communicating - processus vaginalis remains open and the tunica vaginalis is connected to the peritoneal cavity, resulting in fluctuation in size of the hydrocele
65
Examination of hydrocele?
soft, smooth, non-tender swelling simple remains one size, communicating can fluctuate transilluminate with light
66
DDx of inguinal or scrotal swelling in neonate?
hydrocele partially descended testis inguinal hernia testicular torsion haematoma tumours (rare)
67
Mx of hydroceles?
US to confirm diagnosis and exclude other cause simple usually resolve within 2yrs, reassurance and sx only if complicated with hernia etc. communicating - sx operation to remove or ligate the processus vaginalis

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