Renal/Urology/Genitalia Flashcards
(98 cards)
1
Q
What is Potter’s syndrome?
A
Renal agenesis = oligohydramnios = intrauterine compression
- Facies
- Limb deformities
- Lung hypoplasia
2
Q
Why is UTI in children important (2)?
A
- Structural abnormalities in 50%
- Pyelonephritis = scarring = CKD
3
Q
What is dysuria alone usually due to in boys and girls?
A
Boys - balanitis
Girls - cystitis, vulvitis
4
Q
Signs of an atypical UTI
A
Refractory to abx treatment Abdo/pelvic mass Seriously ill/septicaemia Poor urine flow Raised Cr Non- E.coli organism
5
Q
Predisposing factors for UTI
A
Structural abnormality
Incomplete voiding/emptying
Constipation
Vesicoureteric reflux
6
Q
Is nocturnal enuresis more common in boys or girls?
A
Boys (2:1)
7
Q
When is nocturnal enuresis worth investigating?
A
After 6 years
8
Q
Organic causes of nocturnal enuresis
A
- UTI
- Constipation
- DM
- CKD
9
Q
Contributing factors to nocturnal enuresis
A
Organic causes (e.g. UTI, constipation, DM)
Genetics
Emotional stress
Lack of parental approval
10
Q
Management steps of nocturnal enuresis
A
Explanation (common, most self resolve, not conscious)
Ensure easy access to toilet, bladder emptying before bed
Start chart
Alarms
Desmopressin (ADH)
11
Q
When are most children dry by day and night?
A
5 years
12
Q
When are most children dry by day?
A
4 years
13
Q
When is desmopressin appropriate in enuresis?
A
Short ter control e.g. for school trip or sleepover
14
Q
Causes of primary daytime enuresis
A
- Inattention to sensation
- Detrusor overactivity
- Neuropathic bladder
- UTI
- Ectopic ureter (constant dribbling)
15
Q
Treatment for overactive detrusor
A
Anticholinergics e.g. oxybutynin
16
Q
Mx for primary daytime enuresis >5 years
A
Referral to specialists USS Urine dip (MC&S) USS Spine XR
17
Q
Causes of secondary enuresis
A
Emotional upset
UTI
DM
18
Q
Clinical features of nephrotic syndrome
A
Periorbital oedema
Scrotal, vulval, leg and ankle oedema
Abdo distension - ascites
Resp distress (pulm effusion/abdo distension)
19
Q
Nephrotic syndrome triad
A
Proteinuria
Oedema
Hypoalbuminaemia
20
Q
Commonest childhood cause of nephrotic syndrome
A
Minimal change disease
21
Q
Causes of nephrotic syndrome in children
A
Glomerular - minimal change disease, glomerulonephritis
Orthostatic proteinuria
HTN
SECONDARY - SLE, HSP
22
Q
Investigations nephrotic syndrome
A
Urine dip (+ MC&S) FBC + ESR U&E Complement (SLE) Antistreptolysin O/ DNAse B Abs (HSP) Urinary sodium Malaria (if travel)
23
Q
Management nephrotc syndrome
A
Regular urine monitoring
4 weeks PO prednisolone
Wean over next four weeks, or alternate days
(Proteinuria should resolve by 11 days)
Fluid/salt restriction
If it hasn’t resolved after course of pred - consider renal biopsy
- Albumin
- Furosemide
24
Q
Complications of nephrotic syndrome
A
Hypovolaemia (abdo pain/faint) - treated with albumin
Thrombosis
Infection (capsulated e.g. pneumococcus)
Hypercholesterolaemia
25
Commonest cause of haematuria in children
UTI
26
Two broad categories of haematuria causes
Non-glomerular - UTI, trauma, stones, tumour, hypercalciuria, SCD
Glomerular - acute nephritis, post-streptococcocal, HSP, IgA nephropathy, familial (Alport's)
27
Hearing loss and nephritis
Alport's
28
Investigations for haematuria
Urine dip (MC&S)
Bloods (FBC, U&E, albumin, ESR)
Special bloods (anti-streptolysin O titre, anti-DNA)
Renal biopsy
29
Causes of acute nephritis
Post-streptococcal
HSP
IgA nephropathy
30
Acute nephritis (nephritic syndrome) features
Oedema
HTN
Haematuria/proteinuria
Reduced urine output
31
Post strep nephritis
Following throat or skin infection
Raised ASO/Anti-DNAse B titres
Low C3 (resolves over 3-4 weeks)
32
Features of HSP
```
Fever
Characteristic skin rash
Arthralgia
Glomerulonephritis
Periarticular oedema
Abdominal pain (colicky)
```
33
Features of HSP rash
Trunk sparing. Buttocks, legs, extensor surfaces, ankles
Urticarial --> maculopapular --> purpuric
Palpable
34
When does HSP typically occur
Winter months
After URTI
(3-10 years)
35
Demographics of patients at highest risk of HSP
Boys > girls (2:1)
| 3-10 years
36
What is HSP?
IgA mediated vasculitis
37
Management of HSP (by feature)
Arthralgia - ibuprofen/paracetamol
Severe oedema or abdominal pain - oral prednisolone
Proteinuria/deteriorating renal fx - IV corticosteroids
Follow up to check BP and renal fx
38
Commonest familial nephritis
Alport's
39
Commonest vasculitis to involve the kidney
HSP
40
When is dialysis appropriate?
```
Severe hyperkalaemia
Metabolic acidosis
Severe hypo/hypernatraemia
Pulmonary oedema
HTN
```
41
Commonest cause of AKI in children
Pre-renal
42
Mx pre-renal AKI
Fluid replacement
Circulatory support
Dopamine/adrenaline is very low blood pressure
Furosemide if volume overloaded
43
Causes of prerenal AKI
Hypovolaemia (gastroenteritis, sepsis, burns, haemorrhage, nephrotic syndrome)
Circulatory failure
44
Causes of Renal AKI
Vascular - HSP, HUS
Tubular - ATN, ischaemia, toxins
Interstitial - pyelonephritis
Glomerular - glomerulonephritis
45
Mx of renal AKI
- Treat the underlying cause ***
- Monitor H2O, U&Es
- High calorie, normal protein diet. Reduce catabolism, uraemia nd hyperkalaemia
- Furosemide if vol overload
- IVI if co-existent pre-renal AKI
46
Causes of post-renal AKI
Obstruction
47
Mx of post-renal AKI
Urgent r/f to urology for ax of site of obstruction
Nephrostomy
Bladder catheterisation
48
HUS triad
Uraemia
Haemolytic anaemia
Thrombocytopenia
49
Primary cause HUS
Gastroenteritis (E.coli H157)
50
What type of renal failure is HUS?
Acute renal (vascular)
51
Presentation of HUS
History of bloody diarrhoea (gastroenteritis)
Malaise/lethargy
Bruising
Haematuria
52
Mx HUS
Refer to haematology/nephrology
Supportive:
- Monitor fluid balance and BP
- IV isotonic crystalloids
- Blood transfusion if anaemic
- 50% will require dialysis
53
What % of patients with HUS will require dialysis in the acute phase?
50%
54
What treatments should be avoided in HUS?
Abx, opioids, NSAIDs, anti-diarrhoeals
55
Features of atypical HUS
No diarrhoeal prodrome
Frequent relapses
--> higher risk of HTN and progressive CKD
56
Mx for irreversible renal failure caused by HUS
Transplant
57
Why is long term follow up necessary after resolution of acute HUS?
Persistent proteinuria
HTN
Progressive CKD
58
How is AKI defined?
Oliguria (<0.5ml/kg/day)
59
How is CKD defined?
eGFR <15 ml/min
60
Commonest cause of CKD
Structural abnormalities and malformations
61
Presentation of CKD
Abnormal AN USS
```
Anorexia/lethargy
FTT
Polydipsia, polyuria
Real rickets
HTN
Proteinuria
Anaemia
```
62
Mx CKD (think different symptoms)
Anorexia/lethargy/FTT - nutrition. Consider NGT/gastrotomy with calorie supplements.
Polydipsia, polyuria
Renal rickets - phosphate restriction, calcium carbonate, activated D3
HTN - ACEi/ARB, CCB, dialysis, transplant
Anaemia - EPO stimulating agent
Hormonal abnormalities - Recombinant GH
Salt imbalances, met acidosos - sodium bicarb, salt supplements, water
63
What is renal rickets?
Renal osteodystrophy
- Kidney cannot hydroxylate D2 --> D3
- Impaired absorption of Ca/excretion of PO4
= Osteitis fibrosa, osteomalacia leading to secondary hyperparathyroidism
64
What type of inguinal hernia is more common in children? Why?
Indirect - patent processus vaginalis
65
Which group of children are most at risk of inguinal hernias?
Prems
| Boys
66
Presentation of inguinal hernia
Intermitten groin swelling (on crying/straining)
Irreducible, firm, tender lump in groin/scrotum
Irritability, vomiting
67
Mx of reducible hernia
Reduce under opioid analgesia
| Surgery 24-48h to allow oedema to go down
68
Mx of irreducible hernia
Emergency surgery (might be incarcerated)
69
Common cause of hydrocoele
Patent processus vaginalis
70
Where does the fluid come from/go to in a hydrocoele?
Peritoneal fluid into tunica vaginalis
71
Presentation of hydrocoele
```
Asymptomatic swelling in scrotum (commonly bilateral)
Bluish
Non-tender
Transilluminates
Sometimes present after viral/GI illness
```
72
Treatment of hydrocoele <2 years
Observe - most resolve spontaneously over 18-24 months
73
Treatment of hydrocoele 2-11 years
Surgery with open repair.
| Laparoscopic exploration
74
Treatment of hydrocoele 11+ years
Dependent on cause:
- Idiopathic -- observe. Surgery if particularly large/uncomfortable
- After varicocelectomy - conservative management
- Parasitic - surgery
75
When must surgery occur in suspected testicular torsion?
Immediately
| Before 6 hours
76
Testicular torsion surgery
Orchidectomy
Orchidopexy (if undescended)
Contralateral and affected testicle fixed to the posterior wall
77
When is testicular torsion most common?
Adolescents
78
Risk factors for testicular torsion
Previous self-limiting episodes
Undescended testes
79
Presentation epididymoorchitis
Insidious onset unilateral scrotal/groin pain
+/- urinary symptoms
+/- STI symptoms
+/- mumps symptoms
80
Treatment epididiymoorchitis
Symptomatic relief - bed rest, analgesia, scrotal elevation
Abx if bacteral cause (UTI/STI)
Supportive if viral cause (mumps)
IV abx and fluids if systemically unwell with high-grade fever
81
Three types of cryptorchidism
Retractile - can manipulate testis into the scortum, but retracts back
Palpable - palpated in groin, but not in scrotum
Impalpable - in inguinal canal/intraabdominal/absent (10%)
82
What percentage of impalpable testes are completely absent?
10%
83
Why are undescended testes more common in pre-term infants?
Testes' descent through the inguinal canal largely occurs during the third trimester
84
Investigations for undescended testes
USS
Hormonal (check testosterone response to hCG - check to see if there is any testicular tissue)
Laparoscopic exploration
85
Management of undescended testes in neonate
R/v at 6-8 weeks.
If still not descended, re-exmaine at 3 months.
If retractile --> reassurance +annual review
If still not descended --> orchidopexy
86
When should infant with undescended testes be referred to paediatrician?
Within first 24 hours if
- possibility of disorder of sexual development
- bilateral
If has not resolved (or at least become retractile) by 3 months
87
When should orchidopexy be performed?
3 months - 1 year
88
Why is orchidopexy performed?
Cosmetic
Reduced risk trauma/torsion
Reduced risk malignancy
Fertility
89
Incidence of hypospasias
1/200 male births
90
Pathophysiology hypospadias
Urethral tubularisation occurs proximally to distally under the influence of fetal testosterone.
Failure to complete this migration = hypospadia
91
Three types of hypospadia
Ventral urethral meatus (on underside)
Hooded dorsal foreskin
Chordee (ventral curvature)
92
What should be investigated in particularly proximal hypospadias?
For other GU anomalies
93
Management of hypospadia
Surgery is NOT mandatory
| May be performend for function or cosmesis after 3 months (ideally before 2 years)
94
What must not happen in infants with hypospadias
Circumcision - foreskin can be used for reconstruction
95
What is the aim of hypospadia surgery
Stand and pee in straight line
| Straight erection
96
Medical indications for circumcision
Phimosis (inability to retract foreskin - whitish scarring caused by localised skin disease BXO)
Recurrent balanoposthitis (redness and inflammation of foreskin, purulent discharge)
Recurrent UTI
97
Paraphimosis
Foreskin trapped in retracted position, proximal to swollen glans
98
Management of paraphimosis
Topic analgesia - ice packs, compression, osmotic agents
Puncture technique - exudation of oedmatous fluids
Surgical reduction and circumcision
