Urology Flashcards
(31 cards)
What are the presenting features of a UTI in children or infants?
fever
lethargy
irritable
vomiting
poor feeding
urinary frequency
incontinence
dysuria
What are the clinical features that allow for a diagnosis of acute pyelonephritis to be made?
temp > 38
loin pain
What are the Abx used for children under 3 months with a fever?
IV ceftriaxone
(+ septic screen, consider LP)
What are the Abx used for children over 3 months of age who are otherwise well with symptoms of a UTI?
Trimethoprim
Nitrofurantoin
Cefalexin
Amoxicillin
What are the ultrasound rules for children?
Under 6 months (first UTI) - abdominal USS within 6 weeks
Children with recurrent UTI - abdominal USS within 6 weeks
Children with atypical UTI - abdominal USS during illness
What is the purpose of a DMSA scan?
= Dimercaptosuccincic acid scan of kidneys
4-6 months after illness to assess for damage from recurrent / atypical UTI
How is vesicle-ureteric reflux diagnosed?
Micturating cystourethrogram (MCUG)
How is vesico-urethreic reflux managed?
Avoid constipation
Avoid delayed micturition
Prophylactic Abx
Surgical input (paediatric urology)
What is a MCUG and what are the indications for one?
= micturating cystourethrogram
investigation of atypical / recurrent UTI in children under 6 months
Fx of vesico-ureteric reflux, dilation of ureter on USS, poor urinary flow
What is the management of volvovaginitis?
Avoid soap and chemicals
Avoid perfume or antiseptics
Toilet hygiene
Keep area dry
Use emollients e.g. sudacrem
Loose cotton clothing
Treat constipation / worms
Avoid activities that exacerbate problem
What is the triad of clinical features of nephrotic syndrome?
Oedema
Hypoalbuminaemia
Proteinuria
What is the most common cause of nephrotic syndrome in children?
Minimal change disease (90%)
Intrinsic causes: FSG, membranoproliferazive glomerulonephritis
Systemic causes: Henoch Schonlein purpura, Diabetes, Infection
What is the diagnostic features of Minimal change disease?
Renal biopsy: no abnormalities
Urinalysis: small molecular weight proteins, hyaline casts
What is the management of Minimal change disease?
Corticosteroids
What is the management of nephrotic syndrome in children?
High dose steroids
Low salt diet
Diuretics (oedema)
Albumin infusions
Abx prophylaxis (in sev cases)
What are the complications associated with nephrotic syndrome in children?
Hypocolaemia
Thrombosis
Infection
Acute / chronic renal failure
Relapse (steroid dependant / resistant)
What are the most common causes of nephritis in children?
Post-streptococcal glomerulonephritis
IgA nephropathy (Berger’s disease)
What are the features of post-streptococcal glomerulonephritis?
Recent tonsillitis infection (streptococcus) e.g. +ve throat swab / anti-streptolysin Ab titres on blood test
What is the management for post-streptococcal glomerulonephritis?
Supportive
OR
Antihypertensives + diuretics (if complications e.g hypertension / oedema)
What is the management of IgA nephropathy?
Supportive management
Immunosuppressant medications e.g. steroids / cyclophosphamide
What is haemolytic uraemic syndrome?
Thrombosis in small blood vessels in body
Typically triggered by bacterial toxin (shiga toxin from E coli / shigella)
What are the features of haemolytic uraemic syndrome?
Haemolytic anaemia
AKI
Thrombocytopenia
What is the presentation of haemolytic uraemic syndrome?
v urine output
haematuria
abdo pain
lethargy
confusion
oedema
HTN
bruising
What is the management of haemolytic uraemic syndrome?
= medical emergency
Supportive management
- ref to paed renal unit for renal dialysis
- antiHTN
- fluid balance
- blood transfusions
