UTI, renal conditions

Question 1

Under what age is urine dipstick unreliable

Answer 1

Under 3 years old

Question 2

What antibiotics are given for UTI in children

Answer 2

• cefuroxime
• trimethoprim

do NOT give nitrofurantoin

Question 3

Type of urine you would get with nephrotic syndrome

Answer 3

White frothy urine

Question 4

Type of urine you would get with diabetes insipidus

Answer 4

Clear urine

Question 5

Type of urine you would get with haematuria

Answer 5

Dilute coke coloured urine

Question 6

Type of urine you would get with UTI

Answer 6

Smelly, cloudy urine

Question 7

3 main symptoms of UTI (related to urine)

Answer 7

Dysuria, frequency, smell

Question 8

Non-urine symptoms of UTI

Answer 8

• swinging fever
• vomiting
• lethargy, irritability
• off-feeds
• jaundice in babies <3 months (for any kind of infection)

Question 9

Why is constipation a risk factor for UTI

Answer 9

o Faeces may irritate bladder

o Children won’t like going to toilet because it hurts, can cause urinary retention

Question 10

Reasons why children may not want to/ not be able to urinate properly

Answer 10

• Phimosis
• Ballinitis
• Meatal ulcer
• Vulvovaginitis
• Nappy rash
• Dehydration
• Neurological deficit eg spina bifida

Question 11

4 conditions that can cause proteinuria

Answer 11

1. transient proteinuria after exercise/ febrile illness
2. nephrotic syndrome
3. nephritic syndrome
4. glomerulonephritis

Question 12

in what 5 cases should urine be sent to the lab

Answer 12

1. All under 3 years with suspected UTI
2. Nitrite and/or leukocyte positive
3. Strong indication of UTI despite negative dipstick
4. Recurrent UTIs
5. UTI unresponsive to treatment after 24-48h

Question 13

In what age group is vesico-urethral reflux more common

Answer 13

Under 5

Usually resolved by 5 years. As child grows, ureter lengthens and straightens

Question 14

What family history might increase a child’s risk of enuresis

Answer 14

• enuresis
• renal hx
• learning difficulties
• diabetes mellitus, insipidus

Question 15

What does a USS look for in assessing UTI

Answer 15

1. Kidney shape, size
2. Number of kidneys
3. Cysts, abscesses

Question 16

What does a micturating cystogram look for in assessing UTI

Answer 16

1. Bladder emptying

2. Bladder reflux

Question 17

What does a DMSA/ MAG3 look for in assessing UTI

Answer 17

Isotope scan

Looks for

1. Scarring
2. Structure
3. Kidney fx

Question 18

Definition of nocturnal enuresis

Answer 18

Involuntary wetting during sleep

without any inherent suggestion of frequency or pathophysiology

Question 19

Definition of diurnal enuresis

Answer 19

Involuntary wetting during day

Question 20

Up to 12 years,

how to calculate bladder capacity

Answer 20

[age+1] x30

in mls

Question 21

3 medicines for enuresis

Answer 21

1. Desmopressin
2. Imipramine
3. Oxybutinin

Question 22

MoA of desmopressin

Answer 22

Antidiuretic

increases water reabsorption from urine

Question 23

MoA of imipramine

Answer 23

TCA

shortens stage of sleep where wetting occurs

Question 24

Features of a lack of vasopressin

Answer 24

1. Pass large amount of urine early in night

2. Pass dilute urine in morning and night

Question 25

Pathophysiology of nephrotic syndrome

Answer 25

1. Inflammation of glomeruli 2. Permeable to large protein losses 3. Hypoalbuminaemia 4. Oedema

Question 26

Signs of nephrotic syndrome

Answer 26

1. Oedema (periorbital, ankles, genitals, pulmonary) 2. Ascites 3. Hypovolaemia (due to fluid shift) 4. White frothy urine 4. Leukonychia