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Core clinical problems > 6n. T renal paeds > Flashcards

6n. T renal paeds Flashcards

1
Q

Who needs an USS UTI?

A

In 6 weeks if:
- < 6 months 1st UTI
- recurrent UTIs

During illness if:
- <6 months recurrent or atypical
- atypical

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2
Q

What is a DMSA? when is it done?

A

Assesses damage to kidneys following illness

Do 4-6 months after illness

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3
Q
A
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3
Q

When is an MCUG performed?

A

If < 6 months with atypical or recurrent

If there is a family history of VUR

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4
Q

Management lower UTI in children

A

If < 3 months:
- IV cefuroxime full septic screen

If > 3 months:
- Abx for 3 days:
- Trimethoprim
- Nitrofurantoin
- Cefalexin
- Amoxicillin

safety net: bring back in 24-48 hours if still unwell

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5
Q

Management of upper UTI in children

A

If < 3 months:
- IV cefuroxime full septic screen

If > 3 months consider admission for IV cefuroxime
If not admitting use oral:
oral cefalexin or co-amoxiclav for 7-10 days

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6
Q

Define atypical UTI in children

A
  • seriously unwell
  • sepsis
  • non-e.coli
  • abdominal mass
  • poor urine flow
  • raised creatinine
  • failure to respond to treatment within 48 hours
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7
Q

What is hypospadias?

A

urethral opening on ventral surface
a hooded prepuce
chordee (ventral curvature of the penis) in more severe forms

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8
Q

Management hypospadias?

A

Corrective surgery at 12 months

Do NOT circumsise as this tissue is needed for correction

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9
Q

Define acute pyleonephritis

A

UTI plus either of:
- temp > 38
- tenderness

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10
Q

Define enuresis in the context of nocturnal enuresis

A

Enuresis may be defined as the ‘involuntary discharge of urine by day or night or both, in a child aged 5 years or older, in the absence of congenital or acquired defects of the nervous system or urinary tract’

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11
Q

Management of nocturnal enuresis

A
  • look for underlying triggers
  • advice
  • star charts
  • enuresis alarm (1st line)
  • desmopressin (for sleepovers)
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12
Q

Management of undescended testes?

A

Unilateral:
- refer at 3 months of age
- surgery performed at ~12 months

Bilateral:
- review by senior paeds within 24 hours

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13
Q

Define nephrotic syndrome

A

Nephrotic syndrome is defined as the presence of proteinuria (>3.5 g/24 hours), hypoalbuminaemia (<30 g/L), and peripheral oedema.

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14
Q

What will urinalysis show minimal change disease

A

Urinalysis (analysis of the urine) will show small molecular weight proteins and hyaline casts.

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15
Q

3 year old frothy urine, generalised oedema and pallor

A

minimal change disease

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16
Q

management minimal change disease

A

High dose steroids (i.e. prednisolone) for 4 weeks
Low salt diet
Diuretics may be used to treat oedema
Albumin infusions may be required in severe hypoalbuminaemia
Antibiotic prophylaxis may be given in severe cases

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17
Q

complications minimal change disease

A

hypovolemia
thrombosis
infection
high lipids
high or low blood pressure

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18
Q

what is nephritis

A

Nephritis refers to inflammation within the nephrons of the kidneys. It causes:
Reduction in kidney function
Haematuria: invisible or visible amounts of blood in the urine
Proteinuria: although less than in nephrotic syndrome

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19
Q

nephritis developing 1-3 weeks after URTI/tonsilitis

A

Post-streptococcal glomerulonephritis

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20
Q

management of post strep glomerulonephritis

A

Management is supportive and around 80% of patients will make a full recovery. In some cases patients can develop a progressive worsening of their renal function. They may need treatment with antihypertensive medications and diuretics if they develop complications such as hypertension and oedema.

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21
Q

Pathophysiology post strep glomerulonephritis

A

Immune complexes made up of streptococcal antigens, antibodies and complement proteins get stuck in the glomeruli of the kidney and cause inflammation.

IgG
IgM
C3
depostion

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22
Q

what would bloods show strep glomerulonephritis

A

low C3 (as it has been deposited)
ASO titre rasied (recent strep infection)

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23
Q

Renal biopsy features of strep glomerulonephritis

A

diffuse proliferative glomerulonephritis

endothelial proliferation with neutrophils

subepithelial ‘humps’ caused by lumpy immune complex deposits

immunofluorescence: granular or ‘starry sky’ appearance

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24
young male, recurrent episodes of macroscopic haematuria typically associated with a very recent respiratory tract infection
IgA nephritis (bergers disease)
25
Management IgA nephroathy/bergers disease
isolated hematuria, no or minimal proteinuria (less than 500 to 1000 mg/day), and a normal glomerular filtration rate (GFR) no treatment needed, other than follow-up to check renal function persistent proteinuria (above 500 to 1000 mg/day), a normal or only slightly reduced GFR initial treatment is with ACE inhibitors if there is active disease (e.g. falling GFR) or failure to respond to ACE inhibitors immunosuppression with corticosteroids
26
how to differentiate strep glomer from IgA neph
Age: SG young, IgA teenage Timing of URTI: SG 1-3 weeks ago, IgA days ago Complement levels: SG low Proteinuria: SG has worse Haematuria: IgA has worse
27
Histology IgA nephropathy
mesangial hypercellularity, positive immunofluorescence for IgA & C3
28
a child under the age of 5 years presenting with a mass in the abdomen
consider wilm's
29
what is wilms tumour
tumour affecting the kidney in children, typically under the age of 5 years.
30
management of wilms tumour
Treatment involves surgical excision of the tumour along with the affected kidney (nephrectomy). Adjuvant treatment refers to treatment that is given after the initial management with surgery. This depends on the stage of the disease, the histology and whether it has spread. The main options are: Adjuvant chemotherapy Adjuvant radiotherapy
31
invetsigations for wilms tumour: intial, staging, definitive
The initial investigation is an ultrasound of the abdomen to visualise the kidneys. A CT or MRI scan can be used to stage the tumour. Biopsy to identify the histology is required to make a definitive diagnosis.
32
Presenting feature HSP
Purpuric rash affecting the lower limbs and buttocks in children
33
4 classic features of HSP
Purpura (100%), Joint pain (75%), Abdominal pain (50%) Renal involvement (50%)
34
Investigations for ?HSP
Full blood count and blood film for thrombocytopenia, sepsis and leukaemia Renal profile for kidney involvement Serum albumin for nephrotic syndrome CRP for sepsis Blood cultures for sepsis Urine dipstick for proteinuria Urine protein:creatinine ratio to quantify the proteinuria Blood pressure for hypertension
35
Management HSP
supportive, with simple analgesia, rest and proper hydration. monitoring: Urine dipstick monitoring for renal involvement Blood pressure monitoring for hypertension
36
Define hydrocele
collection of fluid within the tunica vaginalis that surrounds the testes
37
types of hydrocele
simple- fluid trapped and will be resorbed by age 2 communicating- connected via procesus vaginalis to peritoneal cavity, will fluctuate in size - needs surgical treatment
38
investigations hydrocele
transillumination positive USS is diagnostic
39
management communicating hydrocele
surgical operation to remove or ligate the connection between the peritoneal cavity and the hydrocele (the processus vaginalis)
40
management vulvovaginitis
Avoid washing with soap and chemicals Avoid perfumed or antiseptic products Good toilet hygiene, wipe from front to back Keeping the area dry Emollients, such as sudacrem can sooth the area Loose cotton clothing Treating constipation and worms where applicable Avoiding activities that exacerbate the problem In severe cases an experienced paediatrician may recommend oestrogen cream to improve symptoms.
41
PResentaiton of haemolytic uraemic syndrome
E. coli 0157 causes a brief gastroenteritis, often with bloody diarrhoea. The symptoms of haemolytic uraemic syndrome typically start around 5 days after the onset of the diarrhoea. Signs and symptoms of HUS may include: Reduced urine output Haematuria or dark brown urine Abdominal pain Lethargy and irritability Confusion Oedema Hypertension Bruising
42
triad of HUS
Haemolytic anaemia: anaemia caused by red blood cells being destroyed Acute kidney injury: failure of the kidneys to excrete waste products such as urea Thrombocytopenia: low platelet count
43
Management of HUS
HUS is a medical emergency and has a 10% mortality. It needs to be managed by experienced paediatricians under the guidance of a renal specialist. The condition is self limiting and supportive management is the mainstay of treatment: Urgent referral to the paediatric renal unit for renal dialysis if required Antihypertensives if required Careful maintenance of fluid balance Blood transfusions if required 70 to 80% of patients make a full recovery.
44
Pathophysiology HUS
Occurs when there is thrombosis within small blood vessels throughout the body. This is usually triggered by a bacterial toxin called shiga toxin.
45
Most common cause HUS
e. coli 0157 --> shiga toxin
46
What is Alport's syndrome
Alport's syndrome is usually inherited in an X-linked dominant pattern*. It is due to a defect in the gene which codes for type IV collagen resulting in an abnormal glomerular-basement membrane (GBM). The disease is more severe in males with females rarely developing renal failure.
47
Inheritance of alport's syndrome
X linked dominant
48
why may an alport's patient's kideny transplant fail
This may be caused by the presence of anti-GBM antibodies leading to a Goodpasture's syndrome like picture.
49
What does renal biposy show Alport's syndrome
splitting of the lamina densa of the glomerular basement membrane, resulting in a 'basket-weave' appearance
50
Define phismosis
the inability to retract the skin (foreskin or prepuce) covering the head (glans) of the penis.
51
Management of phismosis
Physiological phimosis - since the foreskin becomes retractable with time these patients can be managed conservatively topical steroids can be applied to the preputial ring may be useful (2) Pathological phimosis - circumcision a short course of topical corticosteroids may be beneficial in mild scarring (2) Reference:
52
Antibodies SLE
antinuclear (ANA) (this high sensitivity makes it a useful rule out test, but it has low specificity) anti-dsDNA: highly specific (> 99%), but less sensitive (70%) anti-Smith: highly specific (> 99%), sensitivity (30%) also: anti-U1 RNP, SS-A (anti-Ro) and SS-B (anti-La)
53
Malar rash
think SLE
54
renal complications SLE
proteinuria glomerulonephritis (diffuse proliferative glomerulonephritis is the most common type)
55
cardio complications SLE
pericarditis: the most common cardiac manifestation myocarditis
56
CRP and ESR SLE
Normally in SLE, a patient's ESR will be raised but CRP will be normal A raised CRP in a patient with known SLE may indicate an underlying infection
57
specific test for SLE
Anti-dsDNA
58
sensitive test for SLE
ANA
59
first line SLE
NSAIDs Steroids (prednisolone) Hydroxychloroquine (first line for mild SLE)
60
What anaemia can you get with SLE
normocytic anaemia of chronic disease
61
criteria HSP
There are many different sets of criteria for diagnosing HSP, the most recent being the EULAR/PRINTO/PRES criteria from 2010. This requires the patient to have palpable purpura (not petichiae) + at least one of: Diffuse abdominal pain Arthritis or arthralgia IgA deposits on histology (biopsy) Proteinuria or haematuria
62
triggers HSP
upper airway infection or gastroenteritis
63
can ITP cause a rash
yes - petichiae
64
Abdominal HSP
Abdominal pain is indicative of gastrointestinal involvement. This affects around 50% of patients with HSP. In severe cases, it can lead to gastrointestinal haemorrhage, intussusception and bowel infarction.
65
What is prehn's sign
Prehn's sign is an evaluation used to determine the cause of testicular pain. It is performed by lifting the scrotum and assessing the consequent changes in pain. A positive Prehn's sign indicates relief of pain upon elevation of the scrotum and is associated with epididymitis.
66
examination findings testicular torison
- loss of cremaster reflex - negative phren's sign
67
Presentation neuroblastoma
Neuroblastoma typically crosses the midline presents with symptoms of fever, fatigue, weight loss, diarrhoea and vomiting
68
investigation neuroblastoma tumour
raised urinary vanillylmandelic acid (VMA) and homovanillic acid (HVA) levels calcification may be seen on abdominal x-ray biopsy
69
what is neuroblastoma
The tumour arises from neural crest tissue of the adrenal medulla (the most common site) and sympathetic nervous system.
70
Management renal involvement HSP
corticosteroids

Core clinical problems (94 decks)

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