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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
Q

young male, recurrent episodes of macroscopic haematuria
typically associated with a very recent respiratory tract infection

A

IgA nephritis (bergers disease)

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25
Q

Management IgA nephroathy/bergers disease

A

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

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26
Q

how to differentiate strep glomer from IgA neph

A

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

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27
Q

Histology IgA nephropathy

A

mesangial hypercellularity, positive immunofluorescence for IgA & C3

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28
Q

a child under the age of 5 years presenting with a mass in the abdomen

A

consider wilm’s

29
Q

what is wilms tumour

A

tumour affecting the kidney in children, typically under the age of 5 years.

30
Q

management of wilms tumour

A

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
Q

invetsigations for wilms tumour: intial, staging, definitive

A

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
Q

Presenting feature HSP

A

Purpuric rash affecting the lower limbs and buttocks in children

33
Q

4 classic features of HSP

A

Purpura (100%),
Joint pain (75%),
Abdominal pain (50%)
Renal involvement (50%)

34
Q

Investigations for ?HSP

A

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
Q

Management HSP

A

supportive, with simple analgesia, rest and proper hydration.

monitoring:
Urine dipstick monitoring for renal involvement
Blood pressure monitoring for hypertension

36
Q

Define hydrocele

A

collection of fluid within the tunica vaginalis that surrounds the testes

37
Q

types of hydrocele

A

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
Q

investigations hydrocele

A

transillumination positive

USS is diagnostic

39
Q

management communicating hydrocele

A

surgical operation to remove or ligate the connection between the peritoneal cavity and the hydrocele (the processus vaginalis)

40
Q

management vulvovaginitis

A

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
Q

PResentaiton of haemolytic uraemic syndrome

A

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
Q

triad of HUS

A

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
Q

Management of HUS

A

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
Q

Pathophysiology HUS

A

Occurs when there is thrombosis within small blood vessels throughout the body.

This is usually triggered by a bacterial toxin called shiga toxin.

45
Q

Most common cause HUS

A

e. coli 0157 –> shiga toxin

46
Q

What is Alport’s syndrome

A

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
Q

Inheritance of alport’s syndrome

A

X linked dominant

48
Q

why may an alport’s patient’s kideny transplant fail

A

This may be caused by the presence of anti-GBM antibodies leading to a Goodpasture’s syndrome like picture.

49
Q

What does renal biposy show Alport’s syndrome

A

splitting of the lamina densa of the glomerular basement membrane, resulting in a ‘basket-weave’ appearance

50
Q

Define phismosis

A

the inability to retract the skin (foreskin or prepuce) covering the head (glans) of the penis.

51
Q

Management of phismosis

A

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
Q

Antibodies SLE

A

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
Q

Malar rash

A

think SLE

54
Q

renal complications SLE

A

proteinuria
glomerulonephritis (diffuse proliferative glomerulonephritis is the most common type)

55
Q

cardio complications SLE

A

pericarditis: the most common cardiac manifestation
myocarditis

56
Q

CRP and ESR SLE

A

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
Q

specific test for SLE

A

Anti-dsDNA

58
Q

sensitive test for SLE

A

ANA

59
Q

first line SLE

A

NSAIDs
Steroids (prednisolone)
Hydroxychloroquine (first line for mild SLE)

60
Q

What anaemia can you get with SLE

A

normocytic anaemia of chronic disease

61
Q

criteria HSP

A

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
Q

triggers HSP

A

upper airway infection or gastroenteritis

63
Q

can ITP cause a rash

A

yes - petichiae

64
Q

Abdominal HSP

A

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
Q

What is prehn’s sign

A

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
Q

examination findings testicular torison

A
  • loss of cremaster reflex
  • negative phren’s sign
67
Q

Presentation neuroblastoma

A

Neuroblastoma typically crosses the midline presents with symptoms of fever, fatigue, weight loss, diarrhoea and vomiting

68
Q

investigation neuroblastoma tumour

A

raised urinary vanillylmandelic acid (VMA) and homovanillic acid (HVA) levels
calcification may be seen on abdominal x-ray
biopsy

69
Q

what is neuroblastoma

A

The tumour arises from neural crest tissue of the adrenal medulla (the most common site) and sympathetic nervous system.

70
Q

Management renal involvement HSP

A

corticosteroids

Core clinical problems (94 decks)

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