9. Renal / Urinary Flashcards
What causes nocturnal enuresis and when should it resolve by?
-Normal in <4yrs - delay in the development of normal sphincter control mechanisms
-Refer if >5yrs and still a problem, may be due to:
–Delayed maturation
–Reduced ADH production
–Reduced bladder awareness
–Emotional stress
–UTIs
–Diabetes or renal disease
What can cause diurnal and secondary enuresis?
DIURNAL = day + night
-Causes:
–UTI
–Neurogenic bladder
–Congenital abnormality
–Severe constipation
–Psychogenic, sexual abuse
–Physiological
SECONDARY = wetting in a child who has previously been dry
-Causes:
–Emotional distress, abuse
–DM
–UTI
How should enuresis be managed?
-Rule out treatable causes eg diabetes, UTI, constipation
-Intervention not advised until age 7
–Toileting
–Behaviour management eg reward chart
–Enuresis alarm
–Desmopressin (anti-diuretic)
–Bladder training - stop drinking 90mins before bed time
–Avoid caffeine and fruit juice
What are some underlying causes of UTIs in children?
OBSTRUCTION
-Pelvi-ureteric obstruction
-Urinary stones
-Posterior urethral valves
-Duplex kidneys
-Horseshow kidney
VESICO-URETERIC REFLUX (25%)
-May cause hydronephrosis + renal scarring –> end-stage renal failure
-If mild tends to resolve spontaneously
POOR HABITS
-Wet nappies, wiping back to front
-Hurried micturition
-Infrequent voiding
CONSTIPATION –> poor bladder emptying
NEUROPATHIC BLADDER
-Spinal cord defect
IDIOPATHIC
How do UTIs present differently in children of different ages?
INFANTS
-Fever / sepsis / febrile fits
-Vomiting
-Irritability / lethargy / poor feeding
-Failure to thrive, jaundice
OLDER CHILDREN
-Fever +/- riggers
-Abdo pain
-Dysuria, bedwetting, frequency
-Haematuria / offensive urine
How should you investigate a UTI in a child?
URINALYSIS
-Clean catch if possible
-Dipstick
–+ve for leukocytes + nitrates = UTI
–+ve for one - send for microscopy but treat anyway
–Ketones - how dehydrated?
–Protein
-MC+S
–Most E. coli, proteus more common in boys
IMAGING
-If indicated eg ?VUR, scarring, non E. coli
–USS, MCUG (micturating cysts-urethrograph)
How should a UTI be managed in children?
IF <3yrs
-Admit + IV cefotaxime / gentamicin
IF ?PYELONEPHRITIS
-Admit + IV abx for 2-4 days
-Followed by oral for 10 days
IF LOWER UTI
-Oral trimethoprim / nitrofurantoin / amoxicillin for 3 days
IF RECURRENT / VUR
-Prophylactic abx
What features when associated with haematuria in a child should cause concern?
-HTN
-Proteinuria
-Impaired function
What can cause haematuria in children?
-Post-streptococcal glomerulonephritis
–Preceded by throat or skin infection, HTN + proteinuria
-Polycystic kidneys
–Recessive presents in infancy, dominant in adolescence
-Renal stones
-Renal tumour
–Abdo mass + pain
-Sickle cell disease
-UTI
What can cause red urine?
-Foods eg beetroot
-Drugs eg rifampicin
-Urate crystals
-Menstrual blood
How would you investigate haematuria?
-Urine MC+S
–PCR+CCR
-Bloods
-USS renal tract
-If no resolution after 6 months, refer to nephrology
What is haemolytic uraemic syndrome?
Renal failure, with a charactersitc triad of:
-Microangiopathic haemolytic ANAEMIA (anaemia caused by destruction of RBCs
-Acute kidney failure –> URAEMIA
-THROMBOCYTOPENIA
What causes haemolytic uraemic syndrome?
-Fragmentation of RBCs, usually post-dystentry caused by E coli 0157
-Tumours
-Pregnancy
-Lupus
-HIV
What are some key diagnostic factors of haemolytic uraemic syndrome?
-Diarrhoea (esp bloody)
-Aged <5
-Abdo pain, N+V
-Absence of fever
-Known exposure to E. coli
-Can be a SE of ciclosporins, chemotherapy, quinines
How should haemolytic uraemic syndrome be managed?
-Supportive - fluids, blood transfusion / dialysis
-Monitor electrolytes
-Plasma exchange in severe cases
