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MK SR INDEX CASES CHILD HEALTH > A child with a urinary tract infection > Flashcards

A child with a urinary tract infection Flashcards

1
Q

Characteristics of nephrotic syndrome

A

Greater than 2g/m2/hr protein in urine, Hypoproteinemia , Oedema, Hypercholesterolaemia

Clinical presentation: Pitting oedema, ascites, abdominal pain

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2
Q

Nephrotic syndrome triad

A

Oedema
Decreased Albumin
Protein

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3
Q

Why do you get hypercholesterolaemia in nephrotic syndrome?

A

Liver works overtime to produce more proteins to compensate for lost albumin

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4
Q

Diagnostic studies for nephrotic syndrome?

A
  • 3+proteinuria x 3 consecutive days in first morning urine
  • Urine protein:creatinine ratio >2
  • Urea, electrolytes, creatinine, complements
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5
Q

Treatment for nephrotic syndrome?

A
  • Steroid therapy for 12 weeks
  • Steroid dependant/resistant may need additional immunosuppressive therapy.
  • Cautious use of 20%albumin infusion
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6
Q

Complications of nephrotic syndrome

A
  • Infections
  • Spontaneous bacterial peritonitis – Strep pneumoniae, E. Coli, Klebsiella
  • Hypovolaemia
  • Hypercoagulable state due to loss of coagulation factors
  • Hyperlipidemia
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7
Q

Prognosis for nephrotic syndrome

A
  • 80% relapse

* May progress to end stage renal disease

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8
Q

Causes of red urine with and without blood on dipstick

A
  • Red urine – dipstick – no blood – food, meds, free haemoglobin, myoglobin
  • Red urine – dipstick – blood – RBC but no RBC casts – bleeding below renal tubules
  • Red urine – dipstick – blood – RBC casts – glomerular disease
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9
Q

How does Glomerulonephritis present?

A

History: Recent streptococcal infection

Clinical features: Proteinuria, hypertension, oliguria, renal insufficiency, mild edema

Lab features: Organism culture, ASO titre, anti-DNAse B, low C3 (may return to normal in 3-4 weeks)

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10
Q

Complications of Glomerulonephritis

A
  • Reduced GFR – increased sodium reabsorption – elevating plasma volume and suppressing plasma renin
  • Heart failure
  • Seizures
  • Encephalopathy
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11
Q

What is Henoch-Schonlein Purpura?

A
  • Inflammatory response with vasculitis, unclear cause
  • Characteristic purpuric skin rash on extensors & buttocks, arthralgia, abdominal pain, glomerulonephritis
  • 3-10years, h/o URTI
  • Microscopic or macroscopic haematuria, mild proteinuria, may progress to renal failure
  • Initially symptomatic treatment
  • Need follow-up for atleast one year
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12
Q

Options for imaging of the urinary tract

A
  • Ultrasound – anatomical assessment
  • DMSA scan – functional defects e.g. scarring
  • MCUG: Contrast study, Bladder & urethral anatomy e.g. VUR, Usually difficult to perform beyond 6 months
  • MAG3 renogram: Dynamic study, Measures drainage, Older child
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13
Q

UTI – Signs & symptoms in child less than 3 months of age

A

fever, irritability, vomiting, faltering growth, jaundice, poor feeding

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14
Q

UTI – Signs & symptoms in pre verbal child

A

fever, lethargy, vomiting, poor feeding, abdominal pain, offensive urine

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15
Q

UTI - how to get clean catch urine in child

A
  • Urine collecting pads
  • Suprapubic aspirate
  • Catheter
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16
Q

UTI Interpretation of Dipsticks - what three result combinations are definitive for UTI?

A

Positive leucocytes and nitrites

Positive bacteriuria without pyuria

Positive bacteriuria with pyuria

17
Q

UTI Interpretation of Dipsticks - what result combination indicates a possible UTI?

A

Negative leucocytes with positive nitrites - possible UTI

Positive leucocytes with negative nitrites - wait for C/S

18
Q

Risk factors for UTI in children

A
  • Poor urine flow
  • Family h/o vesico-ureteric reflux
  • Previous confirmed UTI
  • Recurrent fever of unknown origin
  • Antenatal diagnosis of urogenital abnormality
  • Dysfunctional voiding
  • Constipation
  • Spinal lesions
19
Q

True or false? CRP should be used as a marker for differentiating between upper and lower UTI

A

FALSE

CRP should NOT be used as a marker for differentiating between upper and lower UTI

20
Q

When are scans indicated in UTI in children?

A

If responding well to antibiotics, no imaging required at any age

Atypical UTI (Non-E.Coli):

  • Less than 6 months: Urgent USS, MCUG, DMSA
  • 6 months - 3 years: Urgent USS, DMSA
  • Older than 3: Urgent USS

Recurrent UTI

  • Less than 6 months: Urgent USS, MCUG, DMSA
  • 6 months - 3 years: USS within 6 weeks, DMSA
  • Older than 3 years: USS within 6 weeks, DMSA
21
Q

Definition off recurrent UTI in children

A

2 upper UTI’s or 3 lower UTI’s or 1 upper and 1 lower

22
Q

UTI imaging: What is a MCUG?

A

Micturating Cysto Urethro Gram (MCUG)

23
Q

UTI imaging: What is a DMSA?

A 
Di Mercapto Succinic Acid scan (DMSA)
•Radionuclide study
•Assesses renal morphology (scars), structure
and function
•Static assessment
24
Q

What is Haemolytic Uraemic Syndrome?

A
  • Microangiopathic haemolytic anaemia, thrombocytopenia & renal injury
  • 6 months – 4 years
  • Shiga – like toxins E.coli 0157:H7
  • Pathophysiology – endothelial cell injury, microvascular thrombosis

Clinical features
•Bloody diarrhoea, lethargy, irritability, petechiae, dehydration, renal insufficiency

Lab findings
•Low platelets, blood film – schistocytes, fragmented erythrocytes, DIC, reticulocytosis, low Hb

25
Q

Treatment for Haemolytic Uraemic Syndrome?

A

Supportive

26
Q

What is Vesicoureteric reflux?

A
  • Retrograde flow of urine
  • Incompetence of ureterovesical junction
  • Familial, bladder obstruction (posterior urethral valves)
27
Q

Complications of Vesicoureteric reflux?

A
  • Renal infection
  • Reflux nephropathy
  • Renal scarring
28
Q

Treatment of Vesicoureteric reflux?

A

Treat the pathology (e.g. Incompetence of ureterovesical junction, bladder obstruction)

+/- prophylactic antibiotics

29
Q

Congenital anomalies of urinary tract

A
  • Renal agenesis - May be related to lung hypoplasia (Potter’s syndrome)
  • Renal dysplasia
  • Polycystic kidney diseases
  • Posterior urethral valves (poor stream)
30
Q

What is Fanconi syndrome?

A
  • Loss of amino acids, glucose, phosphate, bicarbonate, sodium, calcium, potassium & magnesium
  • Polydipsia, polyuria, salt depletion, dehydration, hyperchloraemic metabolic acidosis, poor growth
31
Q

Treatment options for nocturnal enuresis

A
  • Bladder training
  • Double voiding
  • Anticholinergics e.g. Oxybutynin
  • Desmopressin
  • Treat the pathology

MK SR INDEX CASES CHILD HEALTH (24 decks)

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