Clinical Teaching Y4 Flashcards
If there is a kidney problem in kids what must you always check?
BP
What is the typical presentation of post-streptococcal glomerulonephritis in kids?
Presents 7-21d after group A strep infection (pharyngitis/impetigo) with gross haematuria, oedema, HTN, malaise, anorexia, abdominal pain
What initial investigations should you do in someone with suspected post-strep GN?
Dipstick - proteinuria, RBC casts
Bloods - urea & Cr high, C3 low
Serum ASO titre
What does protein in the urine indicate?
Kidney damage until proven otherwise
What is the most common cause of painless haematuria in kids?
Post-strep GN
How do you treat post-strep GN?
Sodium restriction, diuretics, antihypertensives, penicillin for 10d
What is the prognosis of post-strep GN?
Very good
Why do you get coca cola urine in post-strep GN?
Blood coming from kidneys and is haemolysed by time it reaches toilet
What things might make you suspected neurofibromatosis?
Café au lait spots
Short stature
What should a hairy growth over the spine indicate?
Spinal abnormality may be present underneath
With neurological examination what are two key things you should always look at?
Spine and skin
When should we worry about strawberry haemangiomas?
Only if they are other sensory areas (e.g. eyes, mouth, nose)
May cause torrential bleeding if exposed to a lot of friction
If forms yellow crust may be infected with impetigo
What is the course of a strawberry haemangioma?
Get bigger over first year of life and then fade (usually gone by 5Y)
How do we treat strawberry haemangiomas?
Propranolol can reduce the size (but only use when problematic)
Removal and skin graft
Laser treatment
What are the side effects of propranolol?
Hypotension, can mask hypoglycaemia, bradycardia
What are cavernous haemangiomas?
Capillary malformations under the skin that can run dee[ into body tissues
What haematological abnormality can cavernous haemangiomas cause?
Thrombocytopenia
How do you pick up cavernous haemangiomas?
Doppler as not always obvious to naked eye
Port wine stain over eye can cause what dangerous condition?
Glaucoma
Cradle cap might be the first sign of?
Atopy
What is an important differential for milia in newborns?
HSV (can cause v. serious neurological damage)
What is the commonest cause of delayed bladder control?
FH
What two things are really important to find out in taking an enuresis history?
- day time or night time wetting or both?
2. secondary or primary enuresis
Which of night time and day time bladder control takes longest to achieve?
Night time (takes to about 7, day time is at about 5)
Define primary enuresis
Never been dry
Never been dry longer than 6m
What is primary enuresis most likely to be?
Structural problem
What is secondary enuresis most likely to be?
A problem outside of the renal tract, e.g. behavioural, abuse, tumour on kidney or UTI
Define enuresis
Continued bedwetting past 6y in boys, 5y in girls
What tests should you do in enuresis?
Renal USS to check for abnormalities, e.g. duplex kidneys
MAG3, MCUG, DSMA
UTI testing
Diabetes testing
Urgency/frequency in children with enuresis may indicate what? What may help these children?
Overactive bladder
Oxybutinin (anticholingeric)
What are some common causes of daytime wetting?
Overactive bladder (detrusor overactivity) Constipation
How do you manage daytime wetting?
Advice re increasing drinking (stretch bladder wall –> contraction & strengthening)
Advice re double voiding to prevent post-void dribbling
Anticholingerics
Why can’t you do a DMSA until 3-4 months after a UTI?
After UTI get temporary scarring and want to wait 3-4m to see if what permanent scarring exists
What can permanent renal scarring lead to?
HTN and renal failure
What screening is offered to those with renal scarring?
Annual USS and dipstick for proteinuria
What kinds of urine samples can you take in paediatrics?
From best to least favoured:
- Clean catch
- Catheter urine
- Suprapubic aspiration
What is the most common presentation of UTI in kids?
Non-specific
From collapse, septicaemia –> V&D, FFT, colic, PUO
What tests can be used to see VUR?
MAG3 (no catheter req.)
MCUG (catheter req.)
What are the grades of VUR?
- Incomplete filling of upper urinary tract without dilatation
- Complete filling with or without slight dilatation
- Ballooned calyces
- Megaureter
- Megaureter & hydronephrosis
How do you treat UTI in <3m?
IV amoxicillin & gentamicin
OR IV cephalosporin and ampicillin to cover listeria
How do you treat uncomplicated UTI in >3m?
Trimethoprim 3d
(or amoxicillin/co-amoxiclav/nitrofurantoin)
Avoid constipation, drink plenty of fluids, encourage full voiding
How do you empirically treat pyelonephritis in children?
Gentamicin
How do you treat enuresis?
- Enuresis alarm
2. Desmopressin can be used for short term relief from night time wetting
