Genitourinary

Question 1

Indications for U/S KUB in UTI

Answer 1

ALL children < 3y/o with first febrile UTI

beyond that, a lot but must think of doing if recurrent UTI, serious illness, shock, rising serum creatinine, and febrile after 48 hrs of antibiotics

Question 2

Use of MCUG and indications

Answer 2

To detect VUR and post urethral valve

Recurrent UTI, first febrile UTI & abnormal renal U/S, high fever > 39 C, poor growth, HTN, non E. coli UTI

Question 3

How should infants with febrile UTI be managed!

Answer 3

Admitted to hosp and given IV antibiotics

Question 4

Antibiotics for lower UTI

Answer 4

trimethoprim PO 4mg/kg/dose BD for 7 days

Question 5

Antibiotics for upper UTI

Answer 5

Cefotaxime IV 100mg/kg/d 8hrly for 10-14 days

Question 6

Features making minimal change syndrome unlikely

Answer 6

Persistent HTN, gross hematuria, reduced complement levels and renal impairment

Question 7

Complications of nephrotic syndrome

Answer 7

Infection
Hypovolemia: treat with volume expander and IV albumin
Anasarca: can cause immobilization, resp distress, site of infection. Treat with IV albumin and furosemide
VTE: due to hemoconcentration, immobility, infection, hypercoagulable state
Renal insufficiency: due to hupovolemia, AKI, U/L glomerular disease

Question 8

Management of nephrotic syndrome

Answer 8

Admission
- all first presentations or if severe edema/intravascular volume depletion
Prednisolone
- daily oral pred 60mg/m2/day for 4 weeks, then 40mg/m2/d for 4 weeks, then taper over 4 weeks and stop
Furosemide +/- albumin
- only if signs of severe shock or edema because can cause severe intravasc volume depletion
- need to monitor V/S and hemodynamics status
Antibiotics
- IV augmenting for pneumonia, penicillin for prophylaxis
Monitor
- V/S, nephrotic chart (daily weight, IO chart, daily urine dipstick)
Other:
- low salt diet, normal protein
- can only take live vaccine 6/52 after stopping steroids

Question 9

Acute Nephritic Syndrome

Answer 9

• hematuria with dysmorphic RBC and RBC casts in urine (tea-coloured)
• oliguria
• azotemja
• HTN
• oedema
• limited proteinuria

Question 10

Difference between Post-strep GN and IgA GN

Answer 10

PSGN: GN only sets in weeks after initial infection
IgA: can present with pharyngitis and GN at the same time

Question 11

Tests for glomerulonephritis

Answer 11

Urinalysis and MC&S
FBC, UEC, ASOT, anti-DNAse B, throat swab, complement levels (usually C3 low)
Renal biopsy, kidney ultrasound (not necessary unless diagnosis unclear)

Question 12

Managing glomerulonephritis

Answer 12

Strict monitoring of fluid intake, urine output, daily weight, BP 
Penicillin V for 10 days 
Diuretics for pulm oedema and HTN 
Less salt in diet 
Fluid restriction during oliguria phase until diuresis and BP controlled 
Monitor for complications
- hypertensive encephalopathy seizures 
- pulm oedema > HF 
- ARF 

Follow-up

• at least 1 year
• monitor BP every visit, urinalysis and UEC
• repeat C3 levels 6 weeks later if not normal at discharge

Question 13

Tests for nephrotic syndrome

Answer 13

FBC, UEC, lipids, LFT, urinalysis, spot ACR/24hr urine
If secondary cause suspected: ANA, complement levels, ASOT, Hep B, Hep C, HIV
Renal biopsy of steroid-resistant

Question 14

VUR management

Answer 14

If Grade I-III

• will spontaneously resolve
• prophylactic antibiotics daily

Grade IV and V
- need to reimplant especially if recurrent UTI/any renal damage