Genitourinary/Renal Flashcards
In MCUG fleuroscopy or plain film X-ray?
Fluoroscopy
In micturating cystourethography (MCUG) where does the dye go?
Into the bladder through a urethral catheter
What is MCUG used to diagnose?
Vesicoureteric reflux
What is the triad of signs of nephrotic syndrome?
Proteinuria
Hypoalbuminaemia
Oedema
(High triglycerides)
What 2 drugs can be used short term in nocturnal enuresis?
Desmopressin- antidiuretic
Oxybutynin - anticholinergic, reduces detrusor muscle instability
Name some causes of nocturnal enuresis?
Stress UTI Constipation Diabetes Neurogenic bladder Structural abnormality
What is haemolytic uraemic syndrome associated with?
Gastroenteritis caused by ecoli 0157:H7
Or occasionally shigella
What is the triad of haemolytic uraemic syndrome?
acute renal failure
Microangiopathic haemolytic anaemia
Thrombocytopenia
What is the history might indicate the child has developed HUS?
Not passing urine
What is the most common cause of AKI in children?
Hypovolaemia
What is the treatment for HUS?
Intensive support involving dialysis
What are the complications of HUS
Encephalopathy
Hypertension
Chronic renal failure
Future proteinuria
In nephrotic syndrome what is the urine creatinine to protein ratio?
It is high
What is the treatment of nephrotic syndrome? How long does this have to be carried out for?
Corticosteroid therapy for approx 8 weeks -slowly ween down.
Fluid restriction, regular weight measurements, low salt diet
Penicillin prophylaxis until protein uria has stopped
A child with nephrotic syndrome low urinary sodium and high packed cell volume.. What is happening?
What is the treatment?
They are hypovolaemic
At risk of thrombosis and shock
IV albumin 4.5%
What is another word for haematocrit?
Packed cell volume
How do you decide whether proteinuria is likely to be transient of not?
24 h urine catch
Or
Protein/creatinine ratio - should not be higher than 20
What is a common benign cause of proteinuria?
Orthostatic proteinuria
What is the most common cause of haematuria in children?
UTI
Name some other causes of haematuria..
UTI Post strep glomerulonephritis Trauma Poly cystic kidneys HSP Stone/ tumour Sickle cell
What investigations would you do in haematuria?
Urine microscopy and culture
Protein and calcium excretion
USS
bloods - U&E, FBC, clotting
As well as urine dip what else is it important to measure in HSP?
Blood pressure
What is the physiology behind nephrotic syndrome?
Increase capillary wall permeability in the glomerulus which allows protein to leak through
Why might someone with nephrotic syndrome have an increased risk of infection?
Because immunoglobulin are lost in the urine
Avoid live vaccines and chicken pox
What does C3 complement do in nephrotic syndrome?
It will be normal
Is decreased in some glomerulonephritis
In those with steroid resistant nephrotic syndrome (10%) what is the management?
Renal biopsy
Cyclophosphamide
What is paraphimosis?
Where the foreskin is trapped in retracted position due to swollen glans
What advise can you give for vulvovaginitis?
More frequent bathing
No soap
Loose fitting underwear
What is the physiology behind vesicouriteric reflux?
Ureters are abnormally short and straight where they insert into wall of bladder so they are not properly occluded when bladder contracts
What is the treatment for VUR?
surveillance monitoring
Prophylactic antibiotics
Surgery in 50% if renal function deteriorates or breakthrough infections
When would you do USS in child with a UTI?
If they are under 6 months
Or have atypical UTI
Or recurrent UTI
What is the definition of recurrent UTI in children?
Over 2 upper tract infections
Or over three lower tract
In torsion of the testes how quickly can irreversible infarction occur?
6-12 hours but tortion should be relieved in 4 hours
What is actually twisted in testicular tortion?
The spermatic cord
What age is teaticular tortion more common?
Adolescents
Where is tender in testicular tortion compared to tortion of the hydatid morgagni?
The actual testicle is painful, in hydatid, the pain is more in the upper pole
If there is a blue dot visible on the scrotum when it is transilluminated what is this suggestive of?
Tortion of the hydatid morgagni
IS the cremaster reflex preserved in tortion of the hydatid morgagni?
Yes
How is testicular tortion treated?
Surgically by manually in twisting the testicle and bilateral fixation to tunica vaginalis
Epididmitis and tortion both present with a painful swollen testicle and potential nausea, how do you differentiate?
Prehns sign- when tenderness is relieved by lifting the testicle suggests epididimitis
