GU Flashcards
corrected GFR in a kid
15-20ml/min/1.73m^3
GFR in 1-2 yo, same as adult
80-120ml/min/1.73m^3
Age of multi cystic dysplastic kidneys
2 years old
Prune Belly Syndrome
= absence/lack of musculature of anterior abdo wall
Prune Belly syndrome a/w
MEGAcystitis
MEGAureters
cryptochric
sites of obstruction to urine flow
- peliureteric junction
- bladder neck
- posterior urethral valves
renal dysplasia a/w
SEVERE VUR in isolation or apart of rare genetic syndromes
antenatal or postnatal treatment of congenital kidney anomalies?
POSTNATAL
since antenatal: intrauterine bladder drainage procedures (NOT VERY GOOD)
postnatal treatment of congenital kidney anomalies- bilateral hydro
48hrs after birth- US
posterior urethral valves?
Y-MCUG-Sx: cystooscopic ablation
N-stop antibiotics and repeat US 2-3 months
postnatal treatment of congenital kidney anomalies- unilateral hydro
4-6weeks after birth- US
any anomaly?
Y-further investigations
N-stop antibiotics and repeat US 2-3 months
NB rf’s UTI’s
Hydration? Completely empty bladder? Holds onto urine? Constipation? Neuro problems? Born with congenital urinary abnormalities? Frequent infections?
infant UTI don’t forget
Jaundice
Febrile convulsions
child UTI don’t forget
Rigors/ febrile convulsions
Recurrence of enuresis
NB urine questions
Pain Frequency Smell Stones Colour Cloudy Tea coloured Red Frank dipstick
Dx UTI
- urine collection/ MSU
- C+S: 10^5 colony/ml
- dipstick
- nitrites
- leukocyte esterase - US
ULTRASOUND/ Imaging UTI
3 yo= US
Tx UTI
IV cefotaxime
Tx UTI >3 months + acute pyeloneph
bacteriuria + fever+ >38
bacteriuria + loin pain +
Tx cystitis/lower UTI
oral antibiotics 3 days
Prevention UTI’s
- hydration
- voiding
- constipation
- hygeiene
- acidophilus
Abx prophylaxis UTI’s
trimethoprim OR
nitrofurantoin OR
cephalexin
age definition of daytime enuresis
should be continent– >3-5yo
DDx daytime enuresis
neuro
- psychogenic
- developmental
- neuropathic bladder
kidney
- detrusor instability
- UTI
- ectopic ureter
CONSTIPATION
DDx secondary onset enuresis
EMOTIONAL UTI POLYURIA - DM - DI - sickle cell - CRF
two types of proteinuria
transient
persistent
transient proteinuria
- febrile illness
- post- exercise
persistent proteinuria
urine protein: creatinine
DDx proteinuria
- orthostatic hypoTN
- glomerular
- increase glomerular filtration pressure
- reduced renal mass
- HTN
- tubular proteinuria
NB investigations for nephrotic syndrome
- Complement: c3,4
- ASOT, DNAse B, throat swab
- urine [Na]
- hep B and C screen
- malaria
1/3 rule steroids
1/3 responsive
1/3 infrequent relapses
1/3 frequent relapses= resistant
nephrotic syndrome
- steroid responsive= MCD
- steroid unresponsive= FSGS, membranoprolif, membranous nephropathy
- congenital
epidemiology congenital nephrotic syndrome
Finnish
consanguinity
PC: 3 months
epi MCD
asian boys 1-10years old
a/w ATOPY
TRIAD HSP
Purpura
arthritis
abdo pain
PC HTN kids
FACIAL PALSY headache HTN retinopathy vomiting proteinuria
PC HTN infants
FTT + HF
DDx unilateral renal mass
5
- MCDK
- Compensatory hypertrophy
- obstructive hydronephrosis
- renal tumor
- renal vein thrombosis
DDx bilateral renal mass
4
- ARPCK
- ADPCKD
- TUBEROUS SCLEROSIS
- renal vein thrombosis
Side effect of furosemide in neonate
NEPHROCALCINOSIS
causes of fanconi syndrome
- idiopathic
- secondary to IEM
- acquired:
- drugs/ toxins
- heavy metals
- vit D deficiency
IEM–> fanconi syndrome
WTF.G.? LC. G. Wilsons Tyrosinaemia Fructose intolerance Galactosemia Lowe syndrome Cystinosis Glycogen storage disorder
Lowe Syndrome
= oculocerebrorenal syndrome
PC fanconi syndrome
- dehydration
- polyuria/ polydipsia
- rickets/ FTT
- hyperchloraemic met. acidosis
Definition AKI
Dx AKI
- Fluid and circulation status
2. Ultrasound–> obstruction
Tx pre-renal AKI
- circulatory and fluid support
Tx renal AKI
- fluid restriction
- diuretics
- high calorie diet, normal protein, uraemia, hyperK
- biopsy: GN–> immunosuppression
Tx post-renal AKI
RELIEVE OBSTRUCTION
- nephrostomy
- bladder catheterisation
- surgery after corrected electrolytes
Tx metabolic acidosis
bicarbonate
Tx hyperiP
- calcium carbonate
- dietary restriction
Tx hyperK
- calcium gluconate– if ECG change
- Ca resins
- glucose/ insulin
- salbutamol– neb or IV
- dietary restrictions
- dialysis
DIALYSIS indications
- failed conservative tx
- failure multiorgam
- hyperK
- hypo/hyperNa
- pulmonary edema or HTN
- severe acidosis
PC chronic renal failure
EXACT SAME AS ADULTS
Tx chronic renal failure
- diet- NG/gastrotomy– want the protein without XS NH3
- phosphate restriction and active vit D– less milk products and calcium carbonate
- salt supplements + water + bicarb
- EPO
- GH
- transplant
- dialysis
R or L inguinal hernias more common
RIGHT
palpable cryptorchid
can palpate in groin, but cannot manipulate into scrotum
= ECTOPIC
- perineum
- femoral triangle
Sx of hydrocele
> 18-24 months
Dx cryptorchid
- US– check if other pelvic organs present
- Hormonal: IM hCG
- Lapro- BEST for impalpable esp– check inguinal canal
Tx for cryptochid
- orchiopexy (infertility, malignancy, cosmesis)
- orchiectomy: if older and very high up, or intra-abdominal
Tx varicocele
OBLITERATE VEINS:
- radiao embolisation
- conventional surgery
- laproscopic
Age of testicular torsion
adolescent, or ANY age
Age of testicular appendage
PRE-puberty
Age of epididymitis, epididymorchitis
infant/toddler– a/w UTI
Age of idiopathic scrotal oedema
PRE-schooler
scrotal pain increasing over 1-2 days
torsion of testicular appendage
blue dot sign
torsion of testicular appendage (tender nodule felt)
Diagnosis of testicular torsion
CLINICAL
- lapro exploration
- US doppler US – testicular blood vessels
Ddx acute scrotum
- testicular torsion
- torsion hydatid morgagni
- epididmyitis
- epididmyorchitis
- idiopathic scrotal edema
- incarcerated inguinal hernia
3 features of hypospadias
ventral meatus
ventral– hooded dorsal foreskin
ventral chordee
sx of hypospadias age
before 2 years old
paraphimosis
foreskin trapped in retracted posiiton proximal to swelling
tx paraphimosis
no need to circumcise– REDUCE WITH ANALGESIA
indications for circumcision
- phimosis
Alternatives to circumcision
- preputioplasty
2. topical steroids
treatment of labial adhesions
- topical oestrogen cream 2 X a week for 1-2 weeks
2. anaesthesia– separate adhesions
treatment of vulvovaginitis
antibiotics– swab
oestrogen cream– sparingly used on vulva
ADVISE:
- no bubble baths
- loose fitting underwear
- salt baths