Incontinence, haematuria and proteinuria Flashcards
When are children usually dry in the day time by?
3 years
When are children usually dry at night?
5-6 years
What is the difference between primary and secondary incontinence
Primary - never been dry
Secondary - incontinence after > 6 months dry
What are the causes of secondary enuresis (incontinence)
UTI, diabetes, pelvic mass (tumour, constipation), renal failure, psychological/abuse
Why might you perform a urine dip for a child with enuresis
To exclude infection and DM
Why might you perform early morning urine osmolality in a child with enuresis
To exclude diabetes insipidus
Threshold for DI is <300
Why might you perform a renal USS in a child with enuresis
To assess anatomy and bladder emptying
Look for any masses
What lifestyle changes should be encouraged in a child with enuresis
Regular toileting, avoiding fizzy drinks, avoiding bedtime drinks
How might you aid a child who has night time wetting
Using a buzzer alarm to wake them up at intervals during the night
Why is desmopressin useful in enuresis
useful in short term use to concentrate urine and reduce volume produced. Good for school trips, sleepovers etc.
When can proteinuria be normal?
In fever or if very active
What are the pathological causes of proteinuria
Nephrotic syndrome, nephritis, renal failure
What triad defines nephrotic syndrome
Heavy proteinuria, hypoalbuminaemia and oedema
Where does oedema usually affect in nephrotic syndrome
Ascities, pulmonary, peripheral
WHat are the acute complications of nephrotic syndrome
Hypovolaemia
Infection
Thrombosis
How is nephrotic syndrome managed
Six week course of high dose steroid
Most respond
What is the prognosis in nephrotic syndrome
Steroid sensitive - may relapse but good long term prognosis
If not steroid sensitive - worse prognosis, many progress to ESRF
What is the difference between macroscopic and microscopic haematuria
Macroscopic haematuria turns the urine red whilst microscopic haematuria is only detected by dip stick
What are the causes of haematuria
Trauma UTI Bleeding problem Renal tumour Nephritis Some food can make urine appear red
What is nephritis
Intrinsic kidney inflammation causing haematuria and proteinuria
Causes of nephritis
Post streptococcal
Hnoch Schoenlien purpura
SLE
IgA nephropathy
How does Hnoch Schoenlien purpura present?
Widespread purpuric rash
Nephritis, renal failure, joints affected
What is the initial management of nephritis
Supportive management: Haematuria Oedema Hypertension Monitor for renal failure
If a child with nephritis is worsening, what investigation might you do?
Blood tests and imaging
May require renal biopsy
