kidney + urinary tracts Flashcards

1
Q

what is potters sequence

A

Renal agenesis - oligohydramnios - death by compression

Also get resp failure due to lung hypoplasia

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2
Q

What is the risk of multicystic dysplastic kidney

A

If both then potters

Shrivel up aged 2, if large can cause HTN

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3
Q

What’s horseshoe kidney

A

Kidneys fuse

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4
Q

What does duplex system cause

A

Obstruction

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5
Q

What can post urethral valve lead to in males

A

Bilateral hydronephrosis

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6
Q

Infecting organisms in UTI

A

E.coli
Klebsiella
Proteus (more in boys, predispose to formation of phosphate stones)
Pseudomonas (more common w/ structural abnormalities)
strep faecalis

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7
Q

Host factors that can predispose to UTI

A

infrequent bladder emptying
incomplete bladder emptying (leaving residual urine)
vulvitis
vesicoureteric reflux (can progress into hydronephrosis and kidney damage)
obstruction by loaded rectum

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8
Q

When to test urine

A

fever >38
signs of UTI
another site of infection

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9
Q

when to send urine for culture

A

UTI and <3 months
if kid gets recurrent UTI
non-responsive to initial treatment
if leucocyte esterase or nitrites positive

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10
Q

Urine dip interpretation

A

LE + nitrites + - probably UTI start Abx
Leucocyte esterase - nitrites + –> start Abx if there’s clinical evidence - culture urine
Leucocyte esterase + nitrites - –> don’t start Abx unless clinical evidence - culture urine
both negative - repeat test, unlikely to be UTI

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11
Q

What are symptoms of pyelo

A

Fever >38 and bacteriuria
OR
loin pain and bacteriuria

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12
Q

Mx of UTI

A

<6 weeks -
IV Abx (cefotaxime)
sepsis screen, admit to hospital
can go onto oral if blood +CSF normal and responding

6 weeks - 2 years
if stable oral co-amoxiclav (7-10d)
if unstable IV Abx - ampicillin and gent

2 years - 13 years
if stable oral (7-10d)
if unstable IV Abx

> 13
if stable oral (3d)
if unstable IV ampicillin and gent

recurrent UTIs
MCUG
DMSA (3 months after UTI)

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13
Q

Causes of Daytime eneuresis

A

don’t pay attention to urge (developmental delay)
detrusor instability
bladder neck weakness
Neuropathic bladder (associated with spina bifida - fills and then doesn’t empty properly)
UTI
Constipation
ectopic ureter

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14
Q

Ix for primary eneuresis

A

MC+S
renal US
urodynamic studies

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15
Q

Causes of secondary eneuresis

A

emotional upset
UTI
Osmotic diuresis (DM, DI, CKD)

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16
Q

Ix for secondary eneuresis

A

urine dip
assess urine concentrating ability (early morning concentration)
US

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17
Q

Mx of primary bedwetting without daytime symptoms

A
primary bedwetting without daytime symptoms
if <5: 
reassure that it's normal
ensure easy access to toilet
reward system 
encourage bladder emptying before bed

if >5 and infrequent (<2 times per week):
watch and wait
positive reward system

if tx needed:
1st line: eneuresis alarm w/ positive reward
2nd line: desmopression (fluid restrict 1 hour before and 8 hours after) + may need drugs for overactive bladder

If it hasn’t responded to 2 courses of treatment refer

Give desmo for short term

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18
Q

mx for primary bedwetting with daytime symptoms

A

refer to clinic

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19
Q

mx for secondary bedwetting

A

If UTI or constipation manage in hospital

Other causes need referral (DM, recurrent UTI etc.)

20
Q

How to assess proteinuria

A

Check protein:Cr in early morning urine

21
Q

Causes of proteinuria

A
orthostatic proteinuria
glomerular problems - minimal change, glomerulonephritis
HTN 
increased GFR
Ca
22
Q

Symptoms of nephrotic syndrome

A
Periorbital oedema (1st thing in morning)
scrotal swelling
ascites
infections (lose Ig in urine)
increased risk of DVT
23
Q

What is nephrotic syndrome associated with

24
Q

Features of steroid sensitive nephrotic syndrome

A

1-10 years
No haematuria
normal BP, complement and renal function

25
mx for nephrotic syndrome
Oral steroids for 4 weeks then wean off fluid and salt restrict may need albumin or furosemide If no response after this do renal biopsy
26
Complications of nephrotic syndrome
Hypovolaemia clots lose antithrombin III and increase clotting factor synthesis in liver hyperlipidaemia infectin (especially capsulated organisms)
27
Causes of haematuria
Glomerular - acute and chronic glomerulonephritis (accompanying proteinuria) IgA nephropathy Familial nephritis (Alport's) ``` Non-glomerular - Infection Stones genital trauma sickle cell disease Ca ```
28
Ix to confirm glomerular haematuria
ESR, complement, anti-dsDNA Ab anti-streptolysin + throat swab mother's urine if Alport's suspected
29
Causes of acute glomerulonephritis
Post-infection (strep) Vasculitis (hsp, wegener's, sle) IgA nephropathy goodpasture's
30
Features of henoch-schonlein purpura
``` Symmetrical purpuric rash on extensor surfaces that spares trunk Polyarthralgia (ankles and knees) abdo pain glomerulonephritis periarticular oedema ``` OFTEN PRECEDED BY URTI
31
Mx HSP
Most cases resolve spontaneously in 4 weeks Manage joint pain with painkillers oral pred if scrotal involvement IV corticosteroids if heavy proteinuria and/or declining renal function
32
Features of IgA nephropathy
Macroscopic haematuria | often preceded by URTI
33
What is Alport's linked with
X-linked recessive renal failure sensorineuronal deafness ocular defects
34
Diagnostic feature of vasculitides
p-ANCA
35
What are present in SLE
anti-dsDNA | also have low C3+4 in active disease
36
Causes of renal mass
Unilateral multicystic kidney tumour obstructive hydronephrosis Bilateral PCKD renal vein thrombosis
37
Causes of calcium stones
Hypercalciuria hyperoxaluria distal renal tubular acidosis
38
Mx of renal stones
IV fluids, morphine, antiemetics Abx if bacterial infection If small it passes on its own (or can give tamsulosin to help) If large - ESWL
39
Causes of AKI
Pre-renal - hypovolaemia, circulatory failure Renal - Vascular - HUS, vasculitis glomerular - glomerulonephrits Tubular - acute tubular necorsis, ischaemia, TOXINS interstitial - pyelonephritis Post-renal- obstruction - congenital (post-urethral valve) acquired - blocked catheter
40
mx of AKI
``` STOP AKI Sepsis - sepsis screen Toxins - look for NSAIDs, aminoglycosides Optimise - BP and volume status prevent harm ``` consider referral for transplant if any of following are unresponive to tx Hyperkalaemia pulmonary oedema acidosis uraemia (pericarditis and encephalopathy)
41
Mx of pre renal AKI
replace lost fluid
42
mx of renal AKI
tx cause monitor fluid and electrolytes high calorie normal protein feed to decrease catabolism and reverse uraemia and hyperkalaemia
43
Mx post renal AKI
reverse obstruction
44
When is dialysis indicated
``` Tx failure severe hyperkalaemia severe hypo/hypernatremia pulmonary oedema acidosis multisystem failure ```
45
What is the HUS triad
acute renal failure thrombocytopenia MAHA
46
What is the difference between DIC and HUS
Clotting is normal in HUS, not in DIC
47
Mx of CKD
stage 1-4 give ACEi/ARB first line, CCB 2nd line stage 5 - dialysis encourage calorific diet w/ high protein as you lose albumin in urine ``` Watch out for anaemia secondary hypoparathyroidism (due to low vit d - at risk of osteitis fibrosa cystica) metabolic acidosis hormonal abnormalities ```