kidney + urinary tracts Flashcards by Guglielmo Vecchio

what is potters sequence

Renal agenesis - oligohydramnios - death by compression

Also get resp failure due to lung hypoplasia

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What is the risk of multicystic dysplastic kidney

If both then potters

Shrivel up aged 2, if large can cause HTN

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What’s horseshoe kidney

Kidneys fuse

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What does duplex system cause

Obstruction

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What can post urethral valve lead to in males

Bilateral hydronephrosis

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Infecting organisms in UTI

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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Host factors that can predispose to UTI

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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When to test urine

fever >38
signs of UTI
another site of infection

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when to send urine for culture

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

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Urine dip interpretation

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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What are symptoms of pyelo

Fever >38 and bacteriuria
OR
loin pain and bacteriuria

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Mx of UTI

<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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Causes of Daytime eneuresis

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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Ix for primary eneuresis

MC+S
renal US
urodynamic studies

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Causes of secondary eneuresis

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

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Ix for secondary eneuresis

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

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Mx of primary bedwetting without daytime symptoms

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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mx for primary bedwetting with daytime symptoms

refer to clinic

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mx for secondary bedwetting

If UTI or constipation manage in hospital

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

How to assess proteinuria

Check protein:Cr in early morning urine

Causes of proteinuria

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

Symptoms of nephrotic syndrome

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

What is nephrotic syndrome associated with

ATOPY

Features of steroid sensitive nephrotic syndrome

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

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

Complications of nephrotic syndrome

Hypovolaemia clots lose antithrombin III and increase clotting factor synthesis in liver hyperlipidaemia infectin (especially capsulated organisms)

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 ```

Ix to confirm glomerular haematuria

ESR, complement, anti-dsDNA Ab anti-streptolysin + throat swab mother's urine if Alport's suspected

Causes of acute glomerulonephritis

Post-infection (strep) Vasculitis (hsp, wegener's, sle) IgA nephropathy goodpasture's

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

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

Features of IgA nephropathy

Macroscopic haematuria | often preceded by URTI

What is Alport's linked with

X-linked recessive renal failure sensorineuronal deafness ocular defects

Diagnostic feature of vasculitides

p-ANCA

What are present in SLE

anti-dsDNA | also have low C3+4 in active disease

Causes of renal mass

Unilateral multicystic kidney tumour obstructive hydronephrosis Bilateral PCKD renal vein thrombosis

Causes of calcium stones

Hypercalciuria hyperoxaluria distal renal tubular acidosis

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

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

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)

Mx of pre renal AKI

replace lost fluid

mx of renal AKI

tx cause monitor fluid and electrolytes high calorie normal protein feed to decrease catabolism and reverse uraemia and hyperkalaemia

Mx post renal AKI

reverse obstruction

When is dialysis indicated

``` Tx failure severe hyperkalaemia severe hypo/hypernatremia pulmonary oedema acidosis multisystem failure ```

What is the HUS triad

acute renal failure thrombocytopenia MAHA

What is the difference between DIC and HUS

Clotting is normal in HUS, not in DIC

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 ```