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paeds > kidney + urinary tracts > Flashcards

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

A

ATOPY

24
Q

Features of steroid sensitive nephrotic syndrome

A

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

25
Q

mx for nephrotic syndrome

A

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
Q

Complications of nephrotic syndrome

A

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

27
Q

Causes of haematuria

A

Glomerular -
acute and chronic glomerulonephritis (accompanying proteinuria)
IgA nephropathy
Familial nephritis (Alport’s)

Non-glomerular - 
Infection 
Stones
genital trauma
sickle cell disease
Ca
28
Q

Ix to confirm glomerular haematuria

A

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

29
Q

Causes of acute glomerulonephritis

A

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

30
Q

Features of henoch-schonlein purpura

A 
Symmetrical purpuric rash on extensor surfaces that spares trunk 
Polyarthralgia (ankles and knees)
abdo pain 
glomerulonephritis
periarticular oedema

OFTEN PRECEDED BY URTI

31
Q

Mx HSP

A

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
Q

Features of IgA nephropathy

A

Macroscopic haematuria

often preceded by URTI

33
Q

What is Alport’s linked with

A

X-linked recessive
renal failure
sensorineuronal deafness
ocular defects

34
Q

Diagnostic feature of vasculitides

A

p-ANCA

35
Q

What are present in SLE

A

anti-dsDNA

also have low C3+4 in active disease

36
Q

Causes of renal mass

A

Unilateral
multicystic kidney
tumour
obstructive hydronephrosis

Bilateral
PCKD
renal vein thrombosis

37
Q

Causes of calcium stones

A

Hypercalciuria
hyperoxaluria
distal renal tubular acidosis

38
Q

Mx of renal stones

A

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
Q

Causes of AKI

A

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
Q

mx of AKI

A 
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
Q

Mx of pre renal AKI

A

replace lost fluid

42
Q

mx of renal AKI

A

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

43
Q

Mx post renal AKI

A

reverse obstruction

44
Q

When is dialysis indicated

A 
Tx failure
severe hyperkalaemia
severe hypo/hypernatremia
pulmonary oedema
acidosis
multisystem failure
45
Q

What is the HUS triad

A

acute renal failure
thrombocytopenia
MAHA

46
Q

What is the difference between DIC and HUS

A

Clotting is normal in HUS, not in DIC

47
Q

Mx of CKD

A

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

paeds (19 decks)

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