kidney + urinary tracts Flashcards
what is potters sequence
Renal agenesis - oligohydramnios - death by compression
Also get resp failure due to lung hypoplasia
What is the risk of multicystic dysplastic kidney
If both then potters
Shrivel up aged 2, if large can cause HTN
What’s horseshoe kidney
Kidneys fuse
What does duplex system cause
Obstruction
What can post urethral valve lead to in males
Bilateral hydronephrosis
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
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
When to test urine
fever >38
signs of UTI
another site of infection
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
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
What are symptoms of pyelo
Fever >38 and bacteriuria
OR
loin pain and bacteriuria
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)
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
Ix for primary eneuresis
MC+S
renal US
urodynamic studies
Causes of secondary eneuresis
emotional upset
UTI
Osmotic diuresis (DM, DI, CKD)
Ix for secondary eneuresis
urine dip
assess urine concentrating ability (early morning concentration)
US
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
mx for primary bedwetting with daytime symptoms
refer to clinic
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
