Kidneys Flashcards
What is Potter’s syndrome?
A result of renal agenesis causing oligohydramnios
Features: Facies: • Low-set ears • Beaked nose • Downward slanted eyes Pulmonary hypoplasia Limb deformity
What are the features of UTI in an infant?
Fever Jaundice Poor feeding Febrile convulsions Vomiting Offensive urine
What are the features of UTI in a child?
Frequency Dysuria Urgency Abdominal pain D&V Haematuria Febrile convulsions Enuresis
What is vesicoureteric reflux and why is it important?
The ureters are displaced laterally and enter directly into the bladder, rather than an angle.
This can lead to backflow of urine from the bladder, back into the ureters
This is problematic because:
1) After voiding, the urine in the ureter will return to the bladder, leading to incomplete bladder emptying
2) If the child has a UTI, the infected urine may backflow to the kidney, leading to kidney damage and scarring
How is vesicoureteric reflux investigated?
Initial ultrasound to identify potential obstruction or renal defects Micturating cystourethrogram (MCUG) is best investigation
What are features of atypical UTIs?
Sepsis Crap urine flow Abdominal mass Raised creatinine Repeated UTI Failure of Abx
What are the investigations for UTI?
Urine dipstick if clinical suspicion
Urine culture if:
• Urine dipstick is leukocyte esterase or nitrite positive
○ If Nitrite +ve and leukocyte -ve, don’t start antibiotics unless there is good clinical evidence
• Child is <3 months
• Suspected upper UTI
• Risk of serious infection
• Recurrent infection
What is the management of UTI in infants <3 months?
REFERRAL TO HOSPITAL
IV Antibiotics (Co-amoxiclav) for 5-7 days
Followed by oral prophylaxis
What is the management of UTI in children >3 months?
If suspected upper UTI (Fever or loin pain):
Trimethoprim (PO) for 7 days
If suspected lower UTI:
Trimethoprim (PO) for 3 days
What are the investigations for atypical UTIs?
- Ultrasound of the urinary tract to identify structural abnormalities
- DMSA and MCUG may also be performed in children < 6 months presenting
What is daytime enuresis?
This is lack of bladder control during the day in a child old enough to be continent (over the age of 3-5). Daytime enuresis may also be accompanied by nocturnal enuresis.
What are the causes of daytime enuresis?
Causes include:
- Lack of attention to the bladder.
- Detrusor instability - Sudden bladder contractions leading to feeling of urgency and enuresis.
- Neuropathic bladder - Enlarged bladder that fails to empty properly. Associated with spina bifida and other neurologic problems. There may be abnormal perianal sensation and anal tone, abnormal leg reflexes and gait.
- UTI (rarely in the absence of other symptoms)
- Constipation
- Ectopic ureter - Causes constant dribbling, and the child is always damp. Girls may be dry all night, but wet themselves when waking due to pooling of the urine in the vagina, secondary to ectopic ureter.
How should daytime enuresis be investigated?
A urine sample should be examined for MC&S. Perform an examination to exclude neurologic causes.
Further investigations may be indicated, including urodynamic studies, ultrasound of bladder, X-ray of spine or MRI.
What is the management of daytime enuresis?
○ Children in whom a neurological cause has been excluded, may benefit from:
§ Star charts
§ Bladder training
§ Pelvic floor exercises
○ Anticholinergic drugs (e.g. oxybutynin), which reduces bladder contractions, may be useful
What is the most common cause of secondary enuresis?
Loss of previously attained bladder control
Most common cause is emotional upset
Other causes include UTI and polyuria from diabetes
