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Foundations of Practise > Nephro-urology > Flashcards

Nephro-urology Flashcards

1
Q

Which children with a UTI should be referred urgently to a paediatrician

A
  • <3 months

- Systemically unwell

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2
Q

What is the first line Abx for acute pyelonephritis/Upper UTI in children >3 months

A

cefalexin - remember to always get a culture

co-amoxiclav

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3
Q

What is the first line Abx for cystisis/lower UTI in children >3 months

A

trimethoprim, nitrofurantoin, amoxicillin

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4
Q

What are considered atypical UTI symptoms

A 
Poor urine flow.
Abdominal or bladder mass.
Raised creatinine.
Sepsis.
Failure to respond to treatment with suitable antibiotics within 48 hours.
Infection with non-E. coli organisms
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5
Q

Who should be referred for an US of the urinary tract (infection)

A
  • Any child with atypical symptoms
  • <6 months with recurrent UTI - During infection
  • > 6 months with recurrent UTI - within 6 weeks
  • Everyone <6 months that presented with first UTI that responds to Rx - Within 6 weeks
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6
Q

What is a dimercaptosuccinic acid scintigraphy (DMSA) scan

A

Scan to assess renal morphology, structure and function

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7
Q

Who should have a dimercaptosuccinic acid scintigraphy (DMSA) scan at 4-6 months

A
  • Any atypical UTI <3 years old

- Any child with recurrent UTIs

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8
Q

Who should have an US scan during an acute UTI

A
  • Any child with an atypical UTI

- Children <6months with recurrent UTIs

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9
Q

Who should have an US scan within 6 weeks of a UTI

A

Any child > 6 months with a recurrent UTI

Children <6 months that responds well to Rx

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10
Q

What is a micturating cysto-urethrogram

A

An X ray of the urinary tract that allows us to view the flow of urine in the tract and also how the bladder empties and fills

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11
Q

Who should have a micturating cysto-urethrogram

A

Any child <6 months with atypical or recurrent UTIs

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12
Q

Which children with UTI require follow up with a paediatric nephrologist

A
  • antenatally diagnosed renal abnormality

- Hypertensive children

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13
Q

What is the most common bacteria causing UTI in childre

A

E.coli

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14
Q

When to suspect UTI in an infant <3 months

A

fever
vomiting
lethargy or irritability
poor feeding or failure to thrive.

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15
Q

When to suspect a UTI in an infant >3 months

A 
fever
frequency
dysuria
Abdominal pain
loin tenderness
vomiting
poor feeding
 dysfunctional voiding
changes to continence.
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16
Q

Who should be started on antibiotics for a UTI without a culture and microscopy

A
  • both leukocyte esterase and nitrite are positive on dip

- leukocyte esterase is negative and nitrite is positive - send urine for sample

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17
Q

When should you diagnose acute pyelonephritis/upper UTI

A
  • temp >38 + bacteriuria

- Temp <38 + loin tenderness + bacteriuria

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18
Q

What are the risk factors for UTI in children

A
  • female
  • <12 months
  • previous UTI
  • Voiding dysfunction
  • Vesicoureteral reflux (VUR)
  • Sexual activity
  • No Hx of breastfeeding
  • Immunosupression
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19
Q

What factors can lead to voiding dysfunction

A
  • structural abnormalities
  • neurogenic bladder
  • voluntary withholding of urine (dysfunctional elimination syndrome)
  • chronic constipation
  • indwelling foreign bodies.
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20
Q

What are the possible complications of childhood UTIs

A
  • renal scarring/damage
  • hypertension
  • Bacteriuria and hypertension in pregnancy; pre-eclampsia:
  • Renal insufficiency and failure
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21
Q

What is defined as recurrent UTIs

A
  • 2 or more episodes of upper UTI
  • 1 Upper + 1 lower UTI
  • 3 or more episodes lower UTI
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22
Q

When can you consider prophylactic Abx in children with recurrent UTIs

A

> 3 months with specialist input - need to rule out why and ensure it has been adequately treated

23
Q

What is Henoch-Schönlein purpura (HSP)

A

Systemic small vessel vasculitis involving the blood vessels of the skin, GIT, kidneys and joints

24
Q

What 4 areas of the body are mainly affected by Henoch-Schönlein purpura (HSP)

A

Skin
GIT
Kidneys
Joints

25
Q

What skin symptoms can you expect with Henoch-Schönlein purpura (HSP)

A
  • Affected in all cases
  • A purple-red rash, which does not turn white when pressed.
  • can turn into ulcers
  • backs of the limbs, especially the legs, which can also be swollen
26
Q

What digestive symptoms can you expect with Henoch-Schönlein purpura (HSP)

A

Tummy aches and pains which can be severe and occasionally result in blood in the stool

27
Q

What joint symptoms can you expect with Henoch-Schönlein purpura (HSP)

A

Painful and swollen joints can occur due to inflammation, usually affecting the knees and ankles

28
Q

What kidney symptoms can you expect with Henoch-Schönlein purpura (HSP)

A
  • Protein and blood in the urine due to inflammation in the kidneys.
  • Often this will resolve as the child gets better
  • can be a more serious long-term problem and will need careful monitoring
29
Q

Who is mostly affected by Henoch-Schönlein purpura (HSP)

A

Children age 3-10
Males > females
2/3 have URTI 1-3w prior

30
Q

How would you describe the rash in Henoch-Schönlein purpura (HSP)

A

symmetrical, erythematous macular rash, especially on the back of the legs, buttocks and ulnar side of the arms.

31
Q

What are the criteria for Henoch-Schönlein purpura (HSP)

A

Must be palpable purpura which is not thrombocytopenic/petechia plus one of:

  1. Diffuse abdominal pain.
  2. Typical histopathology
  3. Arthritis or arthralgia.
  4. Renal involvement (demonstrated by quantified proteinuria or haematuria).
32
Q

What is the typical histopathaology of Henoch-Schönlein purpura (HSP)

A

leukocytoclastic vasculitis or proliferative glomerulonephritis with predominant IgA deposits

33
Q

What are differential diagnoses of Henoch-Schönlein purpura (HSP)

A
  • Intussusception
  • Connective tissue diseases - SLE.
  • Other causes of purpuric rash - eg, thrombocytopenia, meningococcal meningitis.
  • IBD
34
Q

What investigations should you do if suspecting Henoch-Schönlein purpura (HSP)

A
  • Urinalysis
  • FBC U&E
  • ESR
  • Serum IgA levels
  • Autoimmune antibody screen
  • ? Abdo US
35
Q

What is the management of Henoch-Schönlein purpura (HSP)

A
  • Usually self limiting

- NSAIDs (caution in renal insufficiency)

36
Q

What is considered secondary bed wetting

A

accidents after having been dry at night without assistance for 6 months

37
Q

What day time symptoms should you enquire about when taking an enuresis history

A

Urgency.
Frequency (more than seven times a day).
Daytime wetting.
Abdominal straining or poor urinary stream.
Pain passing urine.
Passing urine infrequently (fewer than four times a day).

38
Q

Who should you consider doing a urine dip on in children with enuresis

A
  • Bedwetting started in the past few days or weeks.
  • daytime symptoms.
  • signs of ill health.
  • signs of UTI
  • Signs of diabetes mellitus
39
Q

What are the possible underlying cayuse for enuresis

A
  • UTI
  • Diabetes mellitus
  • Maltreatment
  • congenital malformations
  • Chronic constipation
  • Behavioural/emotional problems
40
Q

How to explain bed wetting in children less than 5

A

It occurs because the volume of urine produced at night exceeds the capacity of the bladder to hold it, and the sensation of a full bladder does not wake the child.

41
Q

What advise should you give regarding diet and fluid in children with enuresis

A
  • balanced diet
  • adequate fluid intake
  • avoid caffeinated drinks
42
Q

What advise should you give regarding toileting patterns in children with enuresis?

A
  • encouraged to empty their bladder regularly during the day and before sleep (between 4–7 times in total).
  • waterproof mattress and duvet cover
  • easy access to a toilet and/or potty at night.
  • If toilet trained by day for > 6 months, consider a trial of at least 2 nights in a row without nappies or pull ups
43
Q

What type of positive reward symptoms can be used to help with enuresis

A
  • avoid negative/penalties for wet nights
  • Do no remove positive rewards because of set backs
  • rewards for dry nights
  • rewards for drinking adequate levels of water at night
44
Q

what is the recommended daily intake for children aged 5-8

A

1000–1400 mL

45
Q

what is the recommended daily intake for children aged 9-13

A

1200–2100 mL (girls); 1400–2300 mL (boys).

46
Q

what is the recommended daily intake for children aged >13

A

1400–2500 mL (girls); 2100–3200 mL (boys).

47
Q

In which group of people would desmospressin be an appropriate treatment for

A
  • > 5
  • in need of short term fix - sleepover/school trip
  • ## enuresis alarm not desirable/appropriate
48
Q

Which children with enuresis should be referred to a community paediatrician

A
  • Failed 2 courses of treatment (desmospresson/enuresis alarm)
  • Tricyclic antidepressants (such as imipramine) or antimuscarinics (such as oxybutynin) may be initiated
49
Q

What is first line treatment in the management of enuresis

A

enuresis alarm (>7 YO) - not on NHS unfortunately

50
Q

How to assess response of enuresis alarms

A
  • check response after 4 weeks if improvement continue until 2 weeks of dry nights
  • If no improvement after 4 weeks - stop
  • If not dry after 3 months - consider stopping
  • consider dual Rx with desmopressin
51
Q

What are the aims of treatment with enuresis alarms

A
  • Recognize the need to pass urine.
  • Wake to go to the toilet or hold on.
  • Learn over time to hold on or to wake spontaneously, and stop wetting the bed.
52
Q

How long should a child stay on desmopression

A
  • Check response after 4 weeks
  • if response, continue for 3 months
  • after 3 months, stop for 1 week to check response
53
Q

How does desmopressin work?

A
  • taken at night
  • reduces amount of urine body produces mimicing the bodys own naturally occuring anti-diuretic hormone
  • In most children and young people, levels of ADH rise overnight and reduce the volume of water excreted by the kidneys compared with during the daytime.
54
Q

What advise should be given to parents of children on desmopressin

A
  • reduce fluid intake 1 hour prior to taking desmopressin to sips only and for 8 hours after to reduce risk of overload and hyponatraemia
  • Avoid swalloing pool water
  • Avoid NSAIDs - cause water retention
  • stop if vomiting and diarrhoea

Foundations of Practise (20 decks)

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