Nephrology

Question 1

Raised Cr

Answer 1

Used to assess and monitor renal function
Increase through childhood
Doesn’t become abnormally high until renal function is markedly reduced

Question 2

Raised Urea

Answer 2

Raised in AKI and CKD before Cr
Rises in dehydration, catabolic states, high protein diet, GI bleeding
High urea levels may cause nausea, vomiting and headaches

Question 3

UTI causative organisms in children

Answer 3

E.coli
Proteus
Pseudomonas

Question 4

Predisposing factors for UTI in children

Answer 4

Incomplete bladder emptying
Vesicoureteric reflux
Poor hygiene

Question 5

UTI in infants presentation

Answer 5

Poor feeding
Vomiting
Irritability

Question 6

Presentation in younger children

Answer 6

Abdominal pain
Fever
Dysuria

Question 7

Presentation in older children

Answer 7

Dysuria
Frequency
Haematuria

Question 8

Features which may suggest upper UTI

Answer 8

Temperature >38

Loin pain/ tenderness

Question 9

NICE guidelines for checking urine sample in a child

Answer 9

Symptoms/signs suggestive of UTI
Unexplained fever >38
Alternative site of infection but remain unwell

Question 10

UTI urine collection method

Answer 10

clean catch is preferable
if not possible then urine collection pads should be used
cotton wool balls, gauze and sanitary towels are not suitable
invasive methods such as suprapubic aspiration should only be used if non-invasive methods are not possible

Question 11

UTI management

Answer 11

infants less than 3 months old should be referred immediately to a paediatrician
children aged more than 3 months old with an upper UTI should be considered for admission to hospital. If not admitted oral antibiotics such as cephalosporin or co-amoxiclav should be given for 7-10 days
children aged more than 3 months old with a lower UTI should be treated with oral antibiotics for 3 days according to local guidelines, usually trimethoprim, nitrofurantoin, cephalosporin or amoxicillin. Parents should be asked to bring the children back if they remain unwell after 24-48 hours
antibiotic prophylaxis is not given after the first UTI but should be considered with recurrent UTI

Question 12

Vesicouretetic reflux

Answer 12

Ureters displaced laterally
Entering bladder at a more perpendicular fashion than at an angle
Shortened intramural course of ureter
VUJ cannot function adequately

Question 13

Vesicoureteric reflux presentations

Answer 13

Antenatal: Hydronephrosis
Recurrent childhood UTI
Reflux nephropathy: chronic pyelonephritis secondary to VUR, commonest cause of chronic pyelonephritis, Renal scar may cause increased quantities of renin causing HTN

Question 14

VUR diagnosis

Answer 14

Micturating cystourethrogram

DMSA scan: performed to look for renal scarring

Question 15

Grading of VUR

Answer 15

I: reflux into ureter only, no dilatation
II: reflux into renal pelvis on micturition, no dilatation
III: mild/moderate dilatation of ureter, renal pelvis and calyces
IV: dilation of the renal pelvis and calyces with moderate ureteral tortuosity
V: gross dilatation of the ureter, pelvis and calyces with ureteral tortuosity

Question 16

Causes of microscopic and macroscopic haematuria

Answer 16

UTI
Irritation to meatus or perineum 
Adenovirus haemorrhagic cystitis 
Wilms tumour
Nephrolithiasis 
Glomerulonephritis: post-infectious, HSP GN, membranoproliferative GN
IgA nephropathy
Focal segmental glomerulosclerosis 
Alport syndrome
Sickle cell disease
Clotting abnormalities
Trauma
Exercise
Haemolytic uraemia s syndrome

Question 17

Microscopic haematuria only

Answer 17

Thin basement membrane disease
Structural abnormalities, e.g. horseshoe kidney
Hypercalciuria
Drug or toxin ingestion