Nephrology Flashcards
when should pyelonephritis be suspected
unexplained fever of 38°C or more, or loin pain/tenderness
investigation for UTI
urine dipstick - ideal is clean catch to avoid contamination
atypical UTI presentation in children
poor urine flow
abdominal or bladder mass
raised creatinine
sepsis
failure to respond to treatment within 48hrs
infection with non-e.coli organisms
criteria for USS for UTI
atypical infection
recurrent UTI
first time UTI for children under 6months
UTI clinical presentation
dysuria
increased frequency
increased bedwetting
foul smelling urine
darker/ cloudy urine
haematuria
abdo pain
loin/ suprapubic tenderness
what is testicular torsion
twisting of the spermatic cord with rotation of the testicle
urological emergency
examination findings of testicles in testicular torsion
firm swollen testicle
retracted testicle
absent cremasteric reflex
abnormal testicular lie
rotation
USS result showing positive testicular torsion
whirpool sign
management of testicular torsion
analgesia
orchiopexy
orchidectomy if surgery is delayed or there is necrosis
clinical presentation of testicular torsion
unilateral testicular pain
abdominal pain
vomiting
risks of undescended testes
higher risk of testicular torsion, infertility, testicular cancer
management for undescended testes
watch and wait in newborns - should descend in first 3-6months
if not by 6months - paeds urologist
orchidopexy carried out between 6-12months
what is nocturnal enuresis
involuntary bedwetting in the night
over the age of 5
risk factors of nocturnal enuresis
fh
m
psychological and behavioural disorders
causes of nocturnal enuresis
UTI
polyuria e.g. dm
bladder dysfunction e.g. overactive bladder
sleep arousal difficulties e.g. inability to wake to noise, sensation of full bladder
management for nocturnal enuresis without daytime symptoms
explain it is not the child’s fault
toilet patterns e.g. encouraged to empty bladder regularly during the day and before sleep
positive reward systems who have dry nights
management for children aged 5yrs or older who have not responded to conservative/ lifestyle management for nocturnal enuresis
alarm or desmopressin
management of primary bedwetting with daytime symptoms
refer to secondary care or enuresis clinic
what is hypospadias
congenital condition where the urethral tabularisation is abnormally displaced on the ventral (underside ) of the penis
classification of hypospadias
glanular (may be solely cosmetic)
midshaft
penoscrotal (most severe - can cause genitourinary problems)
what conditions is hypospadias associated with
chordee
inguinal hernia
cryptorchidism
psychological problems
management of hypospadias and aims
surgery before 2yrs of age
aims
- terminal urethral meatus so they can micturate in normal standing position
- straight erection
- normal looking penis
what is phimosis
inability to retract the foreskin
this is normal before the age of 2
cause of phimosis
balantis xerotica obliterans
causes inflammation and lesions (dry white thickened plaques)
as a result foreskin adheres to glans and pulling it back is painful and difficult
clinical presentation of normal phimosis
end of penis may balloon when passing urine
recurrent UTI
clinical presentation of abnormal phimosis
haematuria
painful erections
pain
weak urine stream
recurrent UTI
management for phimosis
steroid creams or gels
personal hygiene
surgery or circumcision for persisting abnormal phimosis
