Nephrology

Question 1

what are common causes of UTIs in the paediatric population ? 5

Answer 1

E coli
proteus
pseudomonas
klebisella
enterococcus

Question 2

….. (organism) is associated with UTIs in paediatric patients who have renal tract abnormalities

Answer 2

pseudomonas

Question 3

what bacteria that causes UTIs predisposes to stone formation ?

Answer 3

proteus

Question 4

most UTIs in children occur due to … (route of transmission)

Answer 4

ascending bowel flora

Question 5

presentation of UTIs in infants?

Answer 5

1. fever
2. vomitting
3. lethargy
4. poor feeding
5. septicemia
6. febrile seizures

Question 6

presentation of UTIs in children?

Answer 6

1. more localized symptoms (dysuria, frequency, urgency)
2. abdominal pain
3. fever
4. septicaemia and febrile seizures

Question 7

diagnosis of UTI?

Answer 7

1. urinalysis: elevated leukocytes (leukocyte esterase), nitrites
2. urinary microscopy, cultures and sensitivity

Question 8

in a child < …. with a UTI it is important to investigate them with … and ….

Answer 8

1. MCUG (micturating cystourethrogram) - for evidence of vesicoureteral reflux
2. DMSA scan for evidence of kidney scarring

Question 9

management of UTIs (<2 months and > 2 months old)?

Answer 9

< 2 months old: IV amoxicillin + IV gentamicin + IV cefotaxime
> 2 months old: if systemically unwell IV co-amoxiclav + IV gentamicin, if systemically well PO co-amoxiclav

Question 10

preventive measures for UTIs in paediatric population ?

Answer 10

1. high fluid intake
2. regular complete voiding
3. good perineal hygiene
4. treatment of constipation (pressure on bladder and prone to urinary retention)

Question 11

nephrotic syndrome is characterized by a traid?

Answer 11

proteinuria
hypoalbuminema
edema

Question 12

most cases of nephrotic syndrome in the paediatric population are caused by …. disease

Answer 12

minimal change disease

Question 13

other causes of nephrotic syndrome in paediatrics besides minimal change disease?

Answer 13

congenital nephrotic syndrome

Question 14

nephrotic syndromes causes the loss of …. and …. in the urine predisposing a child to … and …

Answer 14

immunoglobulins – predispose to infection
anti-thrombin 3 - hyper coagulable state

Question 15

presentation of nephrotic syndrome ?

Answer 15

1. signs of edema (puffy eyes and ankles, dyspnea, abdominal distension and ascites)
2. normal BP and and no hematuria
3. may rarely present with infections or thromboembolism due to protein loss

Question 16

diagnosis of nephrotic syndrome? other investigations?

Answer 16

1. FBC: infections and hematocrit
2. U and E: for renal function
3. LFT: for low albumin
4. urinary dipstick: for proteinuria

Question 17

the cause of nephrotic syndrome can be assumed to be minimal change disease if : (3)

Answer 17

age 1-12 years
normal complement levels
no hypertension, no gross hematuria, or high creatinine (which would suggest nephritic syndrome)

Question 18

management of nephrotic syndrome (minimal change)

Answer 18

IV fluid and albumin (intravascular volume depletion)
prednisolone for 6 weeks; if non responsive, consider renal biopsy to identify other causes

Question 19

wilms tumour is also known as ?

Answer 19

nephroblastoma

Question 20

…. is the most common renal malignancy in children,

Answer 20

wilms tumour (nephroblastoma)

Question 21

most cases of wilms tumour occur in children < … years old

Answer 21

5

Question 22

Wilms tumour is associated with … syndrome

Answer 22

WAGR (Wilms, aniridia, GU anomalies, and retardation)

Question 23

presentation of Wilms tumour?

Answer 23

1. abdominal mass and hematuria

Question 24

any abdominal mass in children should be considered … until proven otherwise

Answer 24

Wilms tumour

Question 25

diagnosis of Wilms tumour?

Answer 25

1. abdominal ultrasound to identify mass, followed by CT/MRI 2. definitive diagnosis biopsy and histological assessment 3. chest x-ray for metastases

Question 26

neuroblastoma is a malignant tumour originating from .... cells of the ... chain.... occurring mostly in children < .... years old

Answer 26

neural crest sympathetic

Question 27

presentation of neuroblastoma?

Answer 27

1. localizing symptoms depending on location 2. abdominal mass 3. systemic features: weight loss, fever, fatigue 4. paraneoplastic/metastatic complications

Question 28

diagnosis of neuroblastoma?

Answer 28

1. elevated serum and urinary catecholamines HVA and VMA 2. ultrasound and biopsy 3. staging: CT/MRI and I123-MIBG scan (for bone metastases)

Question 29

what markers are used to monitor response to treatment in a patient with neuroblastoma?

Answer 29

urinary and serum catecholamines (VMA, HVA)