Nephrology Flashcards
what are common causes of UTIs in the paediatric population ? 5
E coli
proteus
pseudomonas
klebisella
enterococcus
….. (organism) is associated with UTIs in paediatric patients who have renal tract abnormalities
pseudomonas
what bacteria that causes UTIs predisposes to stone formation ?
proteus
most UTIs in children occur due to … (route of transmission)
ascending bowel flora
presentation of UTIs in infants?
- fever
- vomitting
- lethargy
- poor feeding
- septicemia
- febrile seizures
presentation of UTIs in children?
- more localized symptoms (dysuria, frequency, urgency)
- abdominal pain
- fever
- septicaemia and febrile seizures
diagnosis of UTI?
- urinalysis: elevated leukocytes (leukocyte esterase), nitrites
- urinary microscopy, cultures and sensitivity
in a child < …. with a UTI it is important to investigate them with … and ….
- MCUG (micturating cystourethrogram) - for evidence of vesicoureteral reflux
- DMSA scan for evidence of kidney scarring
management of UTIs (<2 months and > 2 months old)?
< 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
preventive measures for UTIs in paediatric population ?
- high fluid intake
- regular complete voiding
- good perineal hygiene
- treatment of constipation (pressure on bladder and prone to urinary retention)
nephrotic syndrome is characterized by a traid?
proteinuria
hypoalbuminema
edema
most cases of nephrotic syndrome in the paediatric population are caused by …. disease
minimal change disease
other causes of nephrotic syndrome in paediatrics besides minimal change disease?
congenital nephrotic syndrome
nephrotic syndromes causes the loss of …. and …. in the urine predisposing a child to … and …
immunoglobulins – predispose to infection
anti-thrombin 3 - hyper coagulable state
presentation of nephrotic syndrome ?
- signs of edema (puffy eyes and ankles, dyspnea, abdominal distension and ascites)
- normal BP and and no hematuria
- may rarely present with infections or thromboembolism due to protein loss
diagnosis of nephrotic syndrome? other investigations?
- FBC: infections and hematocrit
- U and E: for renal function
- LFT: for low albumin
- urinary dipstick: for proteinuria
the cause of nephrotic syndrome can be assumed to be minimal change disease if : (3)
age 1-12 years
normal complement levels
no hypertension, no gross hematuria, or high creatinine (which would suggest nephritic syndrome)
management of nephrotic syndrome (minimal change)
IV fluid and albumin (intravascular volume depletion)
prednisolone for 6 weeks; if non responsive, consider renal biopsy to identify other causes
wilms tumour is also known as ?
nephroblastoma
…. is the most common renal malignancy in children,
wilms tumour (nephroblastoma)
most cases of wilms tumour occur in children < … years old
5
Wilms tumour is associated with … syndrome
WAGR (Wilms, aniridia, GU anomalies, and retardation)
presentation of Wilms tumour?
- abdominal mass and hematuria
any abdominal mass in children should be considered … until proven otherwise
Wilms tumour
diagnosis of Wilms tumour?
- abdominal ultrasound to identify mass, followed by CT/MRI
- definitive diagnosis biopsy and histological assessment
- chest x-ray for metastases
neuroblastoma is a malignant tumour originating from …. cells of the … chain…. occurring mostly in children < …. years old
neural crest
sympathetic
presentation of neuroblastoma?
- localizing symptoms depending on location
- abdominal mass
- systemic features: weight loss, fever, fatigue
- paraneoplastic/metastatic complications
diagnosis of neuroblastoma?
- elevated serum and urinary catecholamines HVA and VMA
- ultrasound and biopsy
- staging: CT/MRI and I123-MIBG scan (for bone metastases)
what markers are used to monitor response to treatment in a patient with neuroblastoma?
urinary and serum catecholamines (VMA, HVA)
