Nephrology Flashcards
Define enuresis. (2)
Define primary and secondary nocturnal enuresis. (2)
‘involuntary discharge of urine by day or night or both, in A child aged 5 years or older, in the absence of congenital or acquired defects of the nervous system or urinary tract.
Primary - never been continent, secondary - previously continent for at least 6 months previously.
Define ureteric reflux. (2)
Vesicoureteric reflux (VUR) is the abnormal backflow of urine from the bladder into the ureter and kidney.
What is hypospadias? (1)
When is corrective surgery performed for hypospadias? (1)
Congenital abnormality of the penis, characterised by ventral displacement of the urethral meatus, hooded prepuce and chordee (ventral curvature of the penis in severe cases)
Before 2 years old .. boys like to aim
A male asian infant is diagnosed with hypospadias and as the parents are muslim they would like him to be circumcised. What is your advise to the parents? (1)
No circumcision until after corrective surgery has taken place as the extra skin may be required during the procedure.
What is vesicoureteric reflux? (1)
Describe the pathophysiology. (3)
What test can diagnose VUR? (1)
What test can look for renal scarring? (1)
Abnormal back flow of urine from bladder into ureters and kidneys.
Ureters are displaced laterally and enters bladder at a more perpendicular angle, therefore less intramural course of ureter and vesicoureteric junction can not function properly.
Micturiting cystourethrogram
DMSA scan
What is the most common cause of nephrotic syndrome in a child? (1)
Minimal change disease
Describe the pathophysiology of minimal change disease causing nephrotic syndrome. (2)
Name 3 causes of MCD. (3)
T cell and cytokine mediated damage to glomerular basement membrane causes polyanion loss. This causes a reduction in electrostatic charge and albumin can leak out.
NSAIDS, rifampicin, Hodgkins lymphoma, thymoma, infectious mononucleosis.
What is the treatment of minimal change disease? (2)
Steroids if unresponsive cyclophosphamide or renal biopsy.
What age would you expect children to become day and night time continence? (1)
3-4 years
How can nocturnal enuresis be managed? (3)
Look for triggers eg diabetes, constipation,
Give advice on fluid intake, diet and toileting behaviour.
Use reward system for agreed behaviours
Alarm if under 7
Desmopressin if over 7 especially if alarm fails.
Name 4 things tested for on urine dipstick? (4)
protein, glucose, ketones, blood, pH, urobilinogen, leucocytes and nitrites.
What symptoms is urine dipstick mandatory? (2)
polydipsia, polyuria (DM), generalised oedema (nephrotic syndrome)
