Nephrology

Question 1

Best method of urine sample collection in a child in nappies

Answer 1

clean catch- best
adhesive plastic bag to the perineum
catheter if urgent

Question 2

Who requires investigation of urinary tract with UTI?

Answer 2

no response to abx in 48hrs 
under 6m 
atypical UTI 
- seriously ill or sepsis 
-poor urine flow
- abdo mass 
- increased creatine 
-atypical organism

Question 3

Choice of urinary investigation in <1yr

Answer 3

USS KUB
MCUG
DMSA

Question 4

Choice of urinary investigation for 1-3 yes

Answer 4

USS KUB

DMSA

Question 5

Choice of urinary investigation for >3yrs

Answer 5

USS only if normal

Question 6

What is micturating cystourethrography (MCUG)

Answer 6

Contrast into the bladder
? vesicoureteric reflux
? other abnormalities

Question 7

What is DMSA scan?

Answer 7

radionuclide scan

? scarring, pyelonephritis

Question 8

Predisposing factors to UTIs

Answer 8

renal tract abnormality
incomplete bladder emptying
vesicoureteric reflux

Question 9

Vesicoureteric reflux

Answer 9

abnormality of vesicoureteric junction
ureters displaced laterally
enter the bladder directly not at an angle
familial/ ass. with bladder pathology / temporary with UTI
-> ureteric dilatation
–> pyelonephritis
–> voiding pressure transmitted to the renal papillae -> damage

Question 10

UTI management <3m

Answer 10

urgent paeds referral

Question 11

UTI management >3m Lower UTI

Answer 11

Trimethoprim/ Cefalexin

Question 12

UTI prophylaxis

Answer 12

Trimethoprim

Question 13

UTI managmenent >3m pyelonephritis or unwell

Answer 13

cefuroxime

single gentamicin

Question 14

When should bladder control be achieved?

Answer 14

3-5 yrs

Question 15

Clues to neuropathic bladder

Answer 15

distended bladder
abnormal perianal sensation and anal tone
abnormal leg reflexes and gait

Question 16

Enuresis management

Answer 16

star charts 
bladder training 
pelvic floor exercises 
treat constipation 
portable alarms (lack of attention to bladder sensation)
oxybutynin reduces bladder contractions

Question 17

Secondary causes of enuresis

Answer 17

emotional upset 
UTI 
DM 
Renal concentrating problems 
- sickle cell disease
-CKD
-Diabetes insipidus

Question 18

Nocturnal enuresis management

Answer 18

education
star chart
enuresis alarm
desmopressin for short term relief

Question 19

Normal protein to creatine ratio

Answer 19

<20 mg/nmol

in early morning sample

Question 20

Nephrotic syndrome features

Answer 20

periorbital oedema 
scrotal, vuvlal, leg and angle oedema 
ascites 
SOB 
infections

Question 21

Nephrotic syndrome Ix

Answer 21

dipstick 
antisteptomysis O or anti-DNAse B titres 
throat swabs 
urine MSU 
urine sodium 
Hep B and C
Malaria if recent travel

Question 22

Nephrotic syndrome management

Answer 22

steroids 4 wks +

Question 23

Nephrotic syndrome sensitive to steroids clues

Answer 23

<10 yrs
no macroscopic haematuria
normal BP, component levels and renal function

Question 24

Nephrotic syndrome primary causes

Answer 24

minimal change
membranous nephropathy
focal segmental glomerulosclerosis
mesangiocapilary GN

Question 25

Nephrotic syndrome secondary causes

Answer 25

Diabetic nephropathy 
SLE 
Amyloidosis 
Hep B/C 
HSE

Question 26

Nephritic syndrome primary causes

Answer 26

IgA nephropathy -> HSP

Mesangiocapilary GN

Question 27

Naphritic syndrome secondary causes

Answer 27

post step 
SLE 
Anti-GBM (Goodpasture's disease)
Vasculitis 
Alport syndrome

Question 28

Dialysis indications

Answer 28

failure of conservative management 
hyperkalaemia 
severe hypo- and hyper- natraemia 
pulmonary oedema 
severe metabolic acidosis 
multi system failure

Question 29

Haemolytic uraemia syndrome triad

Answer 29

AKI
MAHA
Thrombocytopenia

Question 30

CKD causes in children

Answer 30

renal dysplasia +/- reflux
obstructive uropathy
glomerular disease
congenital nephrotic syndrome