Nephrology Flashcards
Best method of urine sample collection in a child in nappies
clean catch- best
adhesive plastic bag to the perineum
catheter if urgent
Who requires investigation of urinary tract with UTI?
no response to abx in 48hrs under 6m atypical UTI - seriously ill or sepsis -poor urine flow - abdo mass - increased creatine -atypical organism
Choice of urinary investigation in <1yr
USS KUB
MCUG
DMSA
Choice of urinary investigation for 1-3 yes
USS KUB
DMSA
Choice of urinary investigation for >3yrs
USS only if normal
What is micturating cystourethrography (MCUG)
Contrast into the bladder
? vesicoureteric reflux
? other abnormalities
What is DMSA scan?
radionuclide scan
? scarring, pyelonephritis
Predisposing factors to UTIs
renal tract abnormality
incomplete bladder emptying
vesicoureteric reflux
Vesicoureteric reflux
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
UTI management <3m
urgent paeds referral
UTI management >3m Lower UTI
Trimethoprim/ Cefalexin
UTI prophylaxis
Trimethoprim
UTI managmenent >3m pyelonephritis or unwell
cefuroxime
single gentamicin
When should bladder control be achieved?
3-5 yrs
Clues to neuropathic bladder
distended bladder
abnormal perianal sensation and anal tone
abnormal leg reflexes and gait
Enuresis management
star charts bladder training pelvic floor exercises treat constipation portable alarms (lack of attention to bladder sensation) oxybutynin reduces bladder contractions
Secondary causes of enuresis
emotional upset UTI DM Renal concentrating problems - sickle cell disease -CKD -Diabetes insipidus
Nocturnal enuresis management
education
star chart
enuresis alarm
desmopressin for short term relief
Normal protein to creatine ratio
<20 mg/nmol
in early morning sample
Nephrotic syndrome features
periorbital oedema scrotal, vuvlal, leg and angle oedema ascites SOB infections
Nephrotic syndrome Ix
dipstick antisteptomysis O or anti-DNAse B titres throat swabs urine MSU urine sodium Hep B and C Malaria if recent travel
Nephrotic syndrome management
steroids 4 wks +
Nephrotic syndrome sensitive to steroids clues
<10 yrs
no macroscopic haematuria
normal BP, component levels and renal function
Nephrotic syndrome primary causes
minimal change
membranous nephropathy
focal segmental glomerulosclerosis
mesangiocapilary GN
Nephrotic syndrome secondary causes
Diabetic nephropathy SLE Amyloidosis Hep B/C HSE
Nephritic syndrome primary causes
IgA nephropathy -> HSP
Mesangiocapilary GN
Naphritic syndrome secondary causes
post step SLE Anti-GBM (Goodpasture's disease) Vasculitis Alport syndrome
Dialysis indications
failure of conservative management hyperkalaemia severe hypo- and hyper- natraemia pulmonary oedema severe metabolic acidosis multi system failure
Haemolytic uraemia syndrome triad
AKI
MAHA
Thrombocytopenia
CKD causes in children
renal dysplasia +/- reflux
obstructive uropathy
glomerular disease
congenital nephrotic syndrome
