Nephrology and Urinary System Flashcards by Luke Hampshire

When would a child require intervention with enuresis?

5 - 7: Non-pharmacological

7 years +: Pharmacological

How well did you know this?

Not at all

Perfectly

What is the first line pharmacological treatment for enuresis?

Desmopressin

How well did you know this?

Not at all

Perfectly

What is secondary enuresis?

Bed wetting a child who has previously been dry - usually due to emotional/psychological stress

Also classified as a relapse after 6 months dry

How well did you know this?

Not at all

Perfectly

What is the most common pathological cause of enuresis in kids?

UTI

How well did you know this?

Not at all

Perfectly

What factors would indicate an atypical urinary tract infection?

Seriously ill/septic

Poor urinary flow

Abdominal/bladder mass

Lack of response to Abx within 48hrs

How well did you know this?

Not at all

Perfectly

How would a UTI present in neonates?

Pyrexia

Lethargy/irritability

Vomiting

How well did you know this?

Not at all

Perfectly

Give three renal anomalies that can predispose to recurrent UTIs

Single kidney/unilateral renal agenesis

Ectopic kidney

Mutlicystic dysplastic kidneys

Autosomal dominant/recessive PKD

How well did you know this?

Not at all

Perfectly

Give three urological anomalies that can predispose to recurrent UTIs

Ureteric obstruction
Posterior urethral valves
Hypospadias
Phimosis/paraphimosis
Vesicoureteric reflux

How well did you know this?

Not at all

Perfectly

Which other investigations are used to determine:

(i) kidney scarring?
(ii) ureteric reflux?

i. Radioisotope scanning (DMSA)

ii. Micturating cystourethrogram (MCUG)

How well did you know this?

Not at all

Perfectly

Which other investigations are used to determine:

(i) kidney scarring?
(ii) ureteric reflux?

i. Radioisotope scanning (DMSA)

ii. Micturating cystourethrogram (MCUG)

How well did you know this?

Not at all

Perfectly

Give four risk factors for enuresis

Genetic 
Developmental delay
Down's 
Spina bifida
Cerebral palsy
Caffeinated drinks
Emotional stress

How well did you know this?

Not at all

Perfectly

In a history of enuresis, why should you ask about the volume and frequency of enuresis?

Large volumes in the early hours suggests no organic cause

Variable volumes throughout the night suggests disease

How well did you know this?

Not at all

Perfectly

When would you follow-up a child using an enuresis alarm?

After 4 weeks

How well did you know this?

Not at all

Perfectly

When would you stop using an enuresis alarm?

After 14 consecutive dry nights

How well did you know this?

Not at all

Perfectly

What can cause red urine?

Haematuria
Beetroot
Rifampicin

How well did you know this?

Not at all

Perfectly

Who is nocturnal enuresis more common in?

Boys

How well did you know this?

Not at all

Perfectly

Give three causes of nocturnal enuresis

Delayed maturation (often familial)
Reduced ADH production
Reduced bladder awareness
Emotional stress
UTI
Polyuria due to diabetes or renal disease

How well did you know this?

Not at all

Perfectly

Other than emotional stress, what else can cause secondary enuresis?

UTI
DM
Threadworm infection

How well did you know this?

Not at all

Perfectly

Which drinks should be avoided in children with enuresis?

Caffeinated drinks

Fruit juice

How well did you know this?

Not at all

Perfectly

What should parents not do when attempting manage nocturnal enuresis?

Lifting - this trains the child to void whilst half asleep

How well did you know this?

Not at all

Perfectly

How and when is desmopressin given?

Nasal spray or tablets before bed

Given when(i) rapid control is needed (ii) alarms have not worked (iii) short-term control e.g. school trips

How well did you know this?

Not at all

Perfectly

What is second line to desmopressin in the treatment of enuresis?

Oxybutinin - anticholinergic - reduces detrusor instability
Used +/- desmopressin with symptoms of bladder instability such as diurnal enuresis, urgency and frequency

Imipramine - tricyclic antidepressant
Used infrequently and only in resistant cases, it has a lot of side effects and has risk of overdose

How well did you know this?

Not at all

Perfectly

When would you refer a child with enuresis?

Severe diurnal symptoms
Recurrent UTIa
Abnormal renal USS
Neurological signs
Comorbid conditions e.g. incontinence, DM, delay
if they have not responded to GP care after 6 months

How well did you know this?

Not at all

Perfectly

When are children usually dry by day?

How well did you know this?

Not at all

Perfectly

When are children usually dry by night?

How is primary enuresis defined?

Never achieved dryness in child over 5

How might a child with neurogenic bladder present?

Distended bladder Abnormal perianal sensation Abnormal anal tone Abnormal leg findings e.g. weakness

What are two common causes of neurogenic bladder?

Cerebral palsy Spina bifida

How should you advise a parent with a child with urgency incontinence?

Void frequently Train with stream interruption exercises

What drug class is desmopressin?

Arginine vasopressin (AVP) analogue

What counselling should you give to a parent before starting their child on desmopressin?

Minimise fluid intake 1 hour before and and 8 hours after dose - can lead to fluid overload Do not give if vomiting or diarrhoea

Horseshoe kidney is associated with which condition?

Turner's syndrome

What is the most common cause of UTI?

E.coli

What clinical features would make you suspicious of an upper UTI?

Bacteriuria Fever > 38 Loin pain/tenderness

What is classed as a recurrent UTI?

2 upper UTI 3 lower UTI 1 upper and 1 lower UTI

Which UTI causative organism is common in (i) teenage girls? (ii) children with congenital tract anomalies? (iii) haemorrhagic cystitis?

i. Staphylococcus saphrocyticus ii. Pseudomonas iii. Adenovirus 11 and 12

Poor urinary stream in boys can be a sign of what?

Posterior urethral valves

How would you manage a UTI in a child under 3 months

Admit | IV Abx: broad spectrum e.g. cefotaxime, gentamicin

What drug would you give for an acute pyelonephritis?

Oral cephalosporin or co-amoxiclav, for 7 - 10 days

What is the first-line pharmacoloigcal treatment for cystitis/ lower UTI?

Trimethoprim/nitrofurantoin for 3 days Can also give cephalosporins or amoxacillin

Orange-pink stains in the nappy are usually due to what?

Urate crystals

What does frothy urine indicate?

Presence of protein or bile

On a urine dipstick, what indicates infection?

Nitrites - urinary pathogens reduce nitrates to nitrites Excess leucocytes indicate inflammation, and sometimes infection

When is the urine +ve for ketones?

General illness, anorexia or vomiting Many school children who haven't had breakfast!

What investigation(s) should you do for a child < 6 months with a typical UTI?

USS within 6 weeks

What investigation(s) should you do for a child < 6 months with an atypical/recurrent UTI?

USS DMSA MCUG

What investigation(s) should you do for a child aged 6 months - 3 years with a typical UTI?

None

What investigation(s) should you do for a child aged 6 months - 3 years with an atypical/recurrent UTI?

USS during acute atypical infection USS within 6 weeks if recurrent infection DMSA

What investigation(s) should you do for a child over 3 with a typical UTI?

None

What investigation(s) should you do for a child over 3 with an atypical/recurrent UTI?

USS during acute atypical infection USS within 6 weeks and DMSA if recurrent infection

Give three causes of haematuria in kids

``` Post strep glomerulonephritis Polycystic kidneys Renal stones Renal/Wilms tumourSickle cell disease UTI HSP IgA nephropathy Alport's syndrome Thin basement membrane ```

What is Alport syndrome?

Autosomal dominant genetic condition characterised by kidney disease, hearing loss, and eye abnormalities

How does the inheritance pattern of PKD change between different age groups?

Autosomal recessive in kids | Autosomal dominant in adolescence/adults

When investigating haem/proteinuria, what would you changes might you see in: (i) throat swab (ii) serum CR complement (iii) albumin (iv) proteon/creatinine ratio (v) triglycerides/cholesterol

i. Strep infection ii. Low in some types of glomerulonephritis iii. Low in nephrotic syndrome iv, v. High in nephrotic syndrome

What is the commonest cause of UTI in kids?

Haemolytic uraemic syndrome

What is HUS associated with?

Thrombocytopenia AKI Haemolytic anaemia

How does HUS usually present?

Profuse diarrohoea that turns bloody 1 - 3 days later Fever Abdominal pain Vomiting

What causes HUS?

E.coli 0157:H7

What are the risk factors for HUS?

``` Rural poulations Warmer summer months Young age (6 months - 5 years) Older people/those with altered immune response Farm animal contact ```

What changes might you see with HUS in the FBC?

Falling Hb Fragmented RBC on blood film Low/falling platelet count

What are early indicators of HUS onset?

Increasing urea and Cr | High LDH

What is the treatment of HUS?

Notify authorities Fluid and electrolytes Antihypertensives Dialysis (if required)

Who should you notify with notifiable infectious diseases?

Public Health England

What is the criteria for diagnosis of nephrotic syndrome?

Proteinuria > 3g/day or P/Cr ratio > 300 Hypoalbuminaemia < 25 Peripheral oedema Severe hyperlipidaemia >10

What is the commonest cause of nephrotic syndrome in children?

Minimal change glomerular disease

Who does nephrotic syndrome usually affect?

More commonly, boys under 6

What is the pattern of oedema in nephrotic syndrome?

Initially periorbital and facial Then more generalised with pitting oedema

Give three other causes of nephrotic syndrome in children

``` Focal segmental glomerulosclerosis Membranous glomerular disease Membranoproliferative glomerulonephritis Infection Collagen vascular diseases e.g. SLE, RA DM Alport syndrome Pre-eclampsia Transplant rejection Malignancy ```

What are the other clinical features of nephrotic syndrome?

``` May follow viral URTI Frothy urine Ascites/pleural effusion Leuconychia Xanthelasma Infection - loss of Ig ```

How should nephrotic syndrome be treated?

Admit Fluid restriction and diuretics Low salt diet Prednisolone, until remission of proteinuria No live vaccines Prophylactic penicillin , until remission of proteinuria

How does glomerulonephritis present?

``` Haematuria Oliguria Oedema Hypertension Variable proteinuria Most cases are post-URTI/sore throat Loin pain Malaise Headache ```

How does the urine appear in glomerulonephritis?

Smoky, coke-coloured

What is the treatment of glomerulonephritis?

``` Penicillin (if strep infection) Diuretics plus potassium Antihypertensives Lipid-lowering therapy Immunosuppression e.g. corticosteroids, cyclophosphamide, azathiprine Antithrombotics e.g. warfarin, aspirin IV Ig Dialysis ```

What are the complications of glomerulonephritis?

``` Hypertension Hyperkalaemia Acidosis Seizures Hypocalcaemia ```

How common is hypospadias?

1 in 500

What are some common complications that can occur with hypospadias?

Chrodee - downward curve of the penis Cryptorchidism Open processus vaginalis/Inguinal hernia

When should surgery for hypospadias be done? What should you not do?

Before the age of 2 Don't circumcise - may use

What is the most common gynaecological disorder in paediatrics?

Vulvovaginitis

What is vulvovaginits caused by?

Strep pyogenes Staph aureus Candida - assoc. with Abx use

How should you advise a parent to manage a child with vulvovaginitis?

Wear loose fitiing underpants made of cotton Avoid tight fitting clothes Avoid use of bubble baths, perfumed soaps etc Cool compresses to releive swelling/tenderness 10 day course of amoxacillin/coamoxiclav if child not improved