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Paediatrics and Child Health > Nephrology and Urinary System > Flashcards

Nephrology and Urinary System Flashcards

1
Q

When would a child require intervention with enuresis?

A

5 - 7: Non-pharmacological

7 years +: Pharmacological

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2
Q

What is the first line pharmacological treatment for enuresis?

A

Desmopressin

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3
Q

What is secondary enuresis?

A

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

Also classified as a relapse after 6 months dry

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4
Q

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

A

UTI

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5
Q

What factors would indicate an atypical urinary tract infection?

A

Seriously ill/septic

Poor urinary flow

Abdominal/bladder mass

Lack of response to Abx within 48hrs

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6
Q

How would a UTI present in neonates?

A

Pyrexia

Lethargy/irritability

Vomiting

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7
Q

Give three renal anomalies that can predispose to recurrent UTIs

A

Single kidney/unilateral renal agenesis

Ectopic kidney

Mutlicystic dysplastic kidneys

Autosomal dominant/recessive PKD

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8
Q

Give three urological anomalies that can predispose to recurrent UTIs

A 
Ureteric obstruction
Posterior urethral valves
Hypospadias
Phimosis/paraphimosis
Vesicoureteric reflux
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9
Q

Which other investigations are used to determine:

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

A

i. Radioisotope scanning (DMSA)

ii. Micturating cystourethrogram (MCUG)

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10
Q

Which other investigations are used to determine:

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

A

i. Radioisotope scanning (DMSA)

ii. Micturating cystourethrogram (MCUG)

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11
Q

Give four risk factors for enuresis

A 
Genetic 
Developmental delay
Down's 
Spina bifida
Cerebral palsy
Caffeinated drinks
Emotional stress
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12
Q

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

A

Large volumes in the early hours suggests no organic cause

Variable volumes throughout the night suggests disease

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13
Q

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

A

After 4 weeks

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14
Q

When would you stop using an enuresis alarm?

A

After 14 consecutive dry nights

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15
Q

What can cause red urine?

A

Haematuria
Beetroot
Rifampicin

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16
Q

Who is nocturnal enuresis more common in?

A

Boys

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17
Q

Give three causes of nocturnal enuresis

A 
Delayed maturation (often familial)
Reduced ADH production
Reduced bladder awareness
Emotional stress
UTI
Polyuria due to diabetes or renal disease
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18
Q

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

A

UTI
DM
Threadworm infection

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19
Q

Which drinks should be avoided in children with enuresis?

A

Caffeinated drinks

Fruit juice

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20
Q

What should parents not do when attempting manage nocturnal enuresis?

A

Lifting - this trains the child to void whilst half asleep

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21
Q

How and when is desmopressin given?

A

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

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22
Q

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

A

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

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23
Q

When would you refer a child with enuresis?

A

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

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24
Q

When are children usually dry by day?

A

2

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25
Q

When are children usually dry by night?

A

3

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26
Q

How is primary enuresis defined?

A

Never achieved dryness in child over 5

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27
Q

How might a child with neurogenic bladder present?

A

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

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28
Q

What are two common causes of neurogenic bladder?

A

Cerebral palsy

Spina bifida

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29
Q

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

A

Void frequently

Train with stream interruption exercises

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30
Q

What drug class is desmopressin?

A

Arginine vasopressin (AVP) analogue

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31
Q

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

A

Minimise fluid intake 1 hour before and and 8 hours after dose - can lead to fluid overload

Do not give if vomiting or diarrhoea

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32
Q

Horseshoe kidney is associated with which condition?

A

Turner’s syndrome

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33
Q

What is the most common cause of UTI?

A

E.coli

34
Q

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

A

Bacteriuria
Fever > 38
Loin pain/tenderness

35
Q

What is classed as a recurrent UTI?

A

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

36
Q

Which UTI causative organism is common in

(i) teenage girls?
(ii) children with congenital tract anomalies?
(iii) haemorrhagic cystitis?

A

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

37
Q

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

A

Posterior urethral valves

38
Q

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

A

Admit

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

39
Q

What drug would you give for an acute pyelonephritis?

A

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

40
Q

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

A

Trimethoprim/nitrofurantoin for 3 days

Can also give cephalosporins or amoxacillin

41
Q

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

A

Urate crystals

42
Q

What does frothy urine indicate?

A

Presence of protein or bile

43
Q

On a urine dipstick, what indicates infection?

A

Nitrites - urinary pathogens reduce nitrates to nitrites

Excess leucocytes indicate inflammation, and sometimes infection

44
Q

When is the urine +ve for ketones?

A

General illness, anorexia or vomiting

Many school children who haven’t had breakfast!

45
Q

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

A

USS within 6 weeks

46
Q

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

A

USS
DMSA
MCUG

47
Q

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

A

None

48
Q

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

A

USS during acute atypical infection

USS within 6 weeks if recurrent infection

DMSA

49
Q

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

A

None

50
Q

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

A

USS during acute atypical infection

USS within 6 weeks and DMSA if recurrent infection

51
Q

Give three causes of haematuria in kids

A 
Post strep glomerulonephritis
Polycystic kidneys
Renal stones
Renal/Wilms tumourSickle cell disease
UTI
HSP
IgA nephropathy
Alport's syndrome
Thin basement membrane
52
Q

What is Alport syndrome?

A

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

53
Q

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

A

Autosomal recessive in kids

Autosomal dominant in adolescence/adults

54
Q

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

A

i. Strep infection
ii. Low in some types of glomerulonephritis
iii. Low in nephrotic syndrome

iv, v. High in nephrotic syndrome

55
Q

What is the commonest cause of UTI in kids?

A

Haemolytic uraemic syndrome

56
Q

What is HUS associated with?

A

Thrombocytopenia
AKI
Haemolytic anaemia

57
Q

How does HUS usually present?

A

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

58
Q

What causes HUS?

A

E.coli 0157:H7

59
Q

What are the risk factors for HUS?

A 
Rural poulations
Warmer summer months
Young age (6 months - 5 years)
Older people/those with altered immune response
Farm animal contact
60
Q

What changes might you see with HUS in the FBC?

A

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

61
Q

What are early indicators of HUS onset?

A

Increasing urea and Cr

High LDH

62
Q

What is the treatment of HUS?

A

Notify authorities
Fluid and electrolytes
Antihypertensives
Dialysis (if required)

63
Q

Who should you notify with notifiable infectious diseases?

A

Public Health England

64
Q

What is the criteria for diagnosis of nephrotic syndrome?

A

Proteinuria > 3g/day or P/Cr ratio > 300

Hypoalbuminaemia < 25

Peripheral oedema

Severe hyperlipidaemia >10

65
Q

What is the commonest cause of nephrotic syndrome in children?

A

Minimal change glomerular disease

66
Q

Who does nephrotic syndrome usually affect?

A

More commonly, boys under 6

67
Q

What is the pattern of oedema in nephrotic syndrome?

A

Initially periorbital and facial

Then more generalised with pitting oedema

68
Q

Give three other causes of nephrotic syndrome in children

A 
Focal segmental glomerulosclerosis
Membranous glomerular disease
Membranoproliferative glomerulonephritis
Infection
Collagen vascular diseases e.g. SLE, RA
DM
Alport syndrome
Pre-eclampsia
Transplant rejection
Malignancy
69
Q

What are the other clinical features of nephrotic syndrome?

A 
May follow viral URTI
Frothy urine
Ascites/pleural effusion
Leuconychia
Xanthelasma
Infection - loss of Ig
70
Q

How should nephrotic syndrome be treated?

A

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

71
Q

How does glomerulonephritis present?

A 
Haematuria
Oliguria
Oedema
Hypertension
Variable proteinuria
Most cases are post-URTI/sore throat
Loin pain
Malaise
Headache
72
Q

How does the urine appear in glomerulonephritis?

A

Smoky, coke-coloured

73
Q

What is the treatment of glomerulonephritis?

A 
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
74
Q

What are the complications of glomerulonephritis?

A 
Hypertension
Hyperkalaemia
Acidosis
Seizures
Hypocalcaemia
75
Q

How common is hypospadias?

A

1 in 500

76
Q

What are some common complications that can occur with hypospadias?

A

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

77
Q

When should surgery for hypospadias be done?

What should you not do?

A

Before the age of 2

Don’t circumcise - may use

78
Q

What is the most common gynaecological disorder in paediatrics?

A

Vulvovaginitis

79
Q

What is vulvovaginits caused by?

A

Strep pyogenes
Staph aureus
Candida - assoc. with Abx use

80
Q

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

A

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

Paediatrics and Child Health (11 decks)

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