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Paeds > nephrology + genitourinary > Flashcards

nephrology + genitourinary Flashcards

1
Q

what % of boys and girls get UTI before 6 years old

A

3-7% girls, 1-2% boys

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2
Q

complications pyelonephritis

A

damage growing kidney by forming a scar- hypertension and chronic renal failure

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3
Q

features UTI in infants

A

non specific- fever, vomiting, lethargy, poor feeding, jaundice, septicaemia, offensive urine, febrile convulsions

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4
Q

features UTI in children

A

dysuria and frequency, abdominal pain or loin tendernessm fever +- rigors, lethargy, d +v, haematuria, offensive urine, febrile convulsion, recurring enuresis

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5
Q

what differentiates pyelonephritis from cystitis

A

fever and systemic involvement

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6
Q

what is the best way to get a urine sample in infant

A

clean catch

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7
Q

what should you do with urine culture if

A

culture immediately. or refrigerate

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8
Q

what is the mode of infection in infant

A

haematogenous (older- bacteria from the gut flora)

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9
Q

commonest organisms UTI

A

e coli. others- klebsiella, proteus, pseudomonas, strep faecalis

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10
Q

what is vesicoureteric reflux

A

anomaly vesicoureteric junction. ureters displaced laterally, directly enter into bladder rather than at an angle (backward flow urine from bladder to kidneys)

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11
Q

what is mild VUR

A

reflex of urine into ureter only. on micturition

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12
Q

what is severe VUR

A

gross dilatation ureter, renal pelvis and calyces. reflux during bladder filling and voiding. assoc with intrarenal reflux

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13
Q

what has a high risk of causing scarring to the kidneys

A

intrarenal reflux

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14
Q

if bilateral scarring of kidneys what can occur

A

chronic renal failure. risk of HTN

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15
Q

when is investigation necessary in UTI

A

atypical or recurrent UTIs. septicaemia, poor urine flow, abdominal mass, incr creat, failure to respond to antibiotics within 48h. infection with non e coli organisms

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16
Q

investigations in UTI

A

ultrasound, DMSA (99Tc), MCUG (micturating cystourethrogam), MAG3 renogram, AXR

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17
Q

what is the best investigation for excluding reflux

A

MCUG

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18
Q

which scan is best for dynamic scan

A

MAG3

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19
Q

what can be done in first UTI

A

ultrasound

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20
Q

treatment UTI infant

A

cefotaxime. or amoxicillin + gentamicin

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21
Q

treatment lower UTI

A

trimethoprim 3 days. nitrofurantoin

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22
Q

treastment upper UT/ acute pyelonephritis

A

co amoxiclav for 7-10d or IV cefotaxime 2-4 days then oral for 7-10d

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23
Q

what can be used as prophylaxis

A

trimethoprim

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24
Q

what can enuresis be due to

A

lack of attention to bladder sensation, detrusor instability, bladder neck weakness, neuropathic bladder, UTI, constipation, ectopic ureter

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25
Q

presentation ectopic ureter

A

girls who are dry at night but wet on getting up

26
Q

investigations enuresis

A

urine sample, US, urodynamic studies, X ray, MRI

27
Q

treatment enuresis

A

desmopressin. enuresis alarm

28
Q

causes secondary enuresis

A

when lose previously achieved urinary continence- emotional upset, UTI, polyuria- DM, sickle cell

29
Q

what is nephrotic syndrome

A

proteinuria, low albumin, oedema

30
Q

signs nephrotic syndrome

A

periorbital oedema, scrotal or vulval leg or ankle oedema, ascites, breathless- effusion

31
Q

investigations nephrotic syndrome

A

urine protein, FBC, ESR, U&Es, creat, albumin, complement, urine microscopy and culture, urinary Na, antistrepsolysin O or anti DNAase B titres and throat swab, hep B and C screen

32
Q

what tests can detect group A strep

A

anti DNAase b titre, with anti strepsolysin O

33
Q

what is steroid sensitive nephrotic syndrome

A

85-90% children with NS respond to corticosteroids. dont progress to renal failure. often precipitated by resp infections

34
Q

features of steroid sensitive NS

A

age 1-10y, no macroscopic haematuria, normal bp, normal complement, normal renal function

35
Q

management steroid sensitive NS

A

oral prednisolone 60mg/m/d reduce to 40 after 4 weeks then alternate days for 4 weeks then stop.

36
Q

if steroid sensitive NS doesn’t respond to corticosteroids or atypical what should be done

A

renal biopsy

37
Q

what is the most common NS in children

A

minimal change disease

38
Q

is minimal change disease responsive to steroid treatment

A

yes

39
Q

complication of minimal change disease

A

hypovolaemia, low urinary Na, thrombosis, infection, hypercholesterolaemia

40
Q

what can you treat hypovolaemia with in minimal change disease

A

IV albumin (colloid)

41
Q

causes of steroid resistant NS

A

focal segmental glomerulonephritis, mesangiocapillary glomerulonephritis, membranous nephropathy

42
Q

treatment focal segmental glomerulonephritis

A

cyclophosphamide, ciclosporin, tacrolimus, rituximab

43
Q

associations membranous nephropathy

A

may precede SLE. associated with hep B. most remit spontaneously within 5 years

44
Q

treatment oedema

A

diuretics, salt restriction, ACEi, NSAIDs

45
Q

most common cause haematuria

A

UTI

46
Q

signs glomerular haematuria

A

brown urine, deformed red cells and casts, proteinuria

47
Q

signs lower UT haematuria

A

red. beginning or end of stream

48
Q

when to do renal biopsy in haematuria

A

significant proteinuria, abnormal renal function, recurrent macroscopic haematuria, complement levels abnormal

49
Q

non glomerular causes haematuria

A

trauma, stones, sickle cell, hypercalcuria, bleeding disorders, infection, renal vein thrombosis, tumours

50
Q

glomerular causes haematuria

A

acute and chronic glomerulonephritis, IgA nephropathy, thin basement membrane disease, familial nephritis

51
Q

investigations haematuria

A

urine microscopy and culture, protein and calcium excretion, US, U&Es, creat, Ca, PO4, albumin, FBC, platelets, clotting, sickle cell screen

52
Q

if suspect alports what can you test

A

hearing

53
Q

what is henoch schlonein purpura

A

acute immune complex mediated vasculitis

54
Q

what precedes the purpura in HSP

A

URTI

55
Q

symptoms HSP

A

purpura, arthritis/arthralgia, abdominal pain. renal involvement- glomerulonephritis, haematuria, proteinuria. intussusception, GI petechiae- haematemesis and malaena

56
Q

presentation HSP

A

symmetrical rash over buttocks, extensor surfaces of arms and legs, ankles. trunk spared. usually have a fever. 3-10y. male : female 2:1

57
Q

tests in HSP

A

ESR incr, IgA incr, proteinuria, ASO titres incr, U&E, BP.

58
Q

complications HSP

A

massive GI bleeds, haemoptysis, acute renal failure

59
Q

what is AKI characterised by

A

rapid rise in creat and development oliguria/anuria

60
Q

what is haemolytic uraemic syndrome

A

acute microangiopathic haemolytic anaemia, thrombocytopaenia, renal failure + endothelial damage to glomerular capillaries.

61
Q

what is typical HUS associated with

A

diarrhoea. more freq in summer months, typically occurs children

Paeds (16 decks)

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