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Paediatrics > Nephrology/GU > Flashcards

Nephrology/GU Flashcards

1
Q

Define Nephrotic Syndrome

A

A glomerular disorder when the basement membrane in the glomerulus becomes highly permeable to protein, allowing proteins to leak from the blood into the urine.

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2
Q

Nephrotic syndrome proteinuria criteria

A
  • > 200mg/mmol
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3
Q

Nephrotic syndrome hypoalbuminaemia criteria

A
  • <25g/L
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4
Q

Nephrotic syndrome Epidemiology in the UK

A
  • 2 per 100,000 children per year
  • 6-8 times higher in UK Asian populations
  • twice as common in boys
  • affecting children 2 – 5 years
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5
Q

Ohh

Nephrotic Syndrome classic Triad

A
  • oedema
  • heavy proteinuria (>200mg/mmol)
  • hypoalbuminaemia (<25g/L)
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6
Q

Nephrotic Syndrome Aetiology

A
  • Minimal Change Disease (90% of the cases)
    Secondary to: intrinsic kidney disease
  • Focal segmental glomerulosclerosis
  • Membranoproliferative glomerulonephritis
    Secondary to: systemic illness
  • Henoch schonlein purpura (HSP)
  • Diabetes
  • Infection, such as HIV, hepatitis and malaria
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7
Q

3 Highs

Nephrotic Syndrome uncommon Triad

A
  • High Lipid profile (chol, TGL, LDL)
  • HTN
  • Hyper-coagulability
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8
Q

Nephrotic Syndrome complications

A
  • Hypovolaemia
  • Thrombosis
  • Infection
  • Acute or chronic renal failure
  • Relapse
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9
Q

How do Nephrotic Syndrome lead to hypovolaemia

A

occurs as fluid leaks from the intravascular space into the interstitial space causing oedema and low BP

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10
Q

How do Nephrotic Syndrome lead to Thrombosis

A

can occur because proteins that normally prevent blood clotting are lost in the kidneys, and because the liver responds to the low albumin by producing pro-thrombotic proteins.

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11
Q

immunosuppressant

How do Nephrotic Syndrome lead to infections

A

occurs as the kidneys leak immunoglobulins, weakening the capacity of the immune system to respond. This is exacerbated by treatment with medications that suppress the immune system, such as steroids.

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12
Q

Nephrotic Syndrome Mx

A
  • High dose steroids (i.e. prednisolone)
  • Low salt diet
  • Diuretics may be used to treat oedema
  • Albumin infusions may be required in severe hypoalbuminaemia
  • Antibiotic prophylaxis may be given in severe cases

SEs: steroids on growth

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13
Q

Define Wilms’ Tumour

Nephroblastoma

A

the most common form of renal malignancy in childhood. It usually occurs in children under 5 years

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14
Q

Wilms’ Tumour Sx

A
  • Abdo pain
  • Abdo distention
  • HTN
    RED FLAGS
  • unintenional WL
  • Fever
  • Haematuria
  • Lethargy
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15
Q

Wilms’ Tumour clinical presentations

A
  • Unilateral painless, NT, firm, smooth abdo mass
  • ballotable and does not move with respirations
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16
Q

Wilms’ Tumour Risk factors

A
  • Age <5 years
  • Congenital urogenital anomalies (cryptorchidism etc.)
  • L&raquo_space; R kidney (can be bilateral)
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17
Q

Wilms’ Tumour Diagnostic Ix

A
  1. Abdo USS w/doppler
  2. CT CAP or MRI without contrast for staging
  3. Bloods: U&E, LFTs, FBC, Bone profile
  4. Bone scan (for bone met)
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18
Q

Wilms’ Tumour definitive Dx Ix

A

Bx for histology of tumour

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19
Q

Wilms’ Tumour Mx

A
  • Nephrectomy followed by
    1. Adjuvant chemotherapy
    2. Adjuvant radiotherapy
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20
Q

Define Cryptorchidism

undescended testes

A

a congenital absence of one or both testes in the scrotum due to a failure of the testes to descend during development

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21
Q

Cryptorchidism Risk Factors

A
  • FMHxof undescended testes
  • Low birth weight
  • Small for gestational age
  • Prematurity
  • Maternal smoking during pregnancy
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22
Q

ETA

Types of Cryptorchidism

A
  • Ectopic testis: where the testis is found away from the normal path of decent
  • True undescended testis: where testis is absent from the scrotum but lies along the line of testicular descent
  • Ascending testis: where a testis previously identified in the scrotum undergoes a secondary ascent out of the scrotum
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23
Q

Cryptorchidism Pathophysiology

A

Normally, the testis descends from the abdomen to the scrotum, pulled by the gubernaculum, within the processes vaginalis

  • True undescended testis: This process is incomplete
  • Ectopic testis: Tracks to an abnormal position
  • Bilateral cryptorchidism:, hormonal causes such as androgen insensitivity syndrome or disorder of sex development must also be excluded
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24
Q

True undescended testis locations

A
  • Abdo
  • Inguinal
  • Suprascrotal
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25
Q

Ectopic undescended testis locations

A
  • Prepenile
  • Femoral
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26
Q

Cryptorchidism complications

A
  • Impaired fertility – as testis are 2-3⁰ C warmer if intra-abdominal, this can effect spermatogenesis. Although fertility in unilateral undescended testis is around 90%, this has been reported to drop to around 53% if bilateral. Risk of infertility increases with delayed correction.
  • Testicular cancer – 2-3 times more common with a history of undescended testis (2-3%), and this risk double if correction is undertaken after puberty. In addition to the managing the risk of testicular cancer, orchidopexy also allows for self-examination for testicular abnormalities by the patient when they are older.
    Torsion – undescended testis are at higher risk of torsion
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27
Q

Cryptorchidism Mx

A
  • Watch & wait for infant 3-6 months
  • By 6 months: refer to paeds
  • Surgically: Orchidopexy between 6 and 12 months of age
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28
Q

Define Hydrocele

A

a collection of fluid that builds up within the tunica vaginalis that surrounds the testes

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29
Q

Two types of hydrocele

A
  • Simple Hydrocele
  • Communicating Hydrocele
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30
Q

Define Simple Hydrocele

A

Simple hydroceles are common in newborn males. They occurs where fluid is trapped in the tunica vaginalis. Usually this fluid gets reabsorbed over time and the hydrocele disappears.

31
Q

Define Communicating hydroceles

A

Communicating hydroceles occur where the tunica vaginalis around the testicle is connected with the peritoneal cavity via a pathway called the processus vaginalis. This allows fluid to travel from the peritoneal cavity into the hydrocele, allowing the hydrocele to fluctuate in size.

32
Q

Hydroceles clinical findings

A
  • soft, smooth, non-tender swelling around one of the testes
  • The swelling will be in front of and below the testicle
  • Transilluminate with light: pen torch flat against the skin and watch as the whole thing lights up like a bulb
33
Q

Hydrocele Ix

A

Testicular USS

34
Q

Simple hydroceles Mx

A
  1. Watch & wait: usually resolve within 2 years
  2. Surigically: if not resolve in 2 years
35
Q

Communicating hydroceles Mx

A

Surgically: **laparoscopic PPV ** to remove or ligate the connection between the peritoneal cavity and the hydrocele (the processus vaginalis)

36
Q

Hydrocele aetiology

A
  • Idopathic
    Secondary to:
  • Testicular cancer
  • Testicular torsion
  • Epididymo-orchitis
  • Trauma to testicles
37
Q

Lower UTI

38
Q

Upper UTI

A

pyelonephritis

39
Q

Most common causative organism in children <2years

A

E.coli

if not E.coli = Atypical UTI

40
Q

Paed UTI epidiemiology

A

Girls > boys

41
Q

Paed UTI Risk factors

A
  • Vesico-ureteric reflux (retrograde urine)
  • Voiding dysfunction
  • Caucasian
  • Under 1 year
  • Immunosuppression
  • Girls
  • Sexual activity – adolescent females
42
Q

Paeds UTI

A
  • Renal structural diseases
  • Prev UTIs
43
Q

Paeds UTI clinical presentations

A
  • Fever
  • Dysuria
  • Increased freq.
  • Haematuria
  • Flank pain
44
Q

Paeds referral criteria for <3months of age

A
  • Fever

Red flag

45
Q

Paeds UTI clinical presentations <3months

A
  • Fever (Refer stat)
  • Lethargy
  • Vomiting
  • Irritability
46
Q

Paeds UTI clinical presentations >3months

A
  • Increased Frequency
  • Dysuria
  • Crying whilst urinating
  • Bed wetting
  • Abdo pain
47
Q

Paeds Atypical UTI

A
  • UTI with non-E. coliorganisms
48
Q

Paeds Atypical UTI presentations

A
  • Failure to respond to treatment with suitable antibiotics within 48hours.
  • Poor urine flow.
  • Abdominal or bladder mass.
  • Raised creatinine.
  • Sepsis.
49
Q

Unlikely Paeds UTI Sx

A
  • Resp deficits
  • Missing fever
  • No dysuria
  • Nappy rash
  • Abnormal ear examination
50
Q

Paeds UTI examinations

A
  • Obs + vitals
  • CR
  • ## LNs
51
Q

Acute Pylonephritis

A
  • Fever >38 + Bacteriuria (nitrite in dipsticks)
    OR
  • fever less than 38°C associated with loin pain/tenderness and bacteriuria.
52
Q

Paeds UTI Ix

A

Clean catch urine
MSU
Catheter
Suprapubic aspiration (SPA)

53
Q

Urinalysis: leukocyte positive and nitrite are positive

A
  • Abx stat
  • If the child 3m - 3yr, send sample for MC&S
  • If over 3years and has a high or intermediate risk of serious illness, sx suggestive of uti or a history of infection, send urine sample for culture.
54
Q

Urinalysis: leukocyte is negative and nitrite is positive

A
  • > 3months start antibiotic treatment and send urine sample for culture.
55
Q

If leukocyte is positive and nitrite is negative

A

send urine sample for microscopy and culture
Under 3m - 3 yr: start abx
Over 3 years: only start abx if good clinical evidence of infection.

56
Q

If leukocyte and nitrite are negative

A

do not start treatment for UTI
explore other causes of illness.
Send urine mc and s if risk of serious illness or s, sx suggestive of upper UtI or recurrent UTI

57
Q

Paeds upper UTI < 3months Mx

A

direct referral to paediatrician, full septic screen

58
Q

Paeds upper UTI > 3months Mx

A
  • consider referral to a paediatric specialist
  • treat with oral antibiotics for 7-10 days
    Cefalexin
  • Co-amoxiclav if sensitive on culture result
    Reassess if not improving/getting worse
    USS
59
Q

Paeds lower UTI > 3months Mx

A
  • send urine for culture and susceptibility or dipstick
  • treat with oral antibiotics for 3 days
    1st line: Trimethoprim, nitrofurantion
    2nd line: nitrofurantoin, amoxicillin, cefalexin
    Remember anti-pyretics
    Explain side effects of antibiotics : GI usually
    Safety net/follow up
    USS
60
Q

KUB USS referral criteria

A
  • Under 6 months
  • Recurrent uti
    Two or more episodes of UTI with acute upper UTI (acute pyelonephritis), or
    One episode of UTI with acute upper UTI plus 1 or more episodes of UTI with lower UTI (cystitis), or
    Three or more episodes of UTI with lower UTI
61
Q

DMSA scan criteria

A

4 to 6months after the acute infectionif atypical or recurrent

62
Q

KUB USS criteria for 6m to 3years

A

During infection if atypical
Within 6 weeks if recurrent
DMSA 4-6m post infection atypical/recurrent
MCUG not typically done

63
Q

KUB USS criteria for > 3years

A

During infection if atypical and within 6w if recurrent
DMSA if recurrent

64
Q

2ww referral criteria for Wilm’s tumour

A
  • Abdo mass
  • Haematuria (usu. microscopic)
  • Organomeagly
65
Q

Nephrotic Syndrome 1st clinicla presentation

A

Facial oedeama

66
Q

Define Phimosis

A

Inability to retract the foreskin

67
Q

Primary (physiological)

A

Without sign of scarring

68
Q

Secondary (pathological): due to scarring from conditions

A
  • Recurrent balanitis
  • Traumatic retraction of the foreskin
  • Balanitis xerotica et obliterans
69
Q

Phimosis clinical presentations

A
  • Poor stream
  • Urine spraying
  • Recurrent balanitis
  • Ballooning of foreskin on micturition
70
Q

Phimosis Mx

A

Non-retractile foreskin and/or ballooning during micturition in a child aged under 2 years,
- an expectant approach
- physiological phimosis which will resolve in time.
- Topical steroids can be applied to the preputial ring
Personal hygiene
Pathological phimosis:
- circumcision
- a short course of topical corticosteroids: mild scarring

71
Q

Paraphimosis

A

Inability to pull forward a foreskin that has been retracted behind the glans penis.

72
Q

Paraphimosis Mx

A

urological emergency

Paediatrics (23 decks)

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