Nephrology + Urinary System

Question 1

What is nocturnal enuresis?

Answer 1

Intermittent incontinence of urine during sleep after 5 years of age (bed wetting).

Question 2

What is the difference between monosymptomatic enuresis and non-monosymptomatic enuresis (NMNE)?

Answer 2

Monosymptomatic enuresis: enuresis with no other lower urinate tract symptoms

Non-monosymptomatic enuresis: enuresis with other, mainly daytime, lower urinary tract symptoms

Question 3

What are important symptoms suggestive of underlying bladder dysfunction (overactive bladder/NMNE)?

Answer 3

• Leakage of urine during the day
• Drops of urine in the underpants (before or after voiding)
• Very wet underpants
• Hx of daytime incontinence over the years of 3 and a half

Question 4

What are symptoms suggestive of dysfunctional voiding?

Answer 4

• Voiding postponement
• Holding maneuvers observed
• The need to push in order to urinate
• Interrupted urinary stream, or several voids, one after the other

Question 5

What are examples of secondary causes of nocturnal enuresis?

Answer 5

1. UTI (most common)
2. DM
3. Severe psychological trauma
4. Spina bifida occulta or cystica

Question 6

What is enuresis (esp. NMNE) associated with constipation usually indicate?

Answer 6

Dysfunctional elimination syndrome

Question 7

What drug can be given to children to treat nocturnal polyuria?

Answer 7

Desmopressin

Question 8

What is recommend as first line treatment in treating monosymptomatic enuresis?

Answer 8

Alarms (behavioral therapy)

Question 9

What can be used with combination with rest Detrusor muscle over activity?

Answer 9

Oxybutynin

Question 10

Is UTI more common in girls or boys?

Answer 10

Girls (due to their short urethra)

Question 11

What is the most common renal anomaly that is associated with UTI?

Answer 11

VUR

Question 12

What is the most common presentation of UTI?

Answer 12

Unexplained fever

Question 13

What is the most common microorganism that causes UTI?

Answer 13

E. Coli

Question 14

What are the signs and symptoms of UTI according to age?

Answer 14

Neonates with UTI:
Jaundice, fever, FTT, poor feeding, vomiting and irritability (non-specific symptoms)

Infants (1m) to 2 years:
Fever, poor feeding, vomiting, strong-smelling urine, irritability and abdominal urinate (may masquerade a GI illness)

2-6 years:
Fever, vomiting, abdominal pain, strong-smelling urine, enuresis and urinary symptoms like dysuria, urgency and frequency (more specific symptoms)

Question 15

What are the factors that distinguish between an upper UTI (pyelonephritis) and a lower UTI (cystitis)?

Answer 15

Pyelonephritis (upper UTI):
Febrile UTI + flank abdominal pain + loin pain/tenderness

Cystitis (lower UTI):
Dysuria, frequency and hematuria (may be present) = NO SYSTEMIC FEATURES

Question 16

What is checked in the urine dipstick test of a suspected case of UTI?

Answer 16

Leukocytes
Leukocyte esterase
Nitrites

Question 17

What is the definitive diagnosis method for UTI?

Answer 17

Urine culture

Question 18

What is the best and most accurate method of collection of urine sample?

Answer 18

Suprapubic sample

Question 19

What method of collection of urine sample is used after infancy?

Answer 19

Midstream urine

Question 20

What are the commonest organisms that cause UTI?

Answer 20

E. Coli (most common)
Proteus ~associated with stones
Pseudomonas ~hospital acquired
Klebsiella pneumonia

Question 21

What are characteristics of atypical UTI?

Answer 21

• Seriously ill
• Poor urine flow (think of obstruction like PUV)
• Abdominal or bladder mass
• Raised creatinine
• Septicemia
• Failure to respond to treatment with Abx (within 48 hrs)
• Infection with non-E. Coli organisms

Question 22

What is recurrent UTI?

Answer 22

Two or more episodes of UTI

Question 23

Does PUV occur in females?

Answer 23

NO

Question 24

What are important investigations for atypical or recurrent UTIs?

Answer 24

1. Renal US
2. Voiding cysrourethrogram (VCUG) / micturating cystourethrogram (MCUG) ~to diagnose PUV and reflux
3. DMSA scan (to diagnose renal scarring)

Question 25

What can be done to prevent UTI?

Answer 25

• Prophylactic Abx (until VUR is resolved by age of 5)
• Rarely: deluxe or reimplantation of ureters
• Fulgration of posterior urethral valves
• Management of neurogenic bladder = CIC

Question 26

What antibiotics are usually used to treat UTI?

Answer 26

For empiric Abx therapy = trimethoprim-sulfamethoxazole OR cephalexin

For neonates with UTI = IV antibiotics of ampicillin + gentamicin