Paed:Renal Flashcards by Mel Graham

What is a UTI?

Growth of bacteria within the urinary tract. 10^5 organisms/ml in an appropriate sample.

How well did you know this?

Not at all

Perfectly

What may UTI in a child indicate?

Structural abnormality of urinary tract

How well did you know this?

Not at all

Perfectly

Clinical features of Upper UTI?

Fever
Septicaemic illness
Malaise
Vomiting
Loin/abdo pain in older child
FtT + Jaundice in infancy

How well did you know this?

Not at all

Perfectly

Clinical features of Lower UTI?

Dysuria
Polyuria
Urgency
Incontinence
Lower abdo pain
Haematuria

How well did you know this?

Not at all

Perfectly

Diagnosis of UTI

Collect urine in clean catch sample.
Urethral catheter or suprapubic aspiration are alternatives.
MCS

How well did you know this?

Not at all

Perfectly

What would you see on UTI dipstick?

Nittrites and leucocyte esterase.

How well did you know this?

Not at all

Perfectly

Common causative organism for UTIs

Normally E.Coli

Also: Klebsiella, proteus, pseudomonas, strep faecalis

How well did you know this?

Not at all

Perfectly

Risk factors for developing UTI?

Incomplete bladder emptying
Renal tract abnormality
Vesicoureteric reflex
Constipation

How well did you know this?

Not at all

Perfectly

What is vesicoureteric reflex?

Flow of urine goes wrong way due to anomaly of vesicoureteric junction.

How well did you know this?

Not at all

Perfectly

What is the management of UTI?

<3months: Full septic screen, cefotaxime + amoxicillin.

>3months: Trimethoprim or IV cefuroxime if no improvement.

How well did you know this?

Not at all

Perfectly

Imaging for UTI?

Ultrasound
Micturating cystourethragram
DMSA scan

How well did you know this?

Not at all

Perfectly

What are the 3 signs of nephrotic syndrome?

Proteinuria
Hypoalbuminaemia
Oedema
(also hyperlipidaemia)

How well did you know this?

Not at all

Perfectly

Clinical features of nephrotic syndrome?

Periorbital oedema
Scrotal, vulval, leg, ankle oedema
Ascites
Breathlessness due to pleural effusion

How well did you know this?

Not at all

Perfectly

Investigations for nephrotic syndrome?

Protein on dipstick
Creatinine/Albumin ratio
Urine MCS

How well did you know this?

Not at all

Perfectly

What is Steroid Sensitive Nephrotic Syndrome?

Nephrotic syndrome that resolves with corticosteroid therapy. Often precipitated by respiratory infections.

How well did you know this?

Not at all

Perfectly

Complications of SSNS?

Hypovolaemia - tx with IV albumin
Thrombosis
Infection
Hypercholesterolaemia

How well did you know this?

Not at all

Perfectly

What is Steroid resistant nephrotic syndrome?

Doesnt respond to steroids. Oedema managed by diruetics, ACE-i and NSAIDS to reduce proteinuria.

How well did you know this?

Not at all

Perfectly

Treatment of SSNS?

Prednisolone

Also: Sodium and water moderation, diuretics

How well did you know this?

Not at all

Perfectly

What is one of the most common causes of Nephrotic Syndrome?

Minimal change disease. damage to the podocytes of the kidney.

How well did you know this?

Not at all

Perfectly

What are differences between glomerular and lower tract haematuria?

Glomerular: Brown urine, deformed red cells and casts, often proteinuria too
Lower tract: red, beginning or end of stream. unusual in children.

How well did you know this?

Not at all

Perfectly

Causes of non-glomerular haematuria?

Infection
Trauma
Stones
Tumours
Sickle Cell

How well did you know this?

Not at all

Perfectly

Causes of glomerular haematuria?

Study These Flashcards

Acute Glomerulonephritis
Chronic glomerulonephritis
IgA nephropaty
Familial nephritis
Thin BM disease

Investigation of haematuria

Study These Flashcards

Urine MCS
Urinary tract USS
Bloods

Common causes of acute nephritis?

Study These Flashcards

Post infectious (inc. streptococcal)
Vasculitis (SLE, HSP)
Iga nephropaty
Anti glomerular BM disease

What does acute nephritis lead to?

Hypertension Oedema Haematuria

Manage acute nephritis how?

Fluid and electrolyte balance | diuretics

What type of infections cause a nephritis?

``` Streptococcal infections (skin or throat) Group A beta haem strep ```

Clincial presentation of post strep nephritis?

``` haematuria Decreased urine output oedema (perioribital) fever htn ```

Investigations of post strep nephritis?

Mild anaemia U+Es --> increased urea, hyperkalaemia, acidosis Urine: haematuria and proteinuria

Treatment for post strep nephrtiis?

Fluid balance | treat htn with diuretics

What is Henoch Schonlein Purpura?

An acute immune complex mediated vasculitis. Most patients have antecedent URTI.

Classic triad of HSP?

Purpura (purple spots that dont disappear) Arthtiris/arthralgia Abdominal pain Can also have: Oedema, glomerulonephritis, nephrotic syndrome, intussusception

Investigations for HSP?

Increased ESR and IgA Proteinuria ANCA presen

Management of HSP?

Give steroids, may need immunosuppression.

What is the most common familial nephritis?

Alport syndrome.

What is SLE?

Vasculitis characterised by multiple autoantibodies being present. Decreased C3 and C4.

What is renal agenesis?

Absence of both kidneys. As amniotic fluid is derived from fetal urine, there is severe oligohydramnios resulting in potter syndrome which is fatal.

What is multicystic dysplastic kidney?

Failure of union of the ureteric bud with the nephrogenic mesenchyme. Non functioning structure with large fluid filled cysts and no connection to bladder.

What is AD polcystic kidney disease?

Hypertension and haematuria in childhood, progresses to ESRF in adults.

What is hypospadia?

abnormal position of external urethral meatus on the ventral penis. Difficulty urinating. Correction surgically.

What is horseshoe kidney?

Silent or obstructed uropathy +/- renal infections. Ix: USS diagnosis, kidneys are too medial. Lower pole is too long. Anterior rotated pelvis. Poorly defined inferior border. Isthmus often invisible.

What is Haemolytic Uraemic Syndrome?

Acute microangiopathic haemolytic anaemia (schistocytes, burr cells) thrombocytopenia ( platelets are destroyed) renal failure endothelial damage to glomerular capillaries. Typical HUS is associated with diarrhoea in 95%.

What pathogen causes HUS?

Associated with Shiga toxin producing E.Coli. Causes diarrhoea.

Treatment of HUS

Dialysis | Steroids for maintenance but not that helpful

What is the HUS triad?

nephropathy, thrombocytopenia, microangiopathic haemolytic anaemia

What is like to be the diagnosis if there is a prodrome of bloody diarrhoea 5-7 days before a renal insuffiiency?

Haemolytic ureic syndrome

What is the common cause of vesicoureterial reflux

Short tunnel of ureter ins all of badder

What are symptoms of vesicoureteral reflux?

UTI, pyelonephritis, renal failure

Complications of vesicoureteral reflux?

Pyelonephritis, recurrent UTI, reflux nephropathy, HTN, end-stage renal disease

Mx of vesicoureteral reflux

Usually self-limiting Monitor renal function Prophylactic Abx Surgical intervention if stage 4 or more

What 3 things does hypospadias consist of?

1) ventral urethral meatus 2) hooded dorsal foreskin (failed to fuse ventrally) 3) chordee (ventral curvature of the shaft of the penis, most apparent on erection

What is phimosis?

Inability to retract foreskin, seen as a whitish scarring of foreskin. Usually due to localised skin disease (balantis xerotica obliterates) which involves the glans penis and can cause urethral mental stenosis. May require circumcision.

What are the complications of circumcision?

Bleeding, infection, damage to glans

What is an alternative to circumcision?

Preputioplasty - retraction of foreskin then a tight preputial ring incised longitudinally then sutured transversely. This conserves foreskin but requires regular retraction of foreskin for few weeks post op (better in older boys)

Paed:Renal Flashcards

(54 cards)