Paed:Renal Flashcards
What is a UTI?
Growth of bacteria within the urinary tract. 10^5 organisms/ml in an appropriate sample.
What may UTI in a child indicate?
Structural abnormality of urinary tract
Clinical features of Upper UTI?
Fever Septicaemic illness Malaise Vomiting Loin/abdo pain in older child FtT + Jaundice in infancy
Clinical features of Lower UTI?
Dysuria Polyuria Urgency Incontinence Lower abdo pain Haematuria
Diagnosis of UTI
Collect urine in clean catch sample.
Urethral catheter or suprapubic aspiration are alternatives.
MCS
What would you see on UTI dipstick?
Nittrites and leucocyte esterase.
Common causative organism for UTIs
Normally E.Coli
Also: Klebsiella, proteus, pseudomonas, strep faecalis
Risk factors for developing UTI?
Incomplete bladder emptying
Renal tract abnormality
Vesicoureteric reflex
Constipation
What is vesicoureteric reflex?
Flow of urine goes wrong way due to anomaly of vesicoureteric junction.
What is the management of UTI?
<3months: Full septic screen, cefotaxime + amoxicillin.
>3months: Trimethoprim or IV cefuroxime if no improvement.
Imaging for UTI?
Ultrasound
Micturating cystourethragram
DMSA scan
What are the 3 signs of nephrotic syndrome?
Proteinuria
Hypoalbuminaemia
Oedema
(also hyperlipidaemia)
Clinical features of nephrotic syndrome?
Periorbital oedema
Scrotal, vulval, leg, ankle oedema
Ascites
Breathlessness due to pleural effusion
Investigations for nephrotic syndrome?
Protein on dipstick
Creatinine/Albumin ratio
Urine MCS
What is Steroid Sensitive Nephrotic Syndrome?
Nephrotic syndrome that resolves with corticosteroid therapy. Often precipitated by respiratory infections.
Complications of SSNS?
Hypovolaemia - tx with IV albumin
Thrombosis
Infection
Hypercholesterolaemia
What is Steroid resistant nephrotic syndrome?
Doesnt respond to steroids. Oedema managed by diruetics, ACE-i and NSAIDS to reduce proteinuria.
Treatment of SSNS?
Prednisolone
Also: Sodium and water moderation, diuretics
What is one of the most common causes of Nephrotic Syndrome?
Minimal change disease. damage to the podocytes of the kidney.
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.
Causes of non-glomerular haematuria?
Infection Trauma Stones Tumours Sickle Cell
Causes of glomerular haematuria?
Acute Glomerulonephritis Chronic glomerulonephritis IgA nephropaty Familial nephritis Thin BM disease
Investigation of haematuria
Urine MCS
Urinary tract USS
Bloods
Common causes of acute nephritis?
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)
