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3a > Paed:Renal > Flashcards

Paed:Renal Flashcards

1
Q

What is a UTI?

A

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

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2
Q

What may UTI in a child indicate?

A

Structural abnormality of urinary tract

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3
Q

Clinical features of Upper UTI?

A 
Fever
Septicaemic illness
Malaise
Vomiting
Loin/abdo pain in older child
FtT + Jaundice in infancy
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4
Q

Clinical features of Lower UTI?

A 
Dysuria
Polyuria
Urgency
Incontinence
Lower abdo pain
Haematuria
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5
Q

Diagnosis of UTI

A

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

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6
Q

What would you see on UTI dipstick?

A

Nittrites and leucocyte esterase.

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7
Q

Common causative organism for UTIs

A

Normally E.Coli

Also: Klebsiella, proteus, pseudomonas, strep faecalis

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8
Q

Risk factors for developing UTI?

A

Incomplete bladder emptying
Renal tract abnormality
Vesicoureteric reflex
Constipation

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9
Q

What is vesicoureteric reflex?

A

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

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10
Q

What is the management of UTI?

A

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

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

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11
Q

Imaging for UTI?

A

Ultrasound
Micturating cystourethragram
DMSA scan

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12
Q

What are the 3 signs of nephrotic syndrome?

A

Proteinuria
Hypoalbuminaemia
Oedema
(also hyperlipidaemia)

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13
Q

Clinical features of nephrotic syndrome?

A

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

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14
Q

Investigations for nephrotic syndrome?

A

Protein on dipstick
Creatinine/Albumin ratio
Urine MCS

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15
Q

What is Steroid Sensitive Nephrotic Syndrome?

A

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

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16
Q

Complications of SSNS?

A

Hypovolaemia - tx with IV albumin
Thrombosis
Infection
Hypercholesterolaemia

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17
Q

What is Steroid resistant nephrotic syndrome?

A

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

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18
Q

Treatment of SSNS?

A

Prednisolone

Also: Sodium and water moderation, diuretics

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19
Q

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

A

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

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20
Q

What are differences between glomerular and lower tract haematuria?

A

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

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21
Q

Causes of non-glomerular haematuria?

A 
Infection
Trauma
Stones
Tumours
Sickle Cell
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22
Q

Causes of glomerular haematuria?

A 
Acute Glomerulonephritis
Chronic glomerulonephritis
IgA nephropaty
Familial nephritis
Thin BM disease
23
Q

Investigation of haematuria

A

Urine MCS
Urinary tract USS
Bloods

24
Q

Common causes of acute nephritis?

A

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

25
Q

What does acute nephritis lead to?

A

Hypertension
Oedema
Haematuria

26
Q

Manage acute nephritis how?

A

Fluid and electrolyte balance

diuretics

27
Q

What type of infections cause a nephritis?

A 
Streptococcal infections (skin or throat)
Group A beta haem strep
28
Q

Clincial presentation of post strep nephritis?

A 
haematuria
Decreased urine output
oedema (perioribital)
fever
htn
29
Q

Investigations of post strep nephritis?

A

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

30
Q

Treatment for post strep nephrtiis?

A

Fluid balance

treat htn with diuretics

31
Q

What is Henoch Schonlein Purpura?

A

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

32
Q

Classic triad of HSP?

A

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

33
Q

Investigations for HSP?

A

Increased ESR and IgA
Proteinuria
ANCA presen

34
Q

Management of HSP?

A

Give steroids, may need immunosuppression.

35
Q

What is the most common familial nephritis?

A

Alport syndrome.

36
Q

What is SLE?

A

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

37
Q

What is renal agenesis?

A

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

38
Q

What is multicystic dysplastic kidney?

A

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

39
Q

What is AD polcystic kidney disease?

A

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

40
Q

What is hypospadia?

A

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

41
Q

What is horseshoe kidney?

A

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.

42
Q

What is Haemolytic Uraemic Syndrome?

A

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%.

43
Q

What pathogen causes HUS?

A

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

44
Q

Treatment of HUS

A

Dialysis

Steroids for maintenance but not that helpful

45
Q

What is the HUS triad?

A

nephropathy, thrombocytopenia, microangiopathic haemolytic anaemia

46
Q

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

A

Haemolytic ureic syndrome

47
Q

What is the common cause of vesicoureterial reflux

A

Short tunnel of ureter ins all of badder

48
Q

What are symptoms of vesicoureteral reflux?

A

UTI, pyelonephritis, renal failure

49
Q

Complications of vesicoureteral reflux?

A

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

50
Q

Mx of vesicoureteral reflux

A

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

51
Q

What 3 things does hypospadias consist of?

A

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

52
Q

What is phimosis?

A

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.

53
Q

What are the complications of circumcision?

A

Bleeding, infection, damage to glans

54
Q

What is an alternative to circumcision?

A

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)

3a (25 decks)

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