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Year 4 Paediatrics > Paediatric Nephrology > Flashcards

Paediatric Nephrology Flashcards

1
Q

Presentation of UTIs in children

A

May only oresent with fever

Babies:

  • lethargy
  • irritability
  • vomiting and poor feeding
  • urinary frequency

Infants and children:

  • abdo pain
  • vomiting
  • dysuria
  • urinary frequency
  • incontinence
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2
Q

How is pyelonephritis diagnosed

A

Temperature > 38 degrees celsius

Loin pain or tenderness

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3
Q

Investigations for a UTI in children

A 
Obs 
Clean catch (mid stream) urine sample - MCS - positive nitrites if bacterial, WCC
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4
Q

Management of UTIs in children

A

All children under 3 months old with a fever - IV abx - ceftriaxone, full sepsis screen

Over 3 months old: oral abx

  • trimethoprim
  • nitrofurantoin
  • cefalexin
  • amoxicillin
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5
Q

Investigating recurrent UTIs

A

Under 6 months with first UTI - abdominal USS within 6 weeks or during illness, micturating cystourethrogram (MCUG)
Recurrent UTIs - abdominal USS within 6 weeks, DMSA scan 4 - 6 months after illness
Atypical UTIs - abdominal USS during illness, DMSA scan 4 - 6 months after illness

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6
Q

How to test for renal scarring

A

DMSA scan

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7
Q

How does a DMSA scan work

A

Injecting a radioactive material (DMSA) and using a gamma camera to assess how well the material is taken up by the kidneys

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8
Q

Pathophysiology of vesico-ureteric refoux

A

When urine has a tendency to flow from the bladder back into the ureters, predisposing patients to developing upper UTIs and renal scarring

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9
Q

How to diagnose vesico-ureteric reflux

A

Micturating cystourethrogram

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10
Q

Managment of vesico - ureteric reflux

A

Avoid constipation
Avoid an excessively full bladder
Prophylactic abx
Surgical input may be needed from paediatric urology

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11
Q

How does a MCUG

A

Catheterising a child and injecting contrast into the bladder whilst taking a series of xray films to determine whether the contrast is refluxing into the ureters

Prophylactic abx for 3 days before the investigation

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12
Q

Vulvovaginitis pathophysiology

A

Inflammation and irritation of the vulva and vagina caused by sensitive and thin skin mucosa around the vulvovaginal area

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13
Q

How is vulvovaginitis exacerbated

A
  • Wet nappies
  • Use of chemicals or soaps
  • Tight clothing
  • Poor toilet hygiene
  • Constipation
  • Threadworms
  • Pressure on the area - horse riding
  • Chlorinated pools
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14
Q

Who commonly gets vulvovaginitis

A

Young girls between the ages of 3 and 10 years old

After puberty, oestrogen helps keep the skin healthy and resistant to infection

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15
Q

Presentation of vulvovaginitis

A 
Soreness 
Itching 
Erythema around the labia 
Vaginal discharge 
Dysuria 
Constipation
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16
Q

Investigations for vulvovaginitis

A

Urine dipstick may show higher leucocytes but no nitrites

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17
Q

Managment of vulvovaginitis

A

No medication required

Advice:

  • avoid over washing the area with soap and chemicals
  • good toilet hygiene - wipe front to back
  • Keep area dry
  • Emollients can sooth the area
  • Loose cotton clothing
  • Treat constipation and threadworms

Severe - oestrogen cream given by paediatrician

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18
Q

Nephrotic syndrome triad

A

Hypoalbuminaemia
Proteinuria
Oedema

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19
Q

Presentation of nephrotic syndrome in children

A

Normally occurs within the ages of 2 - 5 years old

Frothy urine
Pallor
Generalised oedema

Hypertension
High lipids
Hypercoaguable

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20
Q

Common cause of nephrotic disease in children

A

Minimal change disease

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21
Q

Secondary causes of nephrotic disease

A

Henoch schonlein purpura
Diabetes
Infection - HIV, hepatitis and malaria

Intrinsic kidney disease:

  • focal segmental glomerulosclerosis
  • membranoproliferative glomerulonephritis
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22
Q

How to investigate minimal chamge disease

A

Urinanalysis - small molecular weight proteins and hyaline casts
Renal Biopsy and microscopy - normal

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23
Q

Treatment for minimal change disease

A

Prednisolone - high dose for 4 weeks then weaned for 8 weeks
Restrict salt intake
Diuretics - oedema

Severe hyperalbuminaemia - albumin infusions
Abx prophylaxis

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24
Q

Nephritic disease triad

A

Haematuria
Hypertension
Low GFR

(Also may have proteinuria but less than nephrotic disease)

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25
Common causes of nephritis in children
IgA nephropathy | Post streptococcal glomerulonephritis
26
When does post streptococcal glomerulonephritis commonly occur
1 - 3 weeks after a beta haemolytic streptococcal infection such as tonsillitis caused by Strep pyogenes
27
Pathophysiology of post streptococcal gonerulonephritis
Imunne complexes made up of streptococcal antigens, antibodies and complement proteins accumulate and and stick to the renal glomeruli which causes inflammation
28
Management of post streptococcal glomerulonephritis
Supportive, may need diuretics for oedema and hypertension
29
IgA nephropathy pathophysiology
Caused by IgA vasculitis where IgA deposits in the glomeruli causing inflammation Renal biopsy shows IgA deposits and glomerular mesangial proliferation
30
Managment of IgA nephropathy
Supportive management of renal failure Immunosuppressant medication - cyclophosphamide
31
Pathophysiology of haemolytic uraemic syndrome
Thrombus formation within small blood vessels throughout the body Normally triggered by shiga toxin produced by E. coli or Shigella Or use of antibiotics such as loperamide which slows down gut motility
32
Haemolytic uraemic syndrome triad
Haemolytic anaemia AKI Thrombocytopenia
33
Presentation of haemolytic uraemic syndrome
Gastroenteritis with blood diarrhoea 5 days after onset of diarrhoea: - reduced urine output - AKI - haematuria - abdo pain - lethargy and irritability - bruising - thrombocytopenia - confusion - oedema - hypertension
34
Management of heamolytic uraemic syndrome
Medical emergency - urgent referral to the paediatric renal unit for renal dialysis if required Supportive management: - antihyoertensives - fluid control - blood transfusion if required
35
Normal age of urination control
Daytime - 2 years old | Night time - 3 - 4 years old
36
Primary nocturnal enuresis
Child has nerver managed to consistently be dry at night
37
Causes of primary nocturnal enuresis
Overactive bladder - frequent small volume urination prevents the development of bladder capacity Fluid intake - at night, especially fizzy drink, caffeine and juice Failure to wake - deep sleep Psychologic stress Secondary causes: - constipation - UTI - learning disability - cerebral palsy
38
Investigations for enuresis
2 week diary - toileting, bed wetting and fluid intake Urine dipstick Pre and post void bladder scan
39
Management of primary nocturnal enuresis
Reassure parents of children < 5 yo that its likely to resolve without treatment Advice - reduce fluid intake at night, regular toilet visits Positive reinforcement Enuresis alarm Treat underlying cause such as constipation Medication 2nd line - desmopressin
40
Secondary nocturnal enuresis meaning
Bed wetting when a child has previously been dry for at least 6 months
41
Causes of secondary nocturnal enuresis
``` T1DM UTI Constipation New psychological problem Maltreatment ```
42
Diurnal eneuresis cause
Urge incontinence - overactive bladder Stress incontinence Recurrent UTIs Psychosocial problems Constipation
43
Medication for enuresis
Desmopressin - vasopressin (ADH) analogue Oxybutynin - anticholinergic for urge incontinence Imipramine - tricyclic antidepressant
44
Which type of polycystic kidney disease presents in neonates and how is it identified?
Autosomal recessive PKD - picked up on antenatal USS
45
Pathophysiology of PKD
- Mutation of the polycystic kidney and hepatic disease 1 (PKHD1) gene on chromosome 6 - Impaired fribrocystin/polyductin protein complex which normally creates tubules
46
Features of polycystic kidney disease
``` Cystic enlargement of the renal collecting ducts Oligohydramnios Pulmonary hypoplasia Congenital liver fibrosis Potters syndrome ```
47
Potters syndrome features
Underdeveloped ear cartilage Low set ears Flat nasal bridge Abnormalities of the skeleton
48
Complications of PKD
End stage renal failure Pulmonary hypoplasia due to oligohydramnios Liver failure Portal hypertension due to oesophageal varices Hypertension Chronic lung disease
49
Wilms tumour
A tumour affecting the kidneys in children that typically presents under the age of 5 years old
50
Presentation of a Wilms tumour
Mass in the abdomen - abdo pain - haematuria - lethargy - fever - hypertension - weight loss
51
Investigations for a Wilms tumour
USS abdomen Staging CT Kidney biopsy and histology
52
Management of a Wilms tumour
Surgical excision and nephrectomy (removing affected kidney) Adjuvant chemotherapy and radiotherapy
53
Pathophysiology of a posterior urethral valve
Tissue at the proximal end of the urethra (closest to the bladder) that causes obstruction of urine output in newborn babies This causes back pressure into the bladder, ureters and the kidneys, causing hydronephrosis
54
Presentation of a posterior urethral valve
``` Difficulty urinating Weak urinary stream Recurrent UTIs Chronic urinary retention Palpable bladder Impaire kidney function ```
55
Investigations for a posteior uretheral valve
Abdominal USS - enlarged thickened bladded and bilateral hydronephrosis Micturating cystourethrogram (MCUG) - location of extra tissue and reflux Cystoscopy - camera inserted into the urethra to directly visualise the extra tissue, can ablate at same time
56
Management of posterior urethral valve
Observe and monitor if not causing too much of a problem Cystoscopy and ablation
57
Undescended testes pathophysiology
Failure of the testes to migrate throught the inguinal canal into the scrotum by birth, therefore the testes is still in the abdomen Also called cryptochidism
58
Risk of undescended testes
Testicular torsion Infertility Testicular cancer
59
Risk factors for undedescended testes
``` FHx Low birth weight Small for gestational age Prematurity Maternal smoking during pregnancy ```
60
Management of undescended testes
Watching and waiting until 6 months - as often descends spontaneously up to 6 moths Not descended by 6 months - refer to paediatric urologist - orchidopexy
61
Hypospadias pathophysiology
Urethral meatus is abnormally displaced ventrally towards the scrotum - normally near glans
62
Management of hypospadias
Refer to paediatric urologists - do not circumcise infant before urologists approves - surgery at 3 - 4 months
63
Complications of hypospadias
Difficulty directing urination Sesual dysfunction Psychological concerns
64
Hydrocele pathophysiology
Collection of fluid within the tunica vaginalis that surrounds the testes
65
Communicating hydrocele
Where the fluid in the tunica vaginalis is connected to the peritonela cavity via the processus vaginalis (remnant of the gubernaculum) therefore hydrocoele fluctuates in size
66
Examination findings of a hydrocele
Transilluminates | Non tender, smooth swelling - anterior and inferior to testes
67
Management of a hydrocele
USS - conform diagnosis Simple hydrocele - normally resolves within 2 years - reassurance and monitoring Communicating hydrocele - surgery to remove processus vaginalis

Year 4 Paediatrics (19 decks)

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