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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
Q

Common causes of nephritis in children

A

IgA nephropathy

Post streptococcal glomerulonephritis

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26
Q

When does post streptococcal glomerulonephritis commonly occur

A

1 - 3 weeks after a beta haemolytic streptococcal infection such as tonsillitis caused by Strep pyogenes

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27
Q

Pathophysiology of post streptococcal gonerulonephritis

A

Imunne complexes made up of streptococcal antigens, antibodies and complement proteins accumulate and and stick to the renal glomeruli which causes inflammation

28
Q

Management of post streptococcal glomerulonephritis

A

Supportive, may need diuretics for oedema and hypertension

29
Q

IgA nephropathy pathophysiology

A

Caused by IgA vasculitis where IgA deposits in the glomeruli causing inflammation

Renal biopsy shows IgA deposits and glomerular mesangial proliferation

30
Q

Managment of IgA nephropathy

A

Supportive management of renal failure

Immunosuppressant medication - cyclophosphamide

31
Q

Pathophysiology of haemolytic uraemic syndrome

A

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
Q

Haemolytic uraemic syndrome triad

A

Haemolytic anaemia
AKI
Thrombocytopenia

33
Q

Presentation of haemolytic uraemic syndrome

A

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
Q

Management of heamolytic uraemic syndrome

A

Medical emergency - urgent referral to the paediatric renal unit for renal dialysis if required

Supportive management:

  • antihyoertensives
  • fluid control
  • blood transfusion if required
35
Q

Normal age of urination control

A

Daytime - 2 years old

Night time - 3 - 4 years old

36
Q

Primary nocturnal enuresis

A

Child has nerver managed to consistently be dry at night

37
Q

Causes of primary nocturnal enuresis

A

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
Q

Investigations for enuresis

A

2 week diary - toileting, bed wetting and fluid intake
Urine dipstick
Pre and post void bladder scan

39
Q

Management of primary nocturnal enuresis

A

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
Q

Secondary nocturnal enuresis meaning

A

Bed wetting when a child has previously been dry for at least 6 months

41
Q

Causes of secondary nocturnal enuresis

A 
T1DM 
UTI 
Constipation 
New psychological problem 
Maltreatment
42
Q

Diurnal eneuresis cause

A

Urge incontinence - overactive bladder
Stress incontinence

Recurrent UTIs
Psychosocial problems
Constipation

43
Q

Medication for enuresis

A

Desmopressin - vasopressin (ADH) analogue

Oxybutynin - anticholinergic for urge incontinence

Imipramine - tricyclic antidepressant

44
Q

Which type of polycystic kidney disease presents in neonates and how is it identified?

A

Autosomal recessive PKD - picked up on antenatal USS

45
Q

Pathophysiology of PKD

A
  • Mutation of the polycystic kidney and hepatic disease 1 (PKHD1) gene on chromosome 6
  • Impaired fribrocystin/polyductin protein complex which normally creates tubules
46
Q

Features of polycystic kidney disease

A 
Cystic enlargement of the renal collecting ducts 
Oligohydramnios 
Pulmonary hypoplasia 
Congenital liver fibrosis 
Potters syndrome
47
Q

Potters syndrome features

A

Underdeveloped ear cartilage
Low set ears
Flat nasal bridge
Abnormalities of the skeleton

48
Q

Complications of PKD

A

End stage renal failure
Pulmonary hypoplasia due to oligohydramnios
Liver failure
Portal hypertension due to oesophageal varices
Hypertension
Chronic lung disease

49
Q

Wilms tumour

A

A tumour affecting the kidneys in children that typically presents under the age of 5 years old

50
Q

Presentation of a Wilms tumour

A

Mass in the abdomen

  • abdo pain
  • haematuria
  • lethargy
  • fever
  • hypertension
  • weight loss
51
Q

Investigations for a Wilms tumour

A

USS abdomen
Staging CT
Kidney biopsy and histology

52
Q

Management of a Wilms tumour

A

Surgical excision and nephrectomy (removing affected kidney)

Adjuvant chemotherapy and radiotherapy

53
Q

Pathophysiology of a posterior urethral valve

A

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
Q

Presentation of a posterior urethral valve

A 
Difficulty urinating 
Weak urinary stream 
Recurrent UTIs
Chronic urinary retention 
Palpable bladder 
Impaire kidney function
55
Q

Investigations for a posteior uretheral valve

A

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
Q

Management of posterior urethral valve

A

Observe and monitor if not causing too much of a problem

Cystoscopy and ablation

57
Q

Undescended testes pathophysiology

A

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
Q

Risk of undescended testes

A

Testicular torsion
Infertility
Testicular cancer

59
Q

Risk factors for undedescended testes

A 
FHx 
Low birth weight  
Small for gestational age 
Prematurity 
Maternal smoking during pregnancy
60
Q

Management of undescended testes

A

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
Q

Hypospadias pathophysiology

A

Urethral meatus is abnormally displaced ventrally towards the scrotum - normally near glans

62
Q

Management of hypospadias

A

Refer to paediatric urologists

  • do not circumcise infant before urologists approves
  • surgery at 3 - 4 months
63
Q

Complications of hypospadias

A

Difficulty directing urination
Sesual dysfunction
Psychological concerns

64
Q

Hydrocele pathophysiology

A

Collection of fluid within the tunica vaginalis that surrounds the testes

65
Q

Communicating hydrocele

A

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
Q

Examination findings of a hydrocele

A

Transilluminates

Non tender, smooth swelling - anterior and inferior to testes

67
Q

Management of a hydrocele

A

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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