Paediatric Nephrology/Urology Flashcards
How do you investigate a child under 6 months with their first UTI? (Not atypical or recurrent, responds well to treatment)
Abdominal ultrasound within 6 weeks
How do you investigate a child over 6 months with a recurrent UTI?
Abdominal ultrasound within 6 weeks
DMSA scan within 4-6 months
How do you investigate a child over 6 months with an atypical UTI?
Ultrasound during illness
DMSA 4-6 months after illness
How do you investigate a child under 6 months with a recurrent UTI?
Ultrasound during illness
DMSA 4-6 months after illness
MCUG
`How do you investigate a child under 6 months with an atypical UTI?
Ultrasound during illness
DMSA 4-6 months after illness
MCUG
What is classed as an atypical UTI?
Seriously ill
poor urine flow
abdominal or bladder mass
raised creatinine
septicaemia
failure to respond to treatment with suitable antibiotics within 48 hours
infection with non-E. coli organisms
How does nephrotic syndrome present in children?
Frothy urine
Generalised oedema - peripheral, ascites, periorbital, pulmonary
Pallor
Low serum albumin
High urine protein
Oedema
What blood results are seen in nephrotic syndrome?
Low serum albumin
Increased cholesterol and lipids
What is the main complication of nephrotic syndrome?
Hypercoagulability causes increased risk of DVT and PE
What is the most common cause of nephrotic syndrome in children?
Minimal change disease
How is minimal change disease managed?
Oral prednisolone
If steroid resistant -> ACEi/immunnosuppresants
What is the first line treatment for nocturnal enuresis after all lifestyle measures have been trialled?
Under 7 -> enuresis alarm
Over 7 -> desmopressin
Which type of polycystic kidney disease presents in neonates?
Autosomal recessive PKD
What are features of autosomal recessive PKD?
Can be seen on antenatal scans with:
enlargement of collecting ducts
Oligohydramnios
Pulmonary hypoplasia (due to oligohydramnios)
Potter syndrome
Congenital liver fibrosis
What is a Wilm’s tumour and how does it present?
Specific type of tumour which affects the kidney in children
Mass in abdomen
Abdominal pain
Haematuria
Lethargy
Weight loss
Fever
How is a Wilm’s tumour diagnosed?
Abdominal ultrasound
Use MRI/CT to stage
How is a Wilm’s tumour treated?
Nephrectomy
What is a posterior urethral valve?
Tissue at the proximal end of the urethra, causing obstruction of urine outflow and build up in the bladder
Leads to back flow to the kidney (Hydronephrosis)
How does a posterior urethral valve present?
Presents antenatally with oligohydramnios and pulmonary hypoplasia
How do you manage a neonate with undescended testes?
Watch and wait - most will descend by 3-6 months
If not descended by 6 months - referral needed
What is hypospadias? How is it treated?
Congenital abnormality of the penis
Urethra is displaced towards the scrotum
Treated with corrective surgery at 12 months age
What is a hydrocele and how does it present? When are they normal?
Collection of fluid within the tunica vaginalis
Soft, smooth non-tender swelling
Transilluminates
Common in newborn males
Should absorb by 2 years of age
