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Year 4 - 3. Paediatrics > Paediatric Nephrology / Urology > Flashcards

Paediatric Nephrology / Urology Flashcards

1
Q

Outline the difference between primary nocturnal enuresis and secondary nocturnal enuresis

A

Primary nocturnal enuresis - child has never managed to be consistently dry at night

Secondary nocturnal enuresis - child starts wetting the bed, after previously being consistently dry at night for 6 MONTHS

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2
Q

State some reasons for primary nocturnal enuresis

A

Part of normal development if < 5 years old

Other causes:
- Excessive fluid intake prior to bedtime
- Overactive bladder
- Failure to wake during deep sleep from a full bladder
- Psychological stress

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3
Q

State some reasons for secondary nocturnal enuresis and how it is managed

A

Secondary to other problems:
- Type 1 diabetes
- Chronic constipation
- UTI
- Psychological stress / abuse or maltreatment

Management:
- Treat the underlying cause!

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4
Q

Outline how primary nocturnal enuresis is managed in the first instance

A

Important to determine cause of enuresis
- Keep a 2 week bladder diary with: toileting patterns, fluid intake and bedwetting episodes
- Undertake history and examination

Management:
- If under 5 = reassurance
- Lifestyle changes e.g. limit fluid intake before bed, toilet before bed
- Encouragement and positive reinforcement
- Enuresis alarm
- Pharmacological treatment e.g. Desmopressin, Oxybutinin, Imipramine

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5
Q

Outline diurnal enuresis, the 2 types and some causes

A

Diurnal enuresis is daytime incontinence of urine

2 types:
- Urge incontinence
- Stress incontinence

Causes:
- UTI
- Chronic constipation
- Psychological stress

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6
Q

For the 3 drugs used in the pharmacological treatment of bedwetting, state the class of drug and how it helps
- Desmopressin
- Oxybutinin

A

Desmopressin = antidiuretic hormone
- Take before bed
- Reduces volume of urine produced by the kidneys

Oxybutinin = anticholingeric
- Reduces contractility of the bladder
- Helpful when cause is an overactive bladder

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7
Q

State what % of boys are born with undescended testes and what future risks this is associated with

A

5% of boy babies testes won’t be descended out of the abdomen at birth

Associated future risks:
- Infertility
- Testicular cancer
- Testicular torsion

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8
Q

State some risk factors for undescended testes

A
  • Family history of undescended testes
  • Prematurity / low birth weight / small for gestational age
  • Maternal smoking
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9
Q

Outline how undescended testes are managed

A

Watch and wait for newborns - in most cases they will descend within 3-6 months (however longer it takes, the less likely it is to happen spontaneously)

If undescended by 6 months, orchidopexy carried out between 6-12 months of age

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10
Q

For epididymo-orchitis, state the most common cause / causative organism for younger paediatric patients, vs older paediatric patients

A

Younger paediatric patients:
- UTI
- E Coli
- ?Mumps

Older paediatric patients and teens:
- STI
- Gonorrhoea or chlamydia

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11
Q

Hypospadias - state the following:
- Pathophysiology
- Presentation
- Management

A

Pathophysiology:
- Congenital abnormality where the urethral meatus is positioned posteriorly on the penis
- Mostly at the bottom of the glands, however can be halfway down the shaft or at the base
- Occurs due to arrest of penile development, leading to hypoplasia of the ventral penis tissue

Presentation:
Commonly diagnosed during newborn examination
- Parents may describe abnormal urinary flow
- May have associated chordee

Management:
- Urethroplasty (either single step or 2 step with a foreskin graft)

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12
Q

Briefly state the difference between hypospadias and epispadias

A

In hypospadias, the urethral meatus displaced posteriorly on the penis
Whereas in epispadias, the urethral meatus displaced anteriorly on the penis

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13
Q

State a differential that must not be missed when hypospadias is suspected

A

Congenital adrenal hyperplasia

Should be considered in females with ambiguous genitalia
If not detected early, can lead to a hyponatraemic crisis due to cortisol and aldosterone deficiency

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14
Q

State some complications of hypospadias if not treated

A
  • Difficultly controlling urination
  • Psychological distress
  • Sexual dysfunction
  • Cosmetic concerns
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15
Q

State some short-term and long-term complications of urethroplasty for management of hypospadias

A

Short term:
- Catheter complications e.g. blockage or infection
- Infection
- Bleeding

Longer term:
- Urethral fistula
- Stenosis of meatus or urethra

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16
Q

Hydrocele - state the following:
- Pathophysiology (including 2 main categories)
- Presentation
- Investigations
- Management

A

Pathophysiology:
- Collection of fluid within the tunica vaginalis
- Either simple (non-communicating) or communicating hydrocele
- Mostly congential

Presentation:
- Swollen/enlarged teste(s), especially after exertion (can get above)
- Soft and smooth
- Minimal associated pain
- Transilluminates

Investigations:
- Often clinical diagnosis with transillumination of testicle
- Ultrasound can be used

Management:
- If simple, reassure that it will resolve within 2 years with follow up
- If communicating/persisting, open / laparoscopic ligation of processus vaginalis

17
Q

State some differentials for hydrocele in newborns / children

A
  • Testicular torsion
  • Partially descended testes
  • Epididymo-orchitis
  • Inguinal hernia
  • Haematoma
  • Tumour (rare)
18
Q

State the difference between simple (non-communicating) and communicating hydroceles in terms of pathophysiology

A

Simple (non-communicating) hydroceles:
- Due to an imbalance absorbing serous fluid from peritoneal cavity

Communicating hydroceles:
- Persistence of processus vaginalis
- Allows flow of peritoneal fluid from peritoneum to the tunica vaginalis

19
Q

Inguinal hernia - state the following:
- Pathophysiology
- Presentation (including any red flags)
- Investigations
- Management

A

Pathophysiology:
- Protrusion of intra-abdominal contents through a defect of the walls of the abdominal cavity, into the inguinal canal
- Indirect hernias are more common due to incomplete closure of processus vaginalis

Presentation:
- Groin swelling / protrusion
- Abdominal discomfort
- Constipation
- Reducible if lying flat / positive cough reflex
Red flag (signs of obstruction or strangulation)
- Vomiting
- Constipation
- Abdominal pain

Investigations:
Largely clinical
- May use ultrasound
- CT scan if features of obstruction or strangulation and uncertainty

Management:
- Surgical herniotomy (repair)
- Emergency surgery may be needed in the case of an irreducible hernia

20
Q

State whether a direct or indirect hernia is more common in children and explain the pathophysiology

A

Indirect inguinal hernia are the most common form in children,

  • Often due to incomplete closure of the processus vaginalis (after the descent of testes in utero)
  • Allows abdominal contents to protrude through the deep inguinal ring into the inguinal canal, and through the superficial inguinal ring into the groin
21
Q

State some differentials for a scrotal hernia

A
  • Testicular torsion
  • Partially descended testes
  • Epididymo-orchitis
  • Hydrocele
  • Haematoma
  • Tumour (rare)
22
Q

State some risk factors for inguinal hernias

A
  • Male
  • Family history of inguinal hernias
  • Prematurity
23
Q

State some complications of inguinal hernias

A
  • Strangulation
  • Incarceration
  • Bowel obstruction
  • Recurrence
24
Q

State how a UTI may present in a young child

A
  • Fever (may be the only sign!)
  • Increased urinary frequency
  • Irritability
  • Lethargy
  • Reduced feeding
  • Vomiting
25
Q

State 2 features in children that indicate pyelonephritis and which a diagnosis can be made off

A
  • Fever (>38)
  • Loin pain / tenderness
26
Q

State how children can be managed for UTIs (under 3 months and over 3 months)

A

If under 3 months and fever:
- Started on IV antibiotics
- Full septic screen (full bloods, blood cultures and lactate)
- Consider lumbar puncture

If over 3 months and fever:
- Consider oral antibiotics if otherwise well
- If features of sepsis or pyelonephritis, start on IV antibiotics

If under 6 months and first UTI, should have ultrasound scan to check for underlying cause

27
Q

Suggest some antibiotics that could be used to treat paediatric UTIs

A
  • Trimethoprim
  • Nitrofurantoin
  • Cefalexin
  • Amoxicillin
28
Q

State the referral criteria to renal USS for UTIs (i.e. when to refer for USS)

A
  • < 6 months old
  • Atypical UTI e.g. abdominal mass, failure to response to antibiotics, non-E.Coli organism
  • Recurrent UTIs (2 or more upper UTIs, 3 or more lower UTIs)
29
Q

State the test used to diagnose vesico-ureteric reflux (VUR)

A

Micturating cysto-urethrogram (MCUG)

30
Q

State some causes of chronic kidney disease in children (inherited and acquired)

A

Inherited:
- Congenital defects e.g. renal atresia, renal hypoplasia, renal dysplasia
- Inherited conditions e.g. polycystic kidney disease or Alport syndrome
glomerulonephritis

Acquired:
- Trauma / dehydration e.g. sepsis
- Nephrotic syndrome
- Infections e.g. haemolytic uraemic syndrome or post-streptococcal
- Systemic conditions e.g. Lupus
- Chronic obstruction
- Vesico-ureteric reflux

31
Q

Acute Kidney Injury (AKI) - state the following:
- Pathophysiology
- Presentation
- Investigations
- Management

A

Pathophysiology:
- Sudden decline in kidney function

Investigations:
- Serum creatinine (> 1.5x reference creatinine or age-specific upper limit)
- Urine output level (<0.5mls/kg/hr for 8 hours)
- FBC
- Ultrasound KUB
- Urinalysis and urine MC&S

Management:
- Resolve underlying cause or any contributing factors
- Omit any nephrotoxic medications

32
Q

State more common causes of AKI in paediatrics

A

Reduced renal blood flow secondary to:
- Hypovolaemia e.g. dehydration, diarrhoea, blood loss
- Sepsis

33
Q

List some causes of true haematuria

A

Benign:
- Vigourous exercise
- Trauma along urinary tract e.g. catheter

Other:
- UTI
- Renal stones
- Clotting abnormalities
- Glomerulonephritis
- Alport syndrome
- Haemolytic uraemic syndrome
- Tumour e.g. Wilms tumour
- Adenovirus haemorrhagic cystitis

+ myoglobin
+ haemoglobin (not RBCs)

34
Q

State some conditions/situations that could lead to brown urine (not haematuria)

A
  • Red foods e.g. beetroot
  • Medications e.g. Rifampicin, Metronidazole, Nitrofurantoin
  • Inborn errors of metabolism
35
Q

Wilm’s tumour - state the following:
- Pathophysiology
- Most common age
- Presentation (including any red flags)
- Investigations
- Management

A

Pathophysiology:
- Renal tumour

Most common age:
- Typically affects children under 5 years old

Presentation:
- Abdominal mass
- Abdominal pain
- Haematuria
- B symptoms e.g. fever, weight loss
- Lethargy
- Hypertension

Investigations:
- USS abdomen (KUB)
- Biopsy needed for definitive diagnosis
- CT/MRI can be used for further staging

Management:
- Surgical excision of tumour and affected kidney (nephrectomy)
- Adjuvant treatment (chemotherapy or radiotherapy)
Early disease has a good prognosis 90% cure

Year 4 - 3. Paediatrics (16 decks)

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