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Phase 3a medicine > Paediatric - Renal and urinary > Flashcards

Paediatric - Renal and urinary Flashcards

1
Q

Name an upper tract UTI and a lower tract UTI

A

Upper: Pyelonephritis / Lower: Cystitis

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2
Q

Name 2 investigations for UTI in children

A
  • USS renal tract
  • Micturating cystourethrogram (MCUG) (prophylactic Abx / VUR?)
  • DMSA scan
  • Urinalysis (MSU/Clean Catch) = only if Sx of UTI (fever, vomit, lethargy, dysuria)
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3
Q

3 criteria for nephrotic syndrome

A

Heavy proteinuria + Hypoalbuminaemia + Oedema

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4
Q

3 criteria for Acute Glomerulonephritis

A

Haematuria + Hypertension + Oedema

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5
Q

Management for Primary Nocturnal Enuresis for children under 7 years old? (+over 7 years old?)

A
  • Reassure parents of children under 5 years that it is likely to resolve without any treatment
  • Lifestyle changes: reduced fluid intake in the evenings, pass urine before bed and ensure easy access to a toilet
  • Encouragement and positive reinforcement. Avoid blame or shame. Punishment should be avoided.
  • Treat any underlying causes or exacerbating factors, such as constipation
  • An enuresis alarm is first-line for children under the age of 7 years
  • (+ rewards system)
  • Pharmacological treatment - Desmopressin
  • (Over 7 years old => desmopressin may be used first-line, particularly if short-term control is needed or an enuresis alarm has been ineffective/is not acceptable to the family)
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6
Q

Name some features for Urinary Tract Infection in babies?

+ older infants and children?

A

Babies:

  • Fever
  • Lethargy
  • Irritability
  • Vomiting
  • Poor feeding
  • Urinary frequency

Older Infants:

  • Fever
  • Abdominal pain, particularly suprapubic pain
  • Vomiting
  • Dysuria (painful urination)
  • Urinary frequency
  • Incontinence
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7
Q

What is the ideal urine sample for UTI?

A

clean catch sample, avoiding contamination

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8
Q

What 2 things might you expect on the urine dipstick of a child with a UTI?

A
  • Nitrites (gram negative bacteria (such as E. coli) break down nitrates into nitrites)
  • Leukocytes (inflammation)
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9
Q

What should be suspected in all children with unexplained fever of 38°C or more, or loin pain/tenderness?

A

Pyelonephritis

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10
Q

How might you investigate recurrent UTI’s in under 16’s?

A
  • Ultrasound scan
  • DMSA (Dimercaptosuccinic Acid) Scan => assesses kidney damage
  • Micturating Cystourethrogram (MCUG) to assess Vesico-Ureteric Reflux (VUR) => urine may flow from the bladder back into the ureters
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11
Q

Name a typical antibiotic choice for urinary tract infections in children

A

First: Cefalexin
Second: Nitrofurantoin, Co-Amoxiclav, Trimethoprim, Amoxicillin

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12
Q

Name some causes of Secondary Nocturnal Enuresis

A 
Urinary tract infection
Constipation
Type 1 diabetes
New psychosocial problems (e.g. stress in family or school life)
Maltreatment (abuse / safeguarding)
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13
Q

Name 2 most common types of incontinence which cause diurnal enuresis

A
  • Urge incontinence is an overactive bladder that gives little warning before emptying
  • Stress incontinence describes leakage of urine during physical exertion, coughing or laughing.
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14
Q

Name a cause of CKD

A
  • Hypertension
  • Diabetes mellitus.
  • Glomerular disease - eg, acute glomerulonephritis.
  • Acute kidney injury.
  • Nephrotoxic drugs - eg, aminoglycosides, ACE inhibitors, angiotensin-II receptor antagonists, bisphosphonates, diuretics, lithium and NSAIDs.
  • Conditions associated with obstructive uropathy - eg, structural renal tract disease, neurogenic bladder, benign prostatic hypertrophy, urinary diversion surgery, recurrent urinary tract calculi.
  • Multisystem diseases with potential renal involvement - eg, systemic lupus erythematosus (SLE), vasculitis, myeloma.
  • Family history of CKD
  • Cardiovascular disease.
  • Obesity with metabolic syndrome (obesity alone is not a risk factor).
  • Gout.
  • Solitary functioning kidney.
  • Low birth weight (2.5 kg or lower).
  • Incidental finding of haematuria or proteinuria.
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15
Q

What is the most common cause of nephrotic syndrome in children?
(+ others)

A

Minimal change disease (2-5 yr old child)

Secondary to intrinsic kidney disease: Focal segmental glomerulosclerosis / Membranoproliferative glomerulonephritis
Secondary to an underlying systemic illness: Henoch schonlein purpura (HSP) / Diabetes / Infection

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16
Q

What part of the kidney is affected in Minimal Change Disease?

A

Damage to Glomeruli

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17
Q

What are some features of Minimal Change Disease?

A
  • 2-5yr old child with foamy urine due to large amounts of protein leaking into your urine, called proteinuria
  • Peripheral Oedema
  • Weight gain due to the fluid your body is not able to get rid of
  • Nephrotic Syndrome:
    Oedema + Proteinuria + Hypoalbuminaemia
    (Loss of protein in your blood)
    (Hypercholesterolaemia)
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18
Q

Management for Minimal Change Disease

A

Corticosteroids (prednisolone)

For symptoms of swelling (edema):
ACE inhibitor or ARB medicines
Diuretics (water pills)
Limit sodium (salt in your diet

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19
Q

Name a cause of Congenital Nephrotic Syndrome

A

Primary CNS

  • Nephrin gene mutations (NPHS1, CNF)
  • Podocin gene mutations (NPHS2)
  • WT1 gene mutations (Denys-Drash, isolated CNS)
  • LamB2 gene mutations (Pierson syndrome)
  • PLCE1 gene mutations
  • LMX1B mutations (nail-patella syndrome)
  • LamB3 gene mutations (Herlitz junctional epidermolysis bullosa)
  • Mitochondrial myopathies

Secondary CNS

  • Congenital syphilis
  • Toxoplasmosis, malaria
  • Cytomegalovirus, rubella, hepatitis B, HIV
  • Maternal systemic lupus erythematosus
  • Neonatal autoantibodies against neutral endopeptidase
  • Maternal steroid–chlorpheniramine treatment
20
Q

What are the two most common causes of nephritis in children?

A

Post-streptococcal glomerulonephritis

  • occurs 1 – 3 weeks after a β-haemolytic streptococcus infection, such as tonsillitis caused by Streptococcus pyogenes
  • Immune complexes made up of streptococcal antigens, antibodies and complement proteins get stuck in the glomeruli of the kidney and cause inflammation

IgA nephropathy (Berger’s disease)

  • Related to Henoch-Schonlein Purpura (IgA vasculitis)
  • Renal biopsy shows ‘glomerular mesangial proliferation + IgA deposits’
  • Fluid + electrolyte balance, immunosuppressants may be required (cyclophosphamide)
21
Q

How long after a β-haemolytic streptococcus infection (such as tonsillitis caused by Streptococcus pyogenes) might Post-streptococcal glomerulonephritis occur?

A

1-3 weeks

22
Q

IgA nephropathy is also called?

A

Berger’s disease

23
Q

What is Berger’s Disease?

A

IgA nephropathy

24
Q

Which IgA vasculitic condition is associated with Berger’s Disease?

A

Henoch-Schonlein Purpura

25
Q

What are the 4 classic features of Alport’s syndrome?

A
  • Haematuria.
  • Progressive chronic kidney disease (hereditary congenital haemorrhagic nephritis).
  • Sensorineural hearing loss.
  • Several ocular abnormalities.
26
Q

Glomerulonephritis is common in what multisystem autoimmune disorder?

A

Systemic Lupus Erythematosus (SLE)

27
Q

Where is the urethral meatus displaced in Hypospadias and Epispadias?

A

Hypospadias - Ventral side

Epispadias - Dorsal side

28
Q

Does Hypospadias require referral?

A

Hypospadias requires referral to a paediatric specialist urologist for ongoing management. It is important to warn parents not to circumcise the infant until a urologist indicates this is ok.

Mild cases may not require any treatment
Surgery is usually performed after 3 – 4 months of age
Surgery aims to correct the position of the meatus and straighten the penis

29
Q

What is the triad of Haemolytic Uraemic Syndrome?

Test result + Blood result + Condition

A
  • Microangiopathic haemolytic anaemia (Coombs’ test negative).
  • Thrombocytopenia.
  • Acute kidney injury (acute renal failure).

(The classical presenting feature is profuse diarrhoea that turns bloody 1 to 3 days later)
(Most adults infected with E.Coli remain asymptomatic)
(There is often fever, abdominal pain and vomiting)

30
Q

What is the most common cause of acute kidney injury in children?

A

Haemolytic Uraemic Syndrome

31
Q

Name a risk factor for Haemolytic Uraemic Syndrome

A
  • Rural populations >urban populations.
  • Warmer summer months (June-September).
  • Young age (6 months to 5 years).
  • Older people or those with altered immune response.
  • Contact with farm animals.
32
Q

Dipstick for Vulvovaginitis may lead to misdiagnosis of what condition?

A

urine dipstick may show leukocytes but no nitrites. This will often result in misdiagnosis as a urinary tract infection

33
Q

Simple measures to improve symptoms of Vulvovaginitis?

A
  • Avoid washing with soap and chemicals
  • Avoid perfumed or antiseptic products
  • Good toilet hygiene, wipe from front to back
  • Keeping the area dry
  • Emollients, such as sudacrem can sooth the area
  • Loose cotton clothing
  • Treating constipation and worms where applicable
  • Avoiding activities that exacerbate the problem
    (severe cases may be treated w oestrogen cream to improve symptoms)
34
Q

Management of minimal change disease

A

corticosteroids (i.e. prednisolone) (prognosis is good and most children (2-5yrs) make a full recovery, however it may reoccur)

35
Q

Nephrotic syndrome management

A
  • High dose steroids (i.e. prednisolone) (given for 4 weeks and then gradually weaned over the next 8 weeks)
  • Low salt diet
  • Diuretics may be used to treat oedema
  • Albumin infusions may be required in severe hypoalbuminaemia
  • Antibiotic prophylaxis may be given in severe cases
    (In steroid resistant children, ACE inhibitors and immunosuppressants such as cyclosporine, tacrolimus or rituximab may be used)
36
Q

Haemolytic Uraemic Syndrome is caused by which toxin?

A

Shiga toxin produced by E.Coli + Shigella

Symptoms typically start around 5 days after the onset of diarrhoea

37
Q

Management of HUS?

A
  • Urgent referral to the paediatric renal unit for renal dialysis if required
  • Antihypertensives if required
  • Careful maintenance of fluid balance
  • Blood transfusions if required
38
Q

Autosomal recessive polycystic kidney disease is caused by mutation of PKHD1 gene on which chromosome?

A

chromosome 6 (PKHD1 codes for fibrocystin/polyductin protein complex (FPC), which is responsible for the creation of tubules and the maintenance of healthy epithelial tissue in the kidneys, liver and pancreas)

39
Q

Complications of Autosomal recessive polycystic kidney disease?

A
  • Liver failure due to liver fibrosis
  • Portal hypertension leading to oesophageal varices
  • Progressive renal failure
  • Hypertension due to renal failure
  • Chronic lung disease
    (The prognosis is poor)
40
Q

Investigation + Management of Wilms’ tumour

A
  • Ix = USS abdomen (CT or MRI for staging) (Biopsy for staging)
  • Surgical excision of the tumour with affected kidney (nephrectomy)
  • Adjuvant treatment refers to treatment that is given after the initial management with surgery
    ○ Adjuvant chemotherapy
    ○ Adjuvant radiotherapy
41
Q 
Child <5 years presenting with a mass in the abdomen + signs of: 		
○ Abdominal pain
○ Haematuria
○ Lethargy
○ Fever
○ Hypertension
Weight loss
A

Wilms tumour

42
Q

Most common complication of posterior urethral valve?

A

UTIs due to restriction of outflow / Severe cases in the developing fetus result in bilateral hydronephrosis and oligohydramnios (low amniotic fluid volume) leading to underdeveloped fetal lungs (pulmonary hypoplasia) with respiratory failure shortly after birth.

43
Q

Ix + Mx of posterior urethral valve

A
  • Abdominal USS may show enlarged, thickened bladder and bilateral hydronephrosis
  • Micturating cystourethrogram (MCUG) shows the location of the extra urethral tissue and reflux of urine back into the bladder
  • . Cystoscopy can be used to get a detailed view of the extra tissue + to ablate or remove the extra tissue.
44
Q

Orchidopexy for undescended testes should be performed at what age?

A

between 6 and 12 months of age

45
Q

What is the condition in which the urethral meatus is displaced on the dorsal side of the penis in males?

A

Epispadias

46
Q

Where is the collection of fluid in a hydrocele?

A

In the tunica vaginalis that surround the testes
(In a communicating hydrocele, the tunica vaginalis is connected to the peritoneum by the processes vaginalis which allows fluctuating size of the hydrocele)

Phase 3a medicine (24 decks)

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