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Paediatric rotation > Paediatric renal and urology > Flashcards

Paediatric renal and urology Flashcards

1
Q

What is cystitis?

A

Inflammation of the bladder and can be a result of a bladder infection

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2
Q

What are the symptoms of UTI in babies?

A

Fever
Lethargy
Irritability
Vomiting
Poor feeding
Urinary frequency

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3
Q

What are the symptoms of UTI in older children?

A

Fever
Abdominal, suprapubic pain
Vomiting
Dysuria
Urinary frequency
Incontinence

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4
Q

When is a diagnosis of pyelonephritis made?

A

A temperature greater than 38 degrees
Loin pain or tenderness

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5
Q

What does the presence of nitrites in urine suggest and why?

A

Bacteria as gram negative bacteria (such as E.coli) break down nitrates, a normal waste product of urine into nitrites

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6
Q

What do leukocytes in the urine suggest?

A

Leukocytes are white blood cells and normally found in urine. A significant rise however can indicate infection. Urine dipstick tests for leukocyte esterase which is a product of leukocytes

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7
Q

Are nitrites or leukocytes a better indication of UTI?

A

Nitrites- if just increased leukocytes then don’t treat for UTI unless there is clinical evidence

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8
Q

What is sent to the lab when testing for UTI?

A

Midstream urine

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9
Q

What is the management for children under 3 months with a fever?

A

Immediate IV abx (e.g. ceftriaxone) and full septic screen, blood cultures and lactate, maybe also a lumbar puncture

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10
Q

What are typical antibiotic choices for management of UTI in children over 3 months?

A

Trimethoprim
Nitrofurantoin
Cefalexin
Amoxicillin

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11
Q

Which children with UTI should have an ultrsound?

A

All children under 6 months with their first UTI
Children with recurrent UTIs within 6 weeks
Children with atypical UTIs

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12
Q

When are Dimercaptosuccinic acid scans used in UTI in children?

A

4-6 months after illness to assess for damage from recurrent or atypical UTIs.

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13
Q

How do DMSA scans work?

A

Involves injecting a radioactive material (DMSA) and using a gamma camera to assess how well material is taken up by the kidneys. Where there are patches of kidney that have not taken up the material, this indicates scarring that may be the result of previous infection

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14
Q

What is vesico-ureteric reflux and what does it predispose people to?

A

Where urine has the tendency to flow from the bladder back into the ureters predisposing to UTIs and subsequent renal scarring

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15
Q

How is vesico-ureteric reflux diagnosed?

A

Micturating cystourethrogram

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16
Q

What is the management of vesico-ureteric reflux?

A

Avoid constipation
Avoid an excessively full bladder
Prophylactic antibiotics
Surgical input from paediatric urology

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17
Q

When should micturating cystourethrogram used?

A

To investigate atypical or recurrent UTIs in children under 6 months. Also used where there is family history of vesico-ureteric reflux, dilation of the ureter on ultrasound or poor urinary flow

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18
Q

What does micturating cystourethrogram involve?

A

Catheterising the child, injecting contrast into the bladder and taking a series of xray films to determine whether the contrast is refluxing. Children are usually given prophylactic antibiotics for 3 days around the time of the investigation

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19
Q

What is vulvovaginitis?

A

Inflammation and irritation of the vulva and vagina

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20
Q

Who does vulvovaginitis affect?

A

Girls aged 3 to 10 years

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21
Q

What can vulvovaginitis be exacerbated by?

A

Wet nappies, Chemicals or soaps, tight clothing that traps moisture or sweat in the area, poor toilet hygiene, constipation, threadworms, pressure on the area e.g. horse riding, heavily chlorinated pools

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22
Q

Why is vulvovaginitis less common after puberty?

A

Oestrogen helps keep the skin and vaginal mucosa healthy and resistant to infection

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23
Q

What does vulvovaginitis present with?

A

Soreness
Itching
Erythema around the labia
Vaginal discharge
Dysuria
Constipation

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24
Q

Why is vulvovaginitis often misdiagnosed as a UTI?

A

Because a urine dipstick may show leukocytes but will not show nitrites

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25
What is the management for vulvovaginitis?
Usually no treatment required Avoid washing area with harsh soaps and perfumes Keep the area dry Emollients Loose cotton clothing
26
What is nephrotic syndrome?
When the basement membrane in the glomerulus becomes highly permeable to protein, allowing proteins to leak from the blood into the urine.
27
At what ages is nephrotic syndrome most common?
2 to 5 years
28
What does nephrotic syndrome present with?
Frothy urine, generalised oedema and pallor
29
What is the classic triad of features for nephrotic syndrome?
Low serum albumin, High urine protein content (>3 + protein on urine dipstick), oedema
30
Apart from the classic triad, what other three symptoms occur in patients with nephrotic syndrome?
Deranged lipid profile with high levels of cholesterol., triglycerides and low density lipoproteins High BP Hyper-coagulability with an increased tendency for blood clots
31
What is the most common cause of nephrotic syndrome in children?
Minimal change disease causes over 90% of cases in children under 10
32
What are the secondary causes of nephrotic syndrome?
Intrinsic kidney disease: focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis Systemic illness: Henoch schonlein purpura, Diabetes, Infection (HIV, hepatitis and malaria)
33
What is the diagnosis for minimal change disease?
Renal biopsy and standard microscopy Urinanalysis will show small molecular weight proteins and hyaline cysts
34
What is the management of minimal change disease?
Corticosteroids and most children make a full recovery.
35
What is the management for nephrotic syndrome?
Corticosteroids Low salt diet Diuretics for oedema Albumin infusions in severe hypo Antibiotic prophylaxis if severe
36
What is the treatment of nephrotic syndrome using corticosteroids?
High dose are given for 4 weeks and then gradually weaned over the next 8 weeks
37
What does steroid sensitive mean?
They respond to steroids (80% of children)
38
What does steroid dependent mean?
Patients struggle to wean steroids due to relapses
39
What is steroid resistant?
Patients that do not respond to steroids
40
What is used for nephrotic syndrome in steroid resistant children?
ACE inhibitors and immunosuppressants such as cyclosporine, tacrolimus or rituximab
41
What are the complications of nephrotic syndrome?
Hypovolemia- fluid from intravascular space leaks into interstitial space, causing oedema and low BP Thrombosis- proteins that prevent blood clotting are lost in the kidneys and liver responds to low albumin by producing pro-thrombotic proteins Infection- kidneys leak immunoglobulins, exacerbated by immunosuppressant meds such as steroids Acute or chronic renal failure Relapse
42
What is nephritis?
Inflammation within the nephrons of the kidneys
43
What does nephritis cause?
Reduction in kidney function Haematuria: invisible or visible amounts of blood in the urine Proteinuria: although less than nephrotic syndrome
44
What are the two most common causes of nephritis in children?
Post-streptococcal glomerulonephritis and IgA nephropathy (Berger's disease)
45
When does post-streptococcal glomerulonephritis occur?
1-3 weeks after a beta-haemolytic streptococcus infection e.g. tonsilitis caused by streptococcus pyogenes.
46
How does strep infection cause glomerulonephritis?
Immune complexes of streptococcal antigens, antibodies and complement proteins get stuck in the glomeruli of the kidney and cause inflammation. Leading to an acute deterioration in renal function causing acute kidney injury.
47
What could suggest tonsilitis caused by streptococcus clinically?
History, throat swab or anti-streptolysin antibody titres on blood test
48
What is the management of post-streptococcal glomerulonephritis?
Usually supportive. May need treatment with anti-HTN medications and diuretics if they develop complications e.g. HTN and oedema
49
What is IgA nephropathy also known as?
Berger's disease
50
What is IgA nephropathy related to?
Henoch-Schonlein purpura which is an IgA vasculitis
51
How is IgA nephropathy related to Henoch-Schonlein purpura?
IgA deposits in the nephrons of the kidney cause inflammation (nephritis).
52
What will be seen in the renal biopsy of IgA nephropathy?
IgA deposits and glomerular mesangial proliferation
53
When does IgA nephropathy usually present?
teenagers or young adults
54
How is IgA nephropathy treated?
Supportive treatment and immunosuppressant medications such as steroids and cyclophosphamide to slow progression
55
What is haemolytic-uraemic syndrome?
Occurs when there is thrombosis within the small blood vessels throughout the body.
56
What is HUS usually triggered by?
Shiga toxin produced by e.coli 0157 or shigella
57
What is the classic triad of HUS?
Haemolytic uraemia Acute kidney injury: failure to excrete waste products Thrombocytopenia: low platelets
58
What can increase the risk of developing HUS?
antibiotics and anti-motility meds such as loperamide for gastroenteritis caused by pathogens
59
What is the timeline of presentation in HUS?
E.coli 0157 caused by brief gastroenteritis, often with bloody diarrhoea. Symptoms of HUS typically start around 5 days after the onset of the diarrhoea
60
What are the signs and symptoms of HUS?
Reduced urine output Haematuria or dark brown urine Abdominal pain Lethargy and irritability Confusion Oedema Hypertension Bruising
61
What is the prognosis of HUS?
Medical emergency and has 10% mortality 70-80% make a full recovery
62
What is the management of HUS?
Condition is self-limiting Renal dialysis may be required Maybe anti-HTN Maybe blood transfusions Careful fluid balance maintenance
63
What is enuresis?
Involuntary urination
64
What is diurnal enuresis?
Inability to control bladder function during the day
65
When do most children have control of urination the day?
2 years
66
When do most children have control of urination at night?
3-4 years
67
What is primary nocturnal enuresis?
Where the child has never managed to be consistently dry at night
68
What is the most common cause of primary nocturnal enuresis?
Variation in normal development especially if child is under 5
69
What are other causes of primary nocturnal enuresis?
Overactive bladder Fluid intake prior to bedtime Failure to wake due to deep sleep and underdeveloped bladder signals Psychological distress e.g. low self esteem Secondary causes such as chronic constipation, UTI, learning disability or cerebral palsy
70
What is the management of primary nocturnal enuresis?
reassurance lifestyle changes pharmacological treatment
71
What are the two types of polycystic kidney disease?
autosomal dominant and autosomal recessive
72
Which type of PKD presents in neonates?
Autosomal recessive
73
What mutation results in ARPKD and what does this code for?
polycystic and hepatic disease 1 genes (PKHD1) on chromosome 6. this codes for the fibrocystin/polyductin protein complex (FPC), which is responsible for the creation fo tubules and the maintenance of healthy epithelial tissue in the kidneys, liver and pancreas
74
What does the underlying pathology cause in ARPKD (3 things)
Cystic enlargement of the renal collecting ducts Oligohydramnios, pulmonary hypoplasia and potter syndrome Congenital liver fibrosis
74
What is usually seen on antenatal scans in ARPKD?
oligohydramnios and polycystic kidneys
74
What is oligohydraminos?
lack of amniotic fluid caused by reduced urine production by the fetus
74
what does a lack of amniotic fluid lead to?
Potter syndrome which si charcterised by dysmorphic features such as underdeveloped ear cartilage, low set ears, a flat nasal bridge and abnormalities of the skeleton
74
What does oligohydromnias lead to apart from Potter syndrome?
Underdeveloped lungs (pulmonary hypoplasia), resulting in respiratory failure shortly after birth. Also large polycystic kidneys take up a lot of space so hard for neonate to breathe
74
What might patients reuqire in teh first few days of life with ARPKD?
renal dialysis
75
What is the prognosis of those with ARPKD?
most patients develop end stage renal failure before reaching adulthood. Around 1/3 will die in neonatal period. Around 1/3 will survive to adulthood
76
What are the ongoing problems patients with ARPKD experience?
Liver failure due to liver fibrosis Portal HTN leading to oesophageal varices Progressive renal failure HTN due to renal failure Chronic lung disease
77
What is multicystic dysplastic kidney? (MCDK)
Where one of the baby's kidneys is made up of many cysts while the othe rkidney is normal
78
How is MCDK diagnsoed?
antenatal ultrasoun scans
79
What treatment is required for MCDK?
no treatment, usually the single kidney is sufficient.
80
What is Wilm's tumour?
Tumour affecting the kidney in children, usually under 5 years
81
What is the presentation of a Wilm's tumour?
Abdominal pain Haematuria Lethargy Fever Hypertension Weight loss Under 5 with a mass in the abdomen
82
What is the investigation for a Wilm's tumour?
Ultrasound A CT or BMI can be used to stage the tumour
83
What is the treatment for Wilm's tumour?
Surgical excision (nephrectomy) Adjuvant chemotherapy or radiotherapy
84
What is the prognosis of Wilm's tumour?
Early stage has a good chance of cure (up to 90%)
85
What is a posterior urethral valve?
Where there is tissue at the proximal end of the urethra that causes obstruction of urine output
86
Who does a posterior urethral valve occur in?
newborn boys
87
What does a posterior urethral valve cause?
Hydronephrosis- a restriction in the outflow of urine prevents the bladder from fully emptying, leading to a reservoir of urine that increases the risk of UTI
88
What is the presentation of posterior urethral valve
Can be asymptomatic Difficulty urinating weak urinary system chronic urinary retention palpable bladder recurrent UTI impaired kidney function
89
What can severe obstruction from posterior urethral valve cause?
Bilateral hydronephrosis oligohydramnios
90
What can be seen on antenatal scans with severe psoterior urethral valve?
Oligohydramnios and hydroneohrosis
91
What investigations are there for posterior urethral valve presenting after birth?
Abdominal ultrasound- may show enlarged, thickened bladder and bilateral hydronephrosis Micturating cystourehtrogram (MCIG) shows location of the extra urethral tissue Cystoscopy can be used to ablate or remove extra tissue
92
How do the testes develop normally?
Develop in the abdomen and then migrates down, through the inguinal canal and into the scrotum
93
What are undescended testes?
When the testes have not made it out of the abdomen by birth (around 5% of boys)
94
What is undescended testes also known as?
Cryptorchidism
95
What is it called when the testes have not descended fully but are palpable in the inguinal canal?
Not undescended testes technically
96
What are the RF for undescended testes?
Family history of undescended testes Low birth weight small for gestational age prematurity maternal smoking during pregnancy
97
What do undescended testes in older children or after puberty hold a higher risk of?
testicular torsion, infertility and testicular cancer
98
What is the management for undescended testes?
most will descend in first 3-6 months. Orchidopexy should be carried out between 6 to 12 months of age
99
What is retractile testicles?
normal before puberty for the testes to move out of the scrotum and into the inguinal canal when it is cold or the cremasteric reflex is activated. usually resolves
100
What is hypospadias?
affects males, where the urethral meatus is abnormally displaced to the ventral side of the penis, towards the scrotum
101
Where is the urethral meatus in hypospadias?
towards the bottom of the glans (90%) halfway down the shaft or base of the shaft
102
What is epispadias?
where the urethral meatus is displaced to the dorsal side (top) of the penis.
103
What is the foreskin like in hypospadias?
usually abnormally formed
104
What condition may be associated with hypospadias?
chordee, where the head of the penis bends downwards
105
When is hypospadias usually diagnosed?
on examination of the newborn
106
What type of condition is hypospadias?
congenital
107
What is the management if hypospadias?
mild cases may not require treatment surgery is usually peformed after 3-4 months of age correct the position of the meatus and straighten the penis
108
What are the complications of hypospadias?
difficulty directing urination cosmetic and pscyhological concerns sexual dysfunction
109
What is a hydrocele?
A collection of fluid within the tunica vaginalis that surrounds the testes.
110
What is the tunica vaginalis?
A sealed pouch of membrane that surrounds the testes
111
What is the tunica vaginalis originally part of?
peritoneal membrane
112
What is a simple hydrocele and who are they common in?
common in newborn males. occur where fluid is trapped in the tunica vaginalis. usually this fluid gets reabsorbed over time
113
what is a communicating hydrocele?
where the tunica vaginalis around the testicle is connected with the peritoneal cavity via a pathway called the processus vaginalis. This allows fluid to travel from the peritoneal cavity into the hydrocele, allowing the hydrocele to fluctuate in size
114
What is a hydrocele like on examination?
soft, smooth, non-tender swelling in front of and below the testicle. They transilluminate with light with a pen torch
115
What are the differential diagnosis for a scrotal or inguinal swelling in a neonate?
Hydrocele partially descended testes Inguinal hernia Testicular torsion Haematoma Tumours (rare)
116
What is a useful investigation for a hydrocele to rule out other causes?
Ultrasound
117
How long does it take for a simple hydrocele to resolve?
within 2 years
118
How is a communicating hydrocele managed?
surgical operation to remove or ligate the connection between the peritoneal cavity and the hydrocele (the processus vaginalis)

Paediatric rotation (14 decks)

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