Paediatric Renal & Urological Disease

Question 1

Neonatal Nephrocalcinosis

Answer 1

Neonatal Nephrocalcinosis: calcium deposits in the parenchyma of the kidney.

This disease is seen in sick premature infants and can be associated with broncho-pulmonary dysplasia and medullary pacification. It often spontaneously resolves but there can be long term problems. Diuretics can be given to help promote calcium excretion (furosemide).

Question 2

Neonatal Renal Vein Thrombosis

Answer 2

Neonatal Renal Vein Thrombosis: poor blood flow to the kidneys causes thrombosis in the renal veins (bilateral or unilateral). The neonate may present with an abdominal mass and gross hematuria (+/- wet lung disease, umbilical infection, CKD), and acute renal failure. The kidneys become large. The treatment is dialysis at a young age and kidney transplant.

Question 3

Cystinosis

Answer 3

Cystinosis: proximal tubulopathy caused by excessive storage of cystine in WBCs resulting in lysosomal dysfunction and renal disease early in life.

Clinically, these babies will present with corneal crystals. There may also be constipation, potassium wasting, phosphaturia, bicarbonaturia, hypothyroidism, FTT. The treatment is to provide eye drops and replace loss electrolytes.

Question 4

What are pre-renal causes of AKI in paediatrics?

Answer 4

AKI Pre-Renal: coarctation, congenital heart disease, renal artery stenosis, large vessel arteritis (Takayasu)

Question 5

What are renal causes of AKI in paediatrics?

Answer 5

AKI Renal: post infectious glomerulonephritis, HUS (ecoli 0157)

Question 6

What are post-renal causes of AKI in paediatrics?

Answer 6

AKI Post-Renal: posterior urethral valves

Question 7

Cryptorchidism

Answer 7

Cryptorchidism: undescended testes. It is associated with inguinal hernias, higher incidence of testicular tumors and higher incidence of infertility.

Question 8

You meet Blake, a 4-month-old boy with a one-day history of fever, vomiting and poor intake. He does not have any other infectious symptoms (no resp. symptoms, rash or diarrhea). What is the best test for diagnosis in this baby?

Answer 8

This baby likely has a UTI. The best test is to obtain a urine sample via catheterization or supra pubic aspirate.

Question 9

What is the most common cause of bladder infections in paediatrics?

Answer 9

Dysfunctional voiding: withholding voiding resulting in bladder sphincter dyssynergia (strong internal bladder sphincter that doesn’t allow for full voiding of the bladder). It is associated with pelvic floor tightness.

Question 10

What is the most common scenario of an impalpable testis?

Answer 10

Testicular atrophy (vanishing testis)

Question 11

Vesivoureteric Reflux (VUR)

Answer 11

VUR: active or passive wash back of urine to the kidneys (passive more severe). Diagnosis is extremely important as VUR + UTIs can cause renal scarring, damage and eventually result in HTN.

Question 12

What is the best way to rule out renal scarring in a case of VUR?

Answer 12

DMSA Renal Scan

Question 13

Name one paediatric urological emergency.

Answer 13

Testicular torsion!