Paediatric Urology

Question 1

Nephrotic syndrome

a) Triad of features
b) Triad of complications
c) Management

Answer 1

a) - HOP: hypoalbuminaemia, oedema (often peri-orbital in children), proteinuria
b) HIT: hyperlipidaemia, infection, thrombosis

c) - Monitor BP, eGFR and urinalysis
- Fluid restriction + diuretics
- Protein supplementation
- Steroids +/- cyclophosphamide, etc.

Question 2

HSP.

a) What is it?
b) Triggers
c) Presentation
d) Management
e) Prognosis

Answer 2

a) IgA-mediated
b) - Often post-infective (eg. strep throat, gastroenteritis), more common in the winter

c) - Skin rash: initially macular, then non-blanching palpable purpurae; backs of legs and buttocks)
- Arthritis
- Abdominal pain and bloody diarrheoa
- Nephritis - haematuria, HTN, proteinuria, oliguria

d) - Urine dip, BP, bloods (FBC, CRP, U+Es, creatinine)
- Image kidneys if worried (USS)
- Supportive care and monitoring (steroids don’t affect disease course)
- NSAIDs may be useful for joint pain but beware if renal involvement

e) - Usually self-limiting
- 1% progress to ESRD

Question 3

UTI: management

a) Initial
b) Further

Answer 3

b) - USS - detects structural abnormality (all children with atypical/severe infection in the acute management)
- DMSA - renal damage (atypical or recurrent infection, 6 weeks later)
- MCUG - reflux (in boys?)

Question 4

Enuresis.

a) Causes
b) Management

Answer 4

a) UTI, Diabetes, GU malformations

b) < 5: watch and wait
> 5: desmopressin (1 week break every 3 months)

Question 5

UTI in children.

a) Presentation < 1 year
b) Presentation > 1 year
c) Management in < 3 months
d) Management in > 3 months
e) Pyelonephritis

Answer 5

a) Fever, vomiting, lethargy, irritability, poor feeding, FTT
b) As for adults; plus: vomiting, poor feeding, dysfunctional voiding, or changes to continence

c) - Refer urgently to paediatrics
- Treatment with IV antibiotics
- Send urine sample sent for urgent MC+S

d) Urine dip:
- Leuk+/nitrite+or just nitrite + = start ABx
- Leuk+ = send for MC+S
- Leuk-/nitrite- = do not send urine, do not treat

e) - Suspect if high fever, loin pain, septic
- Admit to hospital
- oral cefalexin or co-amoxiclav