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Phase 3a conditions list flashcards > Paediatrics - Renal/ urinary > Flashcards

Paediatrics - Renal/ urinary Flashcards

1
Q

What is inflammation/ infection of the kidney known as?

A

Pyelonephritis

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2
Q

What is inflammation of the bladder known as?

A

Cystitis

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3
Q

What condition should all children with a fever be considered and excluded for?

A

UTIs

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4
Q

How does UTI present in babies (6)?

A
  • Fever
  • Lethargy
  • Irritability
  • Vomiting
  • Poor feeding
  • Urinary frequency
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5
Q

What additional symptoms of a UTI may older children have compared to babies (2)?

A
  • Dysuria (painful urination)
  • Incontinence
    abdo pain (suprapubic pain) with pyelonephritis
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6
Q

When should pyelonephritis be suspected (2)?

A
  • Temperature over 38
  • Loin/ groin pain
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7
Q

How should a UTI be investigated in those under 3 months?

A

Send MSU for MC&S (microscopy and culture)

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8
Q

How should UTI be investigated in those over 3 months (2)?

A
  • Urine dip
  • Send for MC&S if necessary
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9
Q

What would suggest a UTI on a urine dip (2)?

A
  • Nitrites (more specific)
  • Leukocytes (more sensitive)
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10
Q

When should MC&S be sent in children over 3 months (4)?

A
  • If UTI suspected from dip stick
  • If high risk form complications
  • If recurrent UTIs
  • Upper UTI suspected
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11
Q

How should children under 3 months with a suspected UTI be managed (3)?

A
  • Start IV Abx
  • Urgent referral to paeds
  • Septic screen
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12
Q

What is included in a septic screen for those under 3 months (3)?

A
  • Blood cultures
  • FBC, CRP, lactate
  • Lumbar puncture considered
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13
Q

How should children over 3 months be treated for a UTI?

A

Oral Abx

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14
Q

How should pyelonephritis be treated in children?

A

(IV) Abx ceftriaxone/ co-amoxiclav

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15
Q

What Abx should be used for UTI in children (4)?

A

First line:
* Nitrofurantoin or
* Trimethoprim
Second:
* Amoxicillin
* Cefalexin/ ceftriaxone

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16
Q

Which antibiotic should be used for pyelonephritis in children?

A

Cefalexin (IV ceftriaxone if severe)
co-amoxiclav = 2nd

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17
Q

How should children with UTIs be managed after the initial infection?

A

Certain groups should be imaged with USS of urinary tract for further problems

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18
Q

When should children under 6 months be imaged for UTIs (2)?

A
  • During the infection if there are recurrent UTIs or atypical bacteria
  • Within 6 weeks of the UTI for all
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19
Q

When should children older than 6 months be imaged for UTIs (2)?

A
  • Recurrent UTIs imaged within 6 weeks
  • Atypical UTIs during the illness
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20
Q

What constitutes an atypical UTI (4)?

A
  • Poor flow
  • Abdo mass
  • Failure to respond to typical Abx
  • Non-E. coli organisms
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21
Q

What other scan should be used to investigate all children with recurrent/ atypical UTI (other than MCUG and USS)?

A

DMSA (dimercaptosuccinic acid) scan

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22
Q

What does a DMSA scan show?

A

Reveals scaring of the kidney
kidney uptakes the acid contrast thing, the areas that don’t take it up are damaged/ scarred

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23
Q

How soon after UTI should a DMSA scan be performed?

A

Within 4-6 months

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24
Q

What does an MCUG scan show?

A

The structure of the urinary tract

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25
Q

What other scan should children under 6 months with recurrent/ atypical UTIs be investigated with (other than USS)?

A

MCUG (micturating cystourethrogram)

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26
Q

What condition causes urine to flow back from the bladder into the ureters?

A

Vesico-ureteric reflux

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27
Q

What are some complications of vesicle-ureteric reflux (2)?

A
  • UTIs + kidney scarring
  • Hydronephrosis
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28
Q

How is vesico-ureteric reflux managed (3)?

A
  • Lifestyle management (constipation, avoid excessively full bladder)
  • Prophylactic Abx
  • Surgery
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29
Q

How is vesico-ureteric reflux diagnosed?

A

MCUG (micturating cystourethrogram)

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30
Q

How are renal malformations investigated in children (5)?

A
  • Ultrasound (pre and post natal)
  • DMSA (for scarring)
  • MCUG (for anatomy)
  • Plasma creatinine ratio
  • eGFR
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31
Q

What are some congenital kidney malformations (5)?

A
  • Renal agenesis
  • Renal dysplasia (cystic kidneys)
  • Renal hypoplasia
  • Pelvic/ horseshoe kidney
  • Duplex kidney
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32
Q

What is renal agenesis?

A

The absence of the kidney (uni or bilateral)

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33
Q

What can cause renal dysplasia (2)?

A
  • Multicystic dysplastic kidney
  • Autosomal recessive/ dominant PKD
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34
Q

What is renal hypoplasia?

A

Kidneys are smaller than expected due to reduced number of nephrons

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35
Q

What is a pelvic/ horseshoe kidney?

A

The kidneys are fused at the lower end forming a U shape

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36
Q

What is a duplex kidney?

A

Kidney has two collecting systems and often two drain ducts (ureters)

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37
Q

What can a lack of amniotic fluid (oligohydramnios) in an unborn infant cause?

A

Potters syndrome

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38
Q

What is often the cause of potters syndrome/ lack of amniotic fluid?

A

Reduction in the production of urine from the foetus, therefore many congenital kidney malformations can cause potters syndrome

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39
Q

What are some features of potters syndrome (4)?

A
  • Low set ears
  • Beaked nose
  • Limb deformities
  • Pulmonary hypoplasia/ respiratory distress
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40
Q

What are some complications of kidney malformation (4)?

A
  • UTIs
  • Hypertension/ electrolyte imbalances
  • CKD
  • Potters syndrome
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41
Q

What are some urinary tract malformations (2)?

A
  • Vesicoureteric reflux
  • Obstructions
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42
Q

Where can an obstruction occur in the urinary tract (4)?

A
  • Pelvic-ureteric junction (between ureter and renal pelvis)
  • Vesico-ureteric junction (between ureter and bladder)
  • Bladder neck
  • Posterior urethra
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43
Q

What is a cause of vesico-ureteric junction obstruction?

A

Ureterocele (cystic swelling at bottom of ureter)

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44
Q

What may cause a bladder neck obstruction?

A

Neuropathic bladder (damaged nerves preventing the bladder neck from relaxing and allowing urine to drain through urethra)

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45
Q

Where is the posterior urethra?

A

Proximal urethra (closest to bladder)

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46
Q

What is a common obstruction at the posterior urethra?

A

Posterior urethral valve

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47
Q

What is a posterior urethral valve?

A

Extra tissue forms at the proximal urethra causing an obstruction to urine outflow from both kidneys

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48
Q

What are some complications of urinary tract malformations (2)?

A
  • UTI
  • Hydronephrosis –> dysplastic kidney –> CKD
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49
Q

How can urinary tract malformations present (3)?

A
  • Difficulty urinating/ weak stream
  • Recurrent UTIs
  • Impaired kidney function + potters syndrome
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50
Q

How are urinary tract malformations investigated (3)?

A
  • Abdo USS
  • MCUG
  • Cystoscopy
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51
Q

How is AKI diagnosed (3)?

A
  • Rise in creatinine of 25 micromol/l within 48 hours
  • Rise in creatinine of 50% in 7 days
  • Urine < 0.5 ml/kg/h for 6 hours
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52
Q

What are the 3 categories of causes of AKI?

A
  • Pre-renal = MC in children
  • Renal
  • Post-renal
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53
Q

What are the main causes of pre-renal AKI in children (2)?

A
  • Hypovolaemia
  • Circulatory failure
54
Q

What may cause hypovolaemia in children (4)?

A
  • Gastroenteritis
  • Burns
  • Sepsis
  • Haemorrhage
55
Q

What are some causes of renal AKI (4)?

A
  • Micrvasulature disease e.g. HUS, HSP
  • Glomerulonephritis
  • Interstitial nephritis
  • Acute tubular necrosis
56
Q

What are some causes of post-renal AKI (4)?

A
  • Congenital obstruction
  • Blocked catheter
  • Trauma
  • Calculi
57
Q

How is AKI managed + investigated (4)?

A
  • Close fluid monitoring
  • Urinalysis
  • USS
  • Dialysis
58
Q

What are the signs/ symptoms of CKD in children (6)?

A
  • Anorexia / vomiting
  • Lethargy
  • Polydipsia/ polyuria
  • Failure to thrive/ growth failure
  • Oedema
  • Hypertension
59
Q

What are the stages of CKD?

A

Same as adults stage 1-5, 5 = renal failure

60
Q

What are the common causes of CKD in children (4)?

A
  • Congenital malformations of the kidneys and urinal tract = MC
  • Glomerular diseases
  • Nephrotic syndrome
  • Hereditary conditions e.g. PKD
61
Q

What are some complications of CKD in children?

A
  • Anaemia (low EPO)
  • Rickets/ bone disease (due to low vitamin D)
  • Hormonal abnormalities –> growth restriction
62
Q

How is CKD managed in children (3)?

A
  • Diet changes/ control
  • Hormone replacement
  • Transplant = definitive
63
Q

What is the pathophysiological cause of nephrotic syndrome?

A

Increased permeability of the basement membrane in the glomerulus to protein

64
Q

What are the 3 classical features of nephrotic syndrome?

A
  • Hypoalbuminaemia
  • Proteinuria
  • Oedema
65
Q

Other than the 3 classical symptoms (hypoalbuminaemia, proteinuria and oedema) what are 3 other signs/ features of nephrotic syndrome?

A
  • Deranged lipids
  • Hypertension
  • Hypercoagulability
66
Q

What are 3 symptoms of nephrotic syndrome in children?

A
  • Frothy urine
  • Generalised oedema
  • Pallor
67
Q

What is the number 1 cause of nephrotic syndrome in children?

A

Minimal change disease

68
Q

What intrinsic kidney diseases can cause nephrotic syndrome (3)?

A
  • Focal segmental glomerulosclerosis
  • Membranoproliferative glomerulonephritis (can also be nephritic)
  • Membranous nephropathy
69
Q

What are some secondary causes of nephrotic syndrome in children (4)?

A
  • Infection
  • HSP/ SLE
  • Drugs
  • Congenital nephrotic syndrome
70
Q

What age does minimal change disease most commonly occur?

A

2-5 year olds

71
Q

How is nephrotic syndrome managed (3)?

A
  • High dose steroids
  • Low salt diet
  • Diuretics
72
Q

What are the two broad responses to treatment of nephrotic syndrome?

A
  • Steroid resistant (80%)
  • Steroid sensitive (20%)
73
Q

How can steroid resistant nephrotic syndrome be treated?

A
  • ACE-i
  • Immunosurpression e.g. cyclosporine, rituximab
74
Q

What are some complications of nephrotic syndrome (5)?

A
  • Hypovolaemia
  • Thrombosis
  • Infection (kidneys leak Igs)
  • AKI/CKD
  • Relapse
75
Q

What are the two main features of nephritic syndrome?

A
  • Haematuria
  • Proteinuria (less than nephrotic syndrome however)
76
Q

What are some signs/ symptoms of nephritic syndrome (3)?

A
  • Oedema (around eyes)
  • Hypertension
  • Decreased urine output
77
Q

What is the most common cause of nephritic syndrome in children?

A

Post streptococcal glomerulonephritis

78
Q

Other than post streptococcal, what are some other causes of nephritic syndrome in children (4)?

A
  • Vasculitis e.g. HSP
  • IgA nephropathy
  • Antiglomerular basement membrane disease (goodpastures syndrome)
  • Familial nephritis
79
Q

What is the most common cause of post-streptococcal glomerulonephritis?

A

Strep pyogenes

80
Q

How soon after infection does post strep glomerulonephritis usually occur?

A

1-3 weeks

81
Q

What are two criteria important in the diagnosis of post-strep glomerulonephritis?

A
  • Positive step infection (tonsillitis)
  • Anti-streptolysin antibody titre
82
Q

How is post strep-glomerulonephritis managed?

A

Supportive care - most improve on their own

83
Q

How is post-strep glomerulonephritis that does not improve treated (20% of cases) (2)?

A
  • Antihypertensives
  • Diuretics
    if they develop high BP and oedema
84
Q

What is IgA nephropathy (Berger’s disease)?

A

IgA deposits in the nephrons of the kidneys cause inflammation

85
Q

How is IgA nephropathy diagnosed?

A

Renal biopsy

86
Q

What would a renal biopsy of a patient with IgA nephropathy show (2)?

A
  • IgA deposits
  • Glomerular mesangial proliferation
87
Q

What age does IgA nephropathy usually present?

A

Late childhood/ early adulthood

88
Q

What condition is closely related to IgA nephropathy?

A

Henoch-schonlein purpura

89
Q

What is the difference between IgA nephropathy and HSP?

A

HSP is like a systemic IgA nephropathy with the whole body affected!!!

90
Q

How is IgA nephropathy managed?

A

Steroids help slow the progress

91
Q

How is nephritic syndrome investigated in children (4)?

A
  • Bloods (U&Es)
  • Urinalysis
  • Imaging
  • Renal biopsy
92
Q

What is haemolytic uraemia syndrome?

A

Thrombosis form in small blood vessels throughout the body

93
Q

What usually causes HUS?

A

Shiga toxin

94
Q

Where does the shiga toxin come from (2)?

A
  • E. coli (O-157)
  • Shigella (bacteria)
95
Q

What is the classic triad of features of HUS (3)?

A
  • Haemolytic anaemia
  • AKI
  • Thrombocytopenia
96
Q

During a gastroenteritis infection what drugs can increase the likelihood of developing HUS after the infection?

A
  • Antibiotics
  • Antimotilities (e.g. loperamide)
97
Q

How serious is HUS?

A

Medical emergency

98
Q

What is the mechanism by which HUS causes anaemia, AKI and thrombocytopenia?

A
  • Thrombocytopenia = platelets used up forming clots
  • AKI = thrombi affect blood flow through kidneys
  • Haemolytic anaemia = thrombi cause turbulent flow and ‘churn’ up RBC damaging them leading to their destruction
99
Q

What type of infection does HUS usually proceed?

A

Gastroenteritis

100
Q

What are more specific symptoms of gastroenteritis caused by E. coli and shigella?

A

Bloody diarrhoea

101
Q

What are the signs/ symptoms of HUS (8)?

A
  • Fever
  • Abdo pain
  • Reduced urine output
  • Haematuria
  • Hypertension
  • Bruising
  • Jaundice
  • Confusion
102
Q

How is HUS managed (4)?

A

Supportive treatment:
* Haemodialysis
* Antihypertensives
* Fluids
* Blood transfusions
self limiting, 80-90% recover without complications

103
Q

What is the term for involuntary urination?

A

Enuresis

104
Q

What is daytime loss of bladder control called?

A

Diurnal enuresis

105
Q

What is nighttime loss of bladder control called?

A

Nocturnal enuresis

106
Q

When should children stop diurnal enuresis by?

A

2 years

107
Q

When should children stop nocturnal enuresis by?

A

3-4 years

108
Q

What are the 2 types of nocturnal enuresis?

A
  • Primary
  • Secondary
109
Q

What is the difference between primary and secondary nocturnal enuresis?

A
  • Primary = never grown out of it
  • Secondary = started bed wetting after being dry for 6 months
110
Q

What is the most common cause of primary nocturnal enuresis?

A

Normal variation in development

111
Q

What are some other causes of primary nocturnal enuresis (other than normal variation in development) (5)?

A
  • Failure to wake - underdeveloped bladder signals
  • Bladder neck weakness
  • Overactive bladder/ neuropathic bladder
  • Psychological stress
  • Fluid intake before bed - e.g. fizzy drinks, caffeine
112
Q

What are the causes of secondary nocturnal enuresis (5)?

A
  • Psychological stress = MC
  • UTI
  • Constipation
  • Abuse
  • Diabetes
113
Q

How is enuresis investigated (4)?

A
  • Thorough history - fluid intake, stresses, family history of bed wetting
  • Urine dip
  • Urine concentrating ability (diabetes insipidus)
  • USS
114
Q

How is enuresis managed?

A
  • Enuresis alarm (wakes child at sign of bed wetting)
  • Medications
115
Q

What medications are used for enuresis (2)?

A
  • Desmopressin
  • Oxybutinin (anticholinergic) - relaxes bladder
116
Q

What is phimosis?

A

When the foreskin cannot be pulled back/ retracted over the glans of the penis

117
Q

By what age should phimosis have resolved?

A

10 years of age

118
Q

What can cause phimosis not to resolve (4)?

A
  • Infection/ scarring of the foreskin
  • Trauma to foreskin
  • Poor hygiene
  • Other medical conditions e.g. diabetes
119
Q

What is it known as when the urethral meatus is abnormally displaced on the ventral (underside) of the penis?

A

Hypospadias

120
Q

What is it known as when the urethral meatus is abnormally displaced on the dorsal (top) side of the penis?

A

Epispadias

121
Q

What is an associated condition with hypospadias where the head of the penis bends downwards?

A

Chordee

122
Q

What age is hypospadias present from?

A

Congenital (from birth)

123
Q

How is hypospadias managed?

A

Surgical correction at 3-4 months

124
Q

What is inflammation of the vulva and vagina known as?

A

Vulvovaginitis

125
Q

What age is vulvovaginitis common?

A

3-10 years

126
Q

What is the cause of vulvovaginitis?

A

Bacterial spread form faeces

127
Q

What are some exacerbating factors for vulvovaginitis (3)?

A
  • Wet nappies
  • Poor hygiene
  • Use of soaps in the vaginal area
128
Q

Why does vulvovaginitis improve after puberty?

A

Oestrogen helps keep the vaginal mucosa healthy and resistant to infection

129
Q

What is vulvovaginitis sometimes misdiagnosed as?

A
  • UTI
  • Thrush
130
Q

What age is thrush more common?

A

After puberty

131
Q

How is vulvovaginitis managed?

A

Lifestyle changes, hygiene measures

132
Q
A

Phase 3a conditions list flashcards (29 decks)

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