Paediatrics - Renal/ urinary Flashcards
What is inflammation/ infection of the kidney known as?
Pyelonephritis
What is inflammation of the bladder known as?
Cystitis
What condition should all children with a fever be considered and excluded for?
UTIs
How does UTI present in babies (6)?
- Fever
- Lethargy
- Irritability
- Vomiting
- Poor feeding
- Urinary frequency
What additional symptoms of a UTI may older children have compared to babies (2)?
- Dysuria (painful urination)
- Incontinence
- Abdo pain (suprapubic pain)
When should pyelonephritis be suspected (2)?
- Temperature over 38
- Loin/ groin pain
How should a UTI be investigated in those under 3 months?
Send MSU for MC&S (microscopy and culture)
How should UTI be investigated in those over 3 months (2)?
- Urine dip
- Send for MC&S if necessary
What would suggest a UTI on a urine dip (2)?
- Nitrites (more specific)
- Leukocytes (more sensitive)
When should MC&S be sent in children over 3 months (3)?
- If UTI suspected from dip stick
- If high risk form complications
- If recurrent UTIs
How should children under 3 months with a suspected UTI be managed (3)?
- Start IV Abx
- Urgent referral to paeds
- Septic screen
What is included in a septic screen for those under 3 months (3)?
- Blood cultures
- FBC, CRP, lactate
- Lumbar puncture considered
How should children over 3 months be treated for a UTI?
Oral Abx
How should pyelonephritis be treated in children?
IV Abx
What Abx should be used for UTI in children (4)?
First line:
* Nitrofurantoin or
* Trimethoprim
Second:
* Amoxicillin
* Cefalexin
Which antibiotic should be used for pyelonephritis in children?
Cefalexin
co-amoxiclav = 2nd
How should children with UTIs be managed after the initial infection?
Certain groups should be imaged with USS of urinary tract for further problems
When should children under 6 months be imaged for UTIs (2)?
- During the infection if there are recurrent UTIs or atypical bacteria
- Within 6 weeks of the UTI for all
When should children older than 6 months be imaged for UTIs (2)?
- Recurrent UTIs imaged within 6 weeks
- Atypical UTIs during the illness
What constitutes an atypical UTI (4)?
- Poor flow
- Abdo mass
- Failure to respond to typical Abx
- Non-E. coli organisms
What other scan should be used to investigate all children with recurrent/ atypical UTI?
DMSA (dimercaptosuccinic acid) scan
What does a DMSA scan show?
Reveals scaring of the kidney
kidney uptakes the acid contrast thing, the areas that don’t take it up are damaged/ scarred
How soon after UTI should a DMSA scan be performed?
Within 4-6 months
What does an MCUG scan show?
The structure of the urinary tract
What other scan should children under 6 months with recurrent/ atypical UTIs be investigated with?
MCUG (micturating cystourethrogram)
What condition causes urine to flow back from the bladder into the ureters?
Vesico-ureteric reflux
What are some complications of vesicle-ureteric reflux (2)?
- UTIs + kidney scarring
- Hydronephrosis
How is vesico-ureteric reflux managed?
- Lifestyle management (constipation, avoid excessively full bladder)
- Prophylactic Abx
- Surgery
How is vesico-ureteric reflux diagnosed?
MCUG (micturating cystourethrogram)
How are renal malformations investigated in children (3)?
- Ultrasound (pre and post natal)
- DMSA (for scarring)
- MCUG (for anatomy)
- Plasma creatinine ratio
- eGFR
What are some congenital kidney malformations (5)?
- Renal agenesis
- Renal dysplasia (cystic kidneys)
- Renal hypoplasia
- Pelvic/ horseshoe kidney
- Duplex kidney
What is renal agenesis?
The absence of the kidney (uni or bilateral)
What can cause renal dysplasia (2)?
- Multicystic dysplastic kidney
- Autosomal recessive/ dominant PKD
What is renal hypoplasia?
Kidneys are smaller than expected due to reduced number of nephrons
What is a pelvic/ horseshoe kidney?
The kidneys are fused at the lower end forming a U shape
What is a duplex kidney?
Kidney has two collecting systems and often two drain ducts (ureters)
What can a lack of amniotic fluid (oligohydramnios) in an unborn infant cause?
Potters syndrome
What is often the cause of potters syndrome/ lack of amniotic fluid?
Reduction in the production of urine from the foetus, therefore many congenital kidney malformations can cause potters syndrome
What are some features of potters syndrome (4)?
- Low set ears
- Beaked nose
- Limb deformities
- Pulmonary hypoplasia/ respiratory distress
What are some complications of kidney malformation (4)?
- UTIs
- Hypertension/ electrolyte imbalances
- CKD
- Potters syndrome
What are some urinary tract malformations (2)?
- Vesicoureteric reflux
- Obstructions
Where can an obstruction occur in the urinary tract (4)?
- Pelvic-ureteric junction (between ureter and renal pelvis)
- Vesico-ureteric junction (between ureter and bladder)
- Bladder neck
- Posterior urethra
What is a cause of vesico-ureteric junction obstruction?
Ureterocele (cystic swelling at bottom of ureter)
What may cause a bladder neck obstruction?
Neuropathic bladder (damaged nerves preventing the bladder neck from relaxing and allowing urine to drain through urethra)
Where is the posterior urethra?
Proximal urethra (closest to bladder)
What is a common obstruction at the posterior urethra?
Posterior urethral valve
What is a posterior urethral valve?
Extra tissue forms at the proximal urethra causing an obstruction to urine outflow from both kidneys
What are some complications of urinary tract malformations (2)?
- UTI
- Hydronephrosis –> dysplastic kidney –> CKD
How can urinary tract malformations present (3)?
- Difficulty urinating/ weak stream
- Recurrent UTIs
- Impaired kidney function + potters syndrome
How are urinary tract malformations investigated (3)?
- Abdo USS
- MCUG
- Cystoscopy
How is AKI diagnosed (3)?
- 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
What are the 3 categories of causes of AKI?
- Pre-renal = MC in children
- Renal
- Post-renal
