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Phase 3a > Paeds GU > Flashcards

Paeds GU Flashcards

1
Q

How would you define a UTI?

+ diagnostic numbers

A

Growth of bacteria in the urinary tract

10*5 organisms/ml grown on culture of appropriate sample

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2
Q

What are the common organisms that cause UTI in children?

A

Proteus
E coli
Pseudomonas
Klebsiella

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3
Q

What are predisposing factors for a UTI in children?

A

Incomplete bladder emptying
- Infrequent emptying, hurried micturition
- Obstruction by rectum due to constipation
Vesicoureteric reflux
Poor hygiene eg wiping back to front

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4
Q

How might a child present with an upper UTI?

A 
Fever, septicaemic illness + meningitis in infancy
General malaise
Vomiting
Loin / abdo pain in an older child
Failure to thrive + jaundice in infancy
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5
Q

How might a child present with a lower UTI?

A 
Dysuria
Urinary frequency / urgency
Incontinence
Lower abdo pain
Haematuria
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6
Q

How do you diagnose a UTI?

A

Urine sample
Urinalysis

10*5 organisms/ml grown on culture = diagnostic ting

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7
Q

How would you get a urine sample in a child?

A

MSU - clean catch
Suprapubic aspirate
Catheter
Bag sample / pad sample if need be

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8
Q

What would you look for in a child’s urine if you suspect a UTI?

A 
Visual inspection - is it cloudy or dark or whatever
Protein
Nitrites
Leucocyte esterase
MC&S
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9
Q

What antibiotics would you give to acutely treat an upper UTI?

A

Ciprofloxacin or co-amoxiclav

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10
Q

What antibiotics would you give to acutely treat a lower UTI?

A

trimethoprim / nitrofurantoin / cephalosporin / amoxicillin - based on local guidelines + results of culture

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11
Q

As well as antibiotics, how would you manage a child with a UTI?

A

Pain relief
Fluids

Later - give scans to see if there’s any underlying abnormality

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12
Q

What methods of imaging would you do for a child with a UTI to see if there’s an underlying abnormality?

A

USS
Micturating cystourethrogram
DMSA (radionuclitide scan)

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13
Q

What would you be looking for on a renal USS in a child with UTI?

A

Obstruction

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14
Q

What would you be looking for on a micturating cystourethrogram in a child with a UTI?

A

Retrograde flow of urine from bladder into ureters

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15
Q

What would you be looking for on a DMSA scan in a child with a UTI?

A

Renal scarring

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16
Q

What are the complications of UTI in childhood?

A

Renal scarring leading to:

  • Hypertension
  • Impaired GFR (so CKD in the future ????)
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17
Q

What is a complication of UTI caused by proteus?

A

Phosphate renal stones - more in boys

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18
Q

What would UTI caused by pseudomonas indicate?

A

Structural abnormality

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19
Q

What are the atypical organisms that cause UTI?

A

Anything other than E coli - so pseudomonas, proteus, klebsiella

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20
Q

What are the indications for further investigation in a child with UTI?

A 
Poor flow
Bladder mass
Raised CK
Not responding to abx
Atypical organism - not E coli
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21
Q

How would you routinely follow up a child who had a UTI?

A

Check BP annually
Proteinuria for CKD
Reflux surgery if progression of scarring
Abx prophylaxis - trimethoprim

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22
Q

What are the 3 features of nephrotic syndrome?

A

Heavy proteinuria 1g/m2/24 hours
Hypoalbuminaemia <25g/L
Oedema

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23
Q

Where would you look for evidence of oedema in a child with nephrotic syndrome?

A 
Peri-orbital on waking = earliest sign
Scrotal
Leg and ankle
Pleural effusion so breathlessness
Ascites
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24
Q

What is commonly the earliest sign of nephrotic syndrome?

A

Periorbital oedema on waking

25
Q

What are the causes of nephrotic syndrome?

A 
Minimal change disease
Focal segmental glomerulosclerosis
Membranoproliferative glomerulonephritis
Membranous glomerulonephritis
Infections - malaria
Allergens eg bee stings
26
Q

What are the types of nephrotic syndrome?

A

Steroid resistant

Steroid sensitive

27
Q

What are the features that indicate steroid-sensitive nephrotic syndrome?

A

Minimal change disease essentially

Normal BP
No blood in urine
Normal renal function
No features to suggest nephritis
Responds to steroids (DUH)
Histology shows minimal change
Normal complement
Age 1-10
28
Q

What are the features that indicate steroid-resistant nephrotic syndrome?

A

Other diseases not minimal change disease

Elevated BP
Haematuria
Impaired renal function
Features to suggest nephritis
Failure to respond to steroids (DUH)
Histology shows pathology ie glomerulonephropathy, basement membrane abnormality
29
Q

What tests would you do to investigate a child with suspected nephrotic syndrome?

A 
Urine dipstick - protein, no nitrites, may be RBCs
Urine MC&amp;S
FBC 
ESR
U&amp;E
Creatinine
Albumin
C3 + C4 (complement levels)
Urinary sodium
Hep B / C screen
Malaria screen if recent foreign travel
30
Q

How do you treat nephrotic syndrome?

first line

A

PREDNISOLOOOOOOONE
60mg/m2 for 4 weeks
Then 40mg/m2 alternate days for 4 weeks

31
Q

Other than steroids, how would you manage a child with steroid responsive nephrotic syndrome?

A

Salt and water moderation
Diuretics
Penicillin V
VZV, measles and pneumococcal immunisation

32
Q

How would you treat steroid resistant nephrotic syndrome?

A 
Refer to nephrology
And treat the oedema:
- Salt restriction
- Diuretics
- ACEi
- NSAIDs - reduce the proteinuria
33
Q

What are the complications of nephrotic syndrome?

A

Hypovolaemia
Thrombosis (because pissing out antithrombin 3)
Infection
Hypercholesterolaemia

34
Q

Which organism causes post-strep glomerulonephritis?

A

strep (no shit sherlock)

Group A beta-haemolytic strep (same bitchin thing as rheumatic fever)

35
Q

CASE

A child presents with swollen testicles, breathlessness, red blood in his urine and a fever.

A week ago he had a sore throat.

What are the differential diagnoses?

A 
Nephrotic syndrome (probs steroid resistant to be picky)
Post-strep glomerulonephritis
36
Q

Which investigations would you perform for a child with suspected post-strep glomerulonephritis?

A 
FBC
U&amp;E
Immunology
Throat / skin swabs for the initial infection
Urinalysis
37
Q

What would you see on urinalysis of a patient with post-strep glomerulonephritis?

A

Increased protein
Increased protein:creatinine ratio
Haematuria (macroscopic)
RBC casts

38
Q

How would you manage a child with post-strep glomerulonephritis?

A 
Fluid balance
Diuretics
Correction of electrolyte imbalance
Dialysis (uncommonly needed)
Penicillin to treat the strep infection
39
Q

What is Alport syndrome?

A

Congenital
Glomerulonephritis
CKD (end-stage)
Hearing loss

40
Q

What are the symptoms of HSP?

A

Rash
Arthralgia + periarticular oedema
Colicky abdo pain
Glomerulonephritis

41
Q

Describe the rash in HSP

A

Non-blanching
Symmetrical
On buttocks, extensors of arms and legs, ankles
Sparing of the trunk
Palpable
Initially urticarial - then goes to maculopapular and purpuric

42
Q

What is haemolytic uraemic syndrome?

A

Triad of:

  • Microangiopathic haemolytic anaemia
  • Acute renal failure (uraemia)
  • Thrombocytopaenia
43
Q

What is the most common cause of HUS?

A

E coli O157:H7

From farm animals or uncooked beef

44
Q

What are the causes of HUS?

A 
E coli O157:H7
Tumours
Pregnancy
The pill
Cyclosporins
SLE
HIV
45
Q

How would you investigate a patient with suspected HUS?

A

FBC - shows the anaemia and the thrombocytopaenia
U&E - shows acute renal failure
Stool culture

46
Q

How would you manage a patient with HUS?

A

Supportive:
Fluids
Blood transfusion
Dialysis if required

47
Q

What is atypical HUS?

A

Without the bloody diarrhoeal prodrome

Or cerebral involvement

48
Q

How would you treat atypical HUS?

A

Plasma exchange

Plasma infusion

49
Q

What are the causes of proteinuria?

A

Transient - febrile illness or after exercise

Persistent - nephrotic syndrome basically

50
Q

What is the definition of daytime enuresis?

A

Lack of bladder control during the day in a child old enough to be continent of urine

51
Q

At what age should children be continent of urine?

A

3-5 years

52
Q

What are the causes of daytime enuresis?

A 
Lack of attention to bladder sensation (don't respond to a full bladder)
Detrusor instability
Neuropathic bladder
Bladder neck weakness
Constipation
UTI
Ectopic ureter
53
Q

How would you treat a child with daytime enuresis?

A 
Star charts
Bladder training / pelvic floor exercises
Enuresis alarm (if lack of attention to bladder sensation)
Treat constipation
54
Q

What is secondary enuresis?

A

Urinary incontinence in a child who has previously achieved continence

55
Q

What are the causes of secondary enuresis?

A

Emotional upset
UTI
Diabetes
Renal concentrating disorders - sickle cell, chronic renal failure

56
Q

What is nocturnal enuresis?

A

Bed-wetting

Genetically determined delay in sphincter competence

57
Q

How would you manage a child with nocturnal enuresis?

A

Explain that it is normal + stop parents from punishing
Star charts
Enuresis alarm

58
Q

What pharmacological treatment would you use for nocturnal enuresis?

A

Desmopressin

Phase 3a (11 decks)

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