Paeds RENAL Flashcards by Georgia Leggett

How does UTI present in an infant as compared to a child?

Infant: fever, vomiting, lethargy, poor feeding, jaundice, septicaemia

Children: dysuria, frequency, abdo pain, lethargy, anorexia, haematuria

How well did you know this?

Not at all

Perfectly

How should UTI be investigated?

URINE DIP
Nitrite stick test: very specific
Leucocyte esterase: less specific than nitrites
Urine MC+S: diagnostic
Only do imaging if recurrent/ atypical UTI

How well did you know this?

Not at all

Perfectly

Recall the different UTI management for different age groups

<3m: admit, IV Abx then switch to oral prophylaxis: emergency: book urgent USS

> 3m, upper UTI: consider admission with IV Abx, if not, oral Abx: book USS

> 3m, lower UTI: oral Abx as local guidelines for 3d (eg trimethoprim, nitrofurantoin)

How well did you know this?

Not at all

Perfectly

How should recurrent UTI be managed in children?

Abx prophylaxis

<6 months: USS urgently + MCUG
>3y: USS within 6w

DMSA scan 4-6m later

How well did you know this?

Not at all

Perfectly

By what age should children be dry by day?

4 years old

How well did you know this?

Not at all

Perfectly

By what age should children be dry by day and night?

5 years old

How well did you know this?

Not at all

Perfectly

What is ‘primary bedwetting’?

Bedwetting that has not previously been resolved

How well did you know this?

Not at all

Perfectly

How should primary bedwetting be managed in children <5 years old?

Reassure parents: often resolves by 5y

Educate: easy access to toilet at night, bladder emptying before bed, positive reward system

How well did you know this?

Not at all

Perfectly

How should primary bedwetting be managed in children >5 years old?

Infrequent (<2/ week): watch + see approach

Frequent: 1st line: enuresis alarm, pos reward system (eg encourage child to help change sheets)

2nd line: desmopressin (1st line for short-term control like sleepovers + school trips)

How well did you know this?

Not at all

Perfectly

How should enuresis with daytime symptoms be managed?

Refer to enuresis clinic, community paediatrician

How well did you know this?

Not at all

Perfectly

What causes of secondary bedwetting can be managed in primary care?

UTI + constipation

How well did you know this?

Not at all

Perfectly

What causes of secondary bedwetting should be managed in secondary care?

Diabetes
Psychological
LD
Recurrent UTI

How well did you know this?

Not at all

Perfectly

What is phimosis?

Inability to retract foreskin as it is too ‘tight’

How well did you know this?

Not at all

Perfectly

By what age should phimosis only be present in 10% of children who were born with it?

4y (it is physiological at birth)

How well did you know this?

Not at all

Perfectly

How should phimosis be managed?

If <2: reassure + review in 6m - add personal hygiene promotion

If >2: circumcision or topical steroid creams (depending on severity)

How well did you know this?

Not at all

Perfectly

What is the name given to pathological phimosis?

Balantis Xerotica Obliterans

How well did you know this?

Not at all

Perfectly

What are 5 signs and symptoms of BXO?

Haematuria
Painful erections
Recurrent UTI
Weak stream
Swelling

How well did you know this?

Not at all

Perfectly

What is paraphimosis?

Emergency in which foreskin becomes trapped in the retracted position proximal to swollen glans

Restriction of blood flow to head of penis: penis turns dark purple

How well did you know this?

Not at all

Perfectly

How should paraphimosis be managed?

1st line: adequate analgesia, attempt to reduce foreskin (gently compresswith saline soaked swab)
2nd line: emergency referral to urologist

How well did you know this?

Not at all

Perfectly

What is hypospadias?

Wrongly positioned meatus ventrally (if dorsal = epispadias)

How well did you know this?

Not at all

Perfectly

What are 4 key features of hypospadias?

Ventral foramen
Hooded foreskin
Chordee (ventral curvature)
Foreskin not fused ventrally

How well did you know this?

Not at all

Perfectly

How should hypospadias be managed?

Repair surgery after 3 month:- no Mx required before that

How well did you know this?

Not at all

Perfectly

What is balanoposthitis?

Inflamed/ purulent discharge from foreskin

How well did you know this?

Not at all

Perfectly

How common is balanoposthitis?

Single attacks are common

How well did you know this?

Not at all

Perfectly

How should balanthoposthitis be managed?

Warm baths + Abx (broad spec) If recurrent (rare): circumcision

What is the mean age for testicular torsion?

16y

What is the appendixtestis?

Small remnant of Mullerian duct

How does torsion of the appendixtestis present?

Similarly to torsion but evolving over a few days

What is the one indication that surgery isn't needed in suspected testicular torsion?

Blue dot seen over superior pole of testes (shows it is torsion of appendixtestis)

Recall the signs and symptoms of torsion?

Redness, oedema, N+V Sudden onset pain in testis or abdomen

How can torsion and epididymitis be differentiated clinically?

Prehn's sign: lifting testes increases pain in torsion but decreases it in epididymitis Torsion = -ve Prehn's

What is the surgical management of testicular torsion?

Exploratory surgery +/- BL orchidopexy +/- orchidectomy +/- fixation of contralateral testes

What is the key window of time in which torsion needs to be fixed?

< 6 hours

Recall the serum creatinine changes/ measurements for each stage of AKI

Stage 1: increase >26 or 1.5-1.9x reference sCr Stage 2: 2-2.9 x reference sCr Stage 3: >354mmol increase or >3 x the reference sCr

Recall the urinary output values for each stage of AKI

Stage 1: <0.5mL/kg/hr, 6-12h Stage 2: <0.5mls/kg/hr, >12h Stage 3: <0.3mL/kg/hr, >24h

What is the difference in clinical syndrome produced by proliferative vs non-proliferative glomerulonephritis?

Proliferative: nephritic syndrome Non-proliferative: nephrotic syndrome

What are the 3 types of non-proliferative glomerulonephritis?

Focal segmental Membranous glomerulonephritis Minimal change disease

What are the 3 types of proliferative glomerulonephritis?

IgA nephropathy Membranoproliferative glomerulonephritis Post-infectious (post strep)

What can focal segmental glomerulonephritis be secondary to?

Obesity HIV

What can membranous glomerulonephritis be secondary to?

SLE Drugs

Which type of glomerulonephritis is most common in children?

Minimal change disease

Recall the triad of symptoms seen in IgA nephropathy

Petechiae Abdo pain Nephritic syndrome

What are the triad of symptoms in nephrotic syndrome?

Low albumin Peripheral oedema Proteinuria

What are the signs and symptoms of nephrotic syndrome?

1st = peri-orbital oedema (often misdiagnosed as allergy) 2nd = other features of oedema (delayed) - eg leg swelling, features of underlying dx

What % of nephrotic syndrome is steroid-sensitive?

80-95%

How quickly does steroid-sensitive nephrotic syndrome respond to treatment?

<6 weeks

How should the nephrotic syndrome be investigated?

Urine tests: dipstick, urea, urine MC+S, urinary sodium FBC, U+Es,ESR, creatinine, albumin Complement (C3,C4) (SLE?) Anti-streptolysin O (recent strep throat) HBV/HCV

If podocyte fusion is seen on microscopy, what is this indicative of?

Minimal change disease

What are the 3 main complications of nephrotic syndrome?

Risk of thrombosis Risk of infection Hypercholesterolaemia

How does the nephrotic syndrome cause hypercholesterolaemia?

Loss of albumin Less oncotic pressure Hepatic cholesterol synthesis

What are the 2 most common causes of Acute renal failure in children?

HUS + ATN

What is the triad of features that characterises the HUS?

Low RBC Low platelets AKI

What is the most common cause of ATN in children?

Organ failure following cardiac surgery

Recall the signs and symptoms of acute renal failure in children

Oligo/anuria Oedema (feet, legs, abdo, weight gain) Brown discoularisation of urine Fatigue, lethargy, N+V

What is the key treatent for prerenal fialure?

Fluid replacement + circulatory support

What is the key treatment for intrinsic renal failure?

High calorie, normal protein feed: to decrease catabolism, uraemia + hyperkalaemia

How should postrenal ARF be managed in children?

Assess site of obstruction: relief may be obtained by nephrostomy/ Catheter

What is the most important investigation to do in ARF children?

Renal USS

What woud be seen on USS In CKD?

Small kidneys

What would be seen on USS in AKI?

Large, bright kidneys with loss of cortical medullary differentiation

In what age group is minimal change disease most common?

2-4 years old

In what age group is focal segmental glomerulonephritis most common?

Older children

How does minimal change disease affect renal function?

Renal function will be normal

How does FSGN affect renal funcion?

Impairs renal function --> HTN

In which age group is membranous nephropathy more common?

Adults

What is another name for IgA vasculitis?

Henoch-Shonlein purpura

Which vessels does IgA vasculitis affect?

Small vessels

What is the usual cause of IgA vasculitis?

Usually preceded by an URTI by 2-3 days

What is the pathophysiolgy of IgA vasculitis?

IgA + IgG complex, deposit in organs, activating complement

Recall the signs and symptoms of IgA vasculitis?

100% = purpuric rash sparing trunk: looks a bit like HUS 60-80% = arthralgia + periarticular oedema: joint pain + swelling 60% = abdo pain: can cause intussusecption 20-60% = glomerulonephritis (within 3m of onset = 97%) with nephritic syndrome

What should be the first investigations ordered in IgA vasculitis?

FBC, clotting screen, urine dip and U+Es Urinalysis to rule out meningococcal sepsis

How should IgA vasculitis be managed?

Most cases resolve spontaneously within 4w For joint pain: NSAIDs If scrotal involvement/ severe oedema/ severe abdo pain: oral prednisolone If renal involvement: IV corticosteroids

What is another name given to nephroblastoma?

Wilm's tumour

In what age group is nephroblastoma most common?

<5 years old

Recall 2 common symptoms and signs of nephroblastoma

Asymptomatic abdo mass Painless haematuria

Recall 4 less common signs and symptoms of nephroblastoma

Abdo pain Anaemia (from haemorrhage into the mass) Anorexia HTN

When is a biopsy indicated in suspected nephroblastoma?

Never: may worsen the condition

What investigations should be done in suspected nephroblastoma?

US SCT/MRI

How is nephroblastoma managed?

Nephrectomy + chemotherapy (+ neoadjuvant radiotherapy if advanced disease) 80% cure rate