Paeds Renal Flashcards
Cystitis|Lower UTi
UTI in children Signs & Symptoms
Ecoli, Proteus, Pseudomonas
- infants: poor feeding, vomiting, irritability
- younger children: abdominal pain, fever, dysuria
- older children: dysuria, frequency, haematuria
- features which may suggest an upper UTI include: temperature > 38ºC, loin pain/tenderness
UTI Management
Urine collection method: clean catch is preferable
- infants less than 3 months old should be referred immediately to a paediatrician
- children aged more than 3 months old with an upper UTI should be considered for admission to hospital. If not admitted oral antibiotics such as cephalosporin or co-amoxiclav should be given for 7-10 days
- children aged more than 3 months old with a lower UTI should be treated with oral antibiotics for 3 days according to local guidelines, usually trimethoprim, nitrofurantoin, cephalosporin or amoxicillin. Parents should be asked to bring the children back if they remain unwell after 24-48 hours
Upper UTI: Kidneys Lower UTI: bladder, urethra
antibiotic prophylaxis is not given after the first UTI but should be considered with recurrent UTIs
Nocturnal Enuresis
‘involuntary discharge of urine by day or night or both, in a child >5Y
if under 5 then reassure parents.
In Order Management
* Reward system chart
* Enuresis Alarm
* Desmopressin - also good for Short term control
look for DM, constipation or UTI indication of 2ndry disease
Nephrotic Syndrome
1.Proteinuria 2.Hypoalbuniaemia 3.Oedema.
Minimal Change Disease (80%)
- Occurs when the basement membrane of the glomerulus becomes highly permeable to protein – allows proteins to leak from the blood into the urine.
- Periorbital/Pitting oedema, Ascities, Breathlessness.
- Investigate urine sample
- prednisolone 60mg/m2 per day for 4 weeks; then drop to 40mg/m2
- Treatment of hypovolaemia with IV fluids; in severe may use albumin transfusion
- Fluid restriction, low salt diet
Congenital nephrotic syndrome is a rare disease, most commonly recessive
Acute Glomerulonephritis
Post Strep or IgA nephropathy
Increased glomerular cellularity restricts glomerular blood flow and therefore glomerular filtration is decreased. This leads to:
- Decreases urine output and volume overload
- Hypertension
- Oedema, characteristically periorbital
- Haematuria and proteinuria
- Usually follows on from throar infection (strep)
Generally supportive management:
- Fluid balance management – can fluid restrict and use diuretic if overload suspected.
- Hypertension management
- 10 course of penicillin to prevent spread of nephrogenic bacterial strains
- 7-14 days following a group A beta-haemolytic Streptococcus infection (usually Streptococcus pyogenes).
nephritic
Henoch-Schlonein Purpura
Caused by an IgA vasculitis.
Inflammatory disease, with inflammation in the affected organs due to IgA deposits in the blood vessels. Affects the skin, kidneys and gastrointestinal tract.
- Self managed
nephritic
Alport’s syndrome
X-linked dominant pattern
defect in the gene which codes for type IV collagen resulting in an abnormal glomerular-basement membrane (GBM).
- common in MALES
- developing into renal failure
- microscopic haematuria
- progressive renal failure
- bilateral sensorineural deafness
- lenticonus: protrusion of the lens surface into the anterior chamber
- retinitis pigmentosa
- renal biopsy: splitting of lamina densa seen on electron microscopy
Alport’s patient with a failing renal transplant. This may be caused by the presence of anti-GBM antibodies leading to a Goodpasture’s syndrome like picture.
Hypospadias
congenital abnormality of the penis
pee hole on shaft of penis?
Hypospadias is characterised by
* a ventral urethral meatus
* a hooded prepuce
* chordee (ventral curvature of the penis) in more severe forms
* the urethral meatus may open more proximally in the more severe variants. However, 75% of the openings are distally located.
associated conditions include cryptorchidism (10%) and inguinal hernia
Management
* once hypospadias has been identified, infants should be referred to specialist services
* corrective surgery is typically performed when the child is around 12 months of age
* it is essential that the child is not circumcised prior to the surgery as the foreskin may be used in the corrective procedure
* in boys with very distal disease, no treatment may be needed
phimosis
- non-retractile foreskin and/or ballooning during micturition in a child under two, an expectant approach should be taken in case this is physiological phimosis which will resolve in time.
- Forcible retraction can result in scar formation so should be avoided. Personal hygiene is important
- child is over 2 years of age and has recurrent balanoposthitis or urinary tract infection then treatment can be considered.
Vesicourteric Reflux
abnormal backflow of urine from the bladder into the ureter and kidney.
- being found in around 30% of children who present with a UTI. As around 35% of children develop renal scarring it is important to investigate for VUR in children following a UTI
Pathophysiology of VUR
* ureters are displaced laterally, entering the bladder in a more perpendicular fashion than at an angle
* therefore shortened intramural course of the ureter
* vesicoureteric junction cannot, therefore, function adequately
Presentations
* recurrent childhood urinary tract infections
reflux nephropathy
* term used to describe chronic pyelonephritis secondary to VUR
* commonest cause of chronic pyelonephritis
* renal scar may produce increased quantities of renin causing hypertension
VUR is normally diagnosed following a micturating cystourethrogram
Management
* Mild is often self resolving.
* Severe that is leading to kidney infection may warrant surgical intervention.
Haemolytic uraemic syndrome
1. AKI 2.Microangipathic Haemolytic anemia 3.thrombocytopenia
classically Shiga toxin-producing Escherichia coli (STEC) 0157:H7, Shigella, HIV, Pneumococcus
Typically secondary to a gastroenteritis; prodrome of bloody diarrhoea for around 5 days.
Presentation then includes:
- Reduced urine output
- Haematuria
- Abdominal pain
- Lethargy and irritability
- Confusion
- Oedema
- Hypertension
- Bruising
Management
- general rule plasma exchange is reserved for severe cases of HUS not associated with diarrhoea
- treatment is suportive
investigation:
* anaemia: microangiopathic hemolytic anaemia characterised by a haemoglobin level less than 8 g/dL with a negative Coomb’s test
* fragmented blood film: schistocytes and helmet cells
* stool culture: looking for evidence of STEC infection
* PCR for Shiga toxins
