Paeds - Renal

Question 1

Infant symptoms of UTI

Answer 1

Poor feeding 
Failure to thrive 
JAUNDICE 
Diarrhoea 
Vomiting 
Irritability

Question 2

Management of UTI

Answer 2

Fluids, analgesia, antiemetics

< 3 months - Refer
> 3 months - Treat

Upper

• Cephalosporin
• Co-amox

Lower

• Nitro
• Trimethoprim

Question 3

UTI complications and prophylaxis

Answer 3

Renal scarring - HTN, CKD

Good hygiene
Regular voiding
Lactobacillus acidophilus

Prophylaxis - Trimethoprim

Question 4

Complicated UTIs and reasons to follow-up

Answer 4

Non-E.coli 
Raised creatinine 
Septicaemia 
Poor urinary flow 
No abx response in 48 hours

Reasons to follow-up

• Reflux
• Structural abnormality
• Recurrent

Question 5

Causes of VUR

Answer 5

Abnormal back flow of urine from the bladder - Ureter - Kidneys

Abnormal VUJ - Lateral and perpendicular - Shortening of ureter

= Reflux + Distension

Question 6

VUR grading

Answer 6

1 - Ureter only
2 - Renal pelvis on micturition
3 - Mild/moderate dilation of ureter, renal pelvic and calyces
4 - Dilation of renal pelvic and calyces, with moderate ureteral tortuosity
5 - Gross dilation of ureter, pelvis and calyces, with ureteral tortuosity

Question 7

VUR investigations / management / complications

Answer 7

MCUG
DMSA - Check for scarring

Management - Surgical correction

Risk of UTIs
Risk of scarring

Question 8

PSGN aetiology and presentation

Answer 8

Antigen-antibody complex in glomerulus
Complement activation
Nephritis

Initially…
URTI - Strep pyogenes
Pharyngitis

2 weeks later...
Haematuria 
Oliguria 
Proteinuria 
Oedema 
HTN - Headache 
CV overload

Question 9

PSGN investigations

Answer 9

FBC - Anaemia

U/E

• Urea ^
• Creatinine ^

ABG - Metabolic acidosis

ASO titre
Anti-DNAse B titre
C3 - LOW

Urinalysis - Haematuria + Proteinuria

Renal biopsy - Immunofluorescence - STARRY SKY

Question 10

PSGN management

Answer 10

Penicillin

Nitroprusside for encephalopathy

Treat HTN
Treat fluid overload
Correct metabolic imbalances

Question 11

Nocturnal enuresis

Answer 11

Bed wetting > 5 years
In the absence of renal or neuro abnormality
More common in males

Question 12

Causes of nocturnal enuresis

Answer 12

Undiagnosed renal abnormality 
Polyuria - DM, UTI
Faecal retention - Underlying psych 
Stress 
Sexual abuse

Question 13

Management of nocturnal enuresis

Answer 13

Treat cause - UTI, DM, constipation
Reward system - Star chart - Positives!

Advice RE fluid intake, toilet habits, etc.

< 7 - Alarm
> 7 - Desmopressin

Question 14

HSP aetiology and presentation

Answer 14

URTI - Strep pyogenes

Purpuric rash

• Buttocks
• Extensors
• Legs
• Ankles

Urinalysis

• Haematuria
• Proteinuria

GI - Abdo pain

MSK

• Polyarthritis
• Periarticular oedema

Question 15

HSP investigations and management

Answer 15

IgA ^
ESR ^
ASO titre

Urine dip - Haematuria + Proteinuria

Management

• Analgesia
• Supportive
• Prednisolone

Question 16

Alport syndrome

Answer 16

Genetic condition

Hearing loss
Visual impairment

Progressive loss of kidney function - Haematuria