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3a > Paeds renal and urology > Flashcards

Paeds renal and urology Flashcards

1
Q

What are a better indication of UTI between nitrites and leukocytes? What single finding would not merit treatment?

A
  • Nitrities
  • UTI treatment should not be commenced if only leukocytes are present
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2
Q

What’s the most common causative organism of UTIs?

A

E coli

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3
Q

What’s the most common causative organism of UTIs in boys?

A

Proteus mirabilis

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4
Q

What is the immediate management of children <3 months with a fever?

A
  • Immediate IV antibiotics
  • Septic screen
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5
Q

What is the management of UTI in systemically unwell children?

A

7-10 days oral abx

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6
Q

What is the management of UTI in systemically well children?

A

3 days oral abx

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7
Q

What factors indicate a child with a UTI should be followed up

A
  • If < 3 months old
  • If were systemically unwell with UTI
  • If suffer with recurrent UTIs
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8
Q

What Ix do atypical UTIs warrant?

A
  • USS renal tract
  • Micturating cyctourecthrogram
  • DMSA scan
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9
Q

What can micturating cystourethrograms diagnose?

A

Vesicle-ureteric reflux

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10
Q

What age group is nephrotic syndrome most common?

A

2-5 years

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11
Q

What triad is seen in nephrotic syndrome

A
  • Low serum albumin
  • Proteinuria
  • Oedema
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12
Q

What’s the most common cause of nephrotic syndrome in children?

A

Minimal change disease

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13
Q

What’s the most common cause of nephrotic syndrome in children?

A

Minimal change disease

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14
Q

What is the management of first episode of nephrotic syndrome?

A
  • 60mg/kg prednisolone for 4 weeks
  • 40mg/kg prednisolone on alternate days for 4 weeks
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15
Q

When do you get frothy urine?

A

Nephrotic syndrome

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16
Q

What happens in nephrotic syndrome?

A

The basement membrane of the glomerulus become highly permeable to protein

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17
Q

What is nephritis?

A

Inflammation within the nephrons of the kidneys

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18
Q

What are the 2 most common causes of nephritis?

A
  • Post strep glomerulonephritis
  • IgA nephropathy
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19
Q

What are 4 features of nephritis?

A
  1. Haematuria
  2. Proteinuria
  3. AKI (impaired GFR, rising CR)
  4. Salt and water retention (HTN, oedema)
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20
Q

Management of nephritis?

A

Supportive, manage underlying cause

21
Q

What is nocturnal enuresis?

A

Bed wetting

22
Q

What is secondary nocturnal enuresis?

A

Where a child being wetting the bed when they have been dry for at least 6 months

23
Q

What is primary nocturnal enuresis?

A

When a child has never been consistently dry at night

24
Q

What type of nocturnal enuresis is more associated with underlying illness?

A

Secondary nocturnal enuresis

25
Q

What is haemolytic uraemic syndrome?

A

When there is thrombosis in small blood vessels throughout the body

26
Q

What usually triggers haemolytic uraemic syndrome?

A

Shiga toxin

27
Q

What triad is seen in haemolytic uraemic syndrome

A
  • Haemolytic anaemia
  • AKI
  • Thrombocytopenia
28
Q

What is the typical disease course of haemolytic uraemic syndrome?

A

Symptoms that start 5 days after brief gastroenteritis

29
Q

How serious is haemolytic uraemic syndrome? What’s the management?

A
  • Its a medical emergency (10% mortality)
  • Supportive management under experienced paediatricans
30
Q

What is hypospadias?

A

When the urethral meatus is abnormally displaced to the ventral side of the penis.

31
Q

What is epispadias?

A

Where the meatus is displaced to the dorsal side (top) of the penis

32
Q

Rx of hypospadias?

A
  • Mild cases may not require treatment
  • Surgery after 3/4 months
33
Q

What antibiotic is indicated in children with a UTI who are unwell or <3 months?

A

IV cefuroxine

34
Q

What features are suggestive of an atypical UTI?

A
  • Seriously ill
  • Poor urine flow
  • Mass
  • Raised Cr
  • Septicaemia
  • Failure to respond to treatment in 48hrs
  • Non E.Coli organisms
35
Q

What is classes as recurrent UTI?

A
  • 2 or more upper UTI/pyelonephritis
  • 1 ep of ^^^ plus 1 or more ep of lower UTI
  • 3 ep or more of lower UTI
36
Q

When would a child <6 months with a UTI have…
1. MCUG
2. DMSA
3. USS (within 6 weeks)

A
  1. If atypical/recurrent
  2. If atypical/recurrent
  3. Anyone <6 months with UTI will have USS post infection
37
Q

Children with an atypical presentation of nephrotic syndrome are less likely to have minimal change disease. What 5 factors indicate atypical nephrotic syndrome?

A
  • <1 or >11 years old
  • Raised creatinine
  • Visible haematuria
  • Raised BP
  • Family history
38
Q

Give 5 complications of nephrotic syndrome

A
  • Hypercholesterolaemia
  • Thrombosis
  • Increased risk of infection
  • Hypovolaemia
  • Relapses
39
Q

What’s the most common cause of nephrotic syndrome in children?

A

Minimal change disease

40
Q

What’s the management of minimal change disease?

A

Prednisolone

41
Q

How long are steroids given for in the management of nephrotic syndrome? What is the Rx of steroid resistant nephrotic syndrome?

A
  • Given for 4 weeks and gradually weaned for the next 8 weeks
  • ACE inhibitors and immunosuppressants e.g. cyclosporine/tacrolimus/rituximab
42
Q

What are the 2 most common causes of nephritis in children?

A
  • Post-streptococcal glomerulonephritis
  • IgA nephropathy
43
Q

What is IgA nephropathy also known as

A

Berger’s disease

44
Q

What will a biopsy show in IgA nephropathy?

A

IgA deposits and glomerular mesangial proliferation

45
Q

When and following what does…
1. IgA nephropathy present
2. Post-strep glomerulonephritis present

A
  1. Days following infection
  2. Weeks after sore throat
46
Q

What triad is seen in HUS?

A
  • AKI
  • Microangiopathic haemolytic anaemia
  • Thrombocytopenia
47
Q

What are 2 tests for testicular torsion?

A
  • Prehn’s sign - elevation of testes does NOT improve pain
  • Cremasteric reflex - negative (testes don’t move)
48
Q

Which abdominal tumour doesn’t cross the midline and which does?

A
  • Wilms tumour doesn’t cross the midline
  • Neuroblastoma does
49
Q

What 2 urinary tests are raised in neuroblastoma?

A
  • Urinary vanillylmandelic acid (VMA)
  • Urinary homovanillic acid (HVA)

3a (34 decks)

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