Paeds renal and urology Flashcards
What are a better indication of UTI between nitrites and leukocytes? What single finding would not merit treatment?
- Nitrities
- UTI treatment should not be commenced if only leukocytes are present
What’s the most common causative organism of UTIs?
E coli
What’s the most common causative organism of UTIs in boys?
Proteus mirabilis
What is the immediate management of children <3 months with a fever?
- Immediate IV antibiotics
- Septic screen
What is the management of UTI in systemically unwell children?
7-10 days oral abx
What is the management of UTI in systemically well children?
3 days oral abx
What factors indicate a child with a UTI should be followed up
- If < 3 months old
- If were systemically unwell with UTI
- If suffer with recurrent UTIs
What Ix do atypical UTIs warrant?
- USS renal tract
- Micturating cyctourecthrogram
- DMSA scan
What can micturating cystourethrograms diagnose?
Vesicle-ureteric reflux
What age group is nephrotic syndrome most common?
2-5 years
What triad is seen in nephrotic syndrome
- Low serum albumin
- Proteinuria
- Oedema
What’s the most common cause of nephrotic syndrome in children?
Minimal change disease
What’s the most common cause of nephrotic syndrome in children?
Minimal change disease
What is the management of first episode of nephrotic syndrome?
- 60mg/kg prednisolone for 4 weeks
- 40mg/kg prednisolone on alternate days for 4 weeks
When do you get frothy urine?
Nephrotic syndrome
What happens in nephrotic syndrome?
The basement membrane of the glomerulus become highly permeable to protein
What is nephritis?
Inflammation within the nephrons of the kidneys
What are the 2 most common causes of nephritis?
- Post strep glomerulonephritis
- IgA nephropathy
What are 4 features of nephritis?
- Haematuria
- Proteinuria
- AKI (impaired GFR, rising CR)
- Salt and water retention (HTN, oedema)
Management of nephritis?
Supportive, manage underlying cause
What is nocturnal enuresis?
Bed wetting
What is secondary nocturnal enuresis?
Where a child being wetting the bed when they have been dry for at least 6 months
What is primary nocturnal enuresis?
When a child has never been consistently dry at night
What type of nocturnal enuresis is more associated with underlying illness?
Secondary nocturnal enuresis
What is haemolytic uraemic syndrome?
When there is thrombosis in small blood vessels throughout the body
What usually triggers haemolytic uraemic syndrome?
Shiga toxin
What triad is seen in haemolytic uraemic syndrome
- Haemolytic anaemia
- AKI
- Thrombocytopenia
What is the typical disease course of haemolytic uraemic syndrome?
Symptoms that start 5 days after brief gastroenteritis
How serious is haemolytic uraemic syndrome? What’s the management?
- Its a medical emergency (10% mortality)
- Supportive management under experienced paediatricans
What is hypospadias?
When the urethral meatus is abnormally displaced to the ventral side of the penis.
What is epispadias?
Where the meatus is displaced to the dorsal side (top) of the penis
Rx of hypospadias?
- Mild cases may not require treatment
- Surgery after 3/4 months
What antibiotic is indicated in children with a UTI who are unwell or <3 months?
IV cefuroxine
What features are suggestive of an atypical UTI?
- Seriously ill
- Poor urine flow
- Mass
- Raised Cr
- Septicaemia
- Failure to respond to treatment in 48hrs
- Non E.Coli organisms
What is classes as recurrent UTI?
- 2 or more upper UTI/pyelonephritis
- 1 ep of ^^^ plus 1 or more ep of lower UTI
- 3 ep or more of lower UTI
When would a child <6 months with a UTI have…
1. MCUG
2. DMSA
3. USS (within 6 weeks)
- If atypical/recurrent
- If atypical/recurrent
- Anyone <6 months with UTI will have USS post infection
Children with an atypical presentation of nephrotic syndrome are less likely to have minimal change disease. What 5 factors indicate atypical nephrotic syndrome?
- <1 or >11 years old
- Raised creatinine
- Visible haematuria
- Raised BP
- Family history
Give 5 complications of nephrotic syndrome
- Hypercholesterolaemia
- Thrombosis
- Increased risk of infection
- Hypovolaemia
- Relapses
What’s the most common cause of nephrotic syndrome in children?
Minimal change disease
What’s the management of minimal change disease?
Prednisolone
How long are steroids given for in the management of nephrotic syndrome? What is the Rx of steroid resistant nephrotic syndrome?
- Given for 4 weeks and gradually weaned for the next 8 weeks
- ACE inhibitors and immunosuppressants e.g. cyclosporine/tacrolimus/rituximab
What are the 2 most common causes of nephritis in children?
- Post-streptococcal glomerulonephritis
- IgA nephropathy
What is IgA nephropathy also known as
Berger’s disease
What will a biopsy show in IgA nephropathy?
IgA deposits and glomerular mesangial proliferation
When and following what does…
1. IgA nephropathy present
2. Post-strep glomerulonephritis present
- Days following infection
- Weeks after sore throat
What triad is seen in HUS?
- AKI
- Microangiopathic haemolytic anaemia
- Thrombocytopenia
What are 2 tests for testicular torsion?
- Prehn’s sign - elevation of testes does NOT improve pain
- Cremasteric reflex - negative (testes don’t move)
Which abdominal tumour doesn’t cross the midline and which does?
- Wilms tumour doesn’t cross the midline
- Neuroblastoma does
What 2 urinary tests are raised in neuroblastoma?
- Urinary vanillylmandelic acid (VMA)
- Urinary homovanillic acid (HVA)
