Paeds renal and urology Flashcards
Acute pyelonephritis is
the infection affects the tissue of the kidney. It can lead to scarring in the tissue and consequently a reduction in kidney function.
Cystitis is
inflammation of the bladder, and can be the result of a bladder infection
UTI symtoms in babies and in older infants and children
The diagnosis of acute pyelonephritis is made if either there is:
A temperature greater than 38°C
Loin pain or tenderness
- Investigations for UTI in children
- The ideal urine sample for UTIs is
clean catch sample, avoiding contamination
- If ..or…are present, the urine should be sent to the microbiology lab. If neither are present the patient is unlikely to have a UTI.
If nitrites or leukocytes are present, the urine should be sent to the microbiology lab. If neither are present the patient is unlikely to have a UTI.
Send a…sample to the microbiology lab to be cultured and have sensitivity testing for UTIs
Send a midstream urine (MSU) sample to the microbiology lab to be cultured and have sensitivity testing.
- …are a better indication of UTI infection than..
Nitrites are a better indication of infection than leukocytes
If only… are present the patient should not be treated as a UTI unless there is clinical evidence they have one.
If only leukocytes are present the patient should not be treated as a UTI unless there is clinical evidence they have one.
management of UTIs in children
Typical antibiotic choices in urinary tract infections in children are:
Trimethoprim
Nitrofurantoin
Cefalexin
Amoxicillin
how do you investigate recurrent UTIs in children
- US are used investigate recurrent UTIs in children when?
- DMSA are used investigate recurrent UTIs in children when?
Micturating cystourethrogram (MCUG) are used investigate recurrent UTIs in children when?
Vesico-ureteric reflux (VUR) definition and how it is diagnosed
Management of Vesico-ureteric reflux (VUR)
Enuresis definition
involuntary urination
Bed wetting is called
nocturnal enuresis
Inability to control bladder function during the day is called
diurnal enuresis
Most children get control of daytime urination by.. years and night-time urination by…
Most children get control of daytime urination by 2 years and nighttime urination by 3 – 4 years
Primary nocturnal enuresis is where
child has never managed to be consistently dry at night
The most common cause of primary nocturnal enuresis is
variation on normal development, particularly if the child is younger than 5 years. Often patients will have a family history of delayed dry nights. In this situation reassurance is important, and there is no need to jump to further investigations or management.
Other causes of primary nocturnal enuresis include:
Management of primary enuresis
particularly if short-term control is needed (e.g. for sleep overs)
desmopressin
Secondary nocturnal enuresis is where
child begins wetting the bed when they have previously been dry for at least 6 months
Causes of secondary nocturnal enuresis include:
Urinary tract infection
Constipation
Type 1 diabetes
New psychosocial problems (e.g. stress in family or school life)
Maltreatment
Always think about abuse and safeguarding
Management of secondary nocturnal enuresis
based on treating the underlying cause. The most common and easily treatable secondary causes are urinary tract infections and constipation. Other problems may require referral to secondary care for further management.
Incontinence comes in two main types:
(related to diurnal enuresis)
Urge incontinence is an overactive bladder that gives little warning before emptying
Stress incontinence describes leakage of urine during physical exertion, coughing or laughing.
causes of diurnal enuresis
An enuresis alarm is
An enuresis alarm is a device that makes a noise at the first sign of bed wetting, waking the child and stopping them from urinating
need to be used for at least 3 months
Pharmacological treatment options for enuresis
Undescended testes in older children or after puberty hold a higher risk of
testicular torsion, infertility and testicular cancer
Risk factors of undescended testes
Family history of undescended testes
Low birth weight
Small for gestational age
Prematurity
Maternal smoking during pregnancy
Management of undescended testes
- Watching and waiting is appropriate in newborns. In most cases the testes will descend in the first 3 – 6 months.
- If they have not descended by 6 months they should be seen by a paediatric urologist.
Orchidopexy (surgical correction of undescended testes) should be carried out between 6 and 12 months of age.
If testes have not descended by… they should be seen by a paediatric urologist
6 months
when is an orchidopexy perfromed
between 6-12 months
retractile testicles definition and management
undescended testes definition/pathophysiology
testicular torsion definition
twisting of the spermatic cord with rotation of the testicle. It is a urological emergency
a delay in treatment of testicular torsion increases the risk of
ischaemia and necrosis of the testicle, leading to sub-fertility or infertility
The typical patient of testicular torsion is
teenage boy
Testicular torsion is often triggered by
activity, such as playing sports. Ask what the patient was doing at the time when the pain started.
Presentation and examination findings in testicular torsion
Other than physical activity what is often the cause of testicular torsion?
bell-clapper deformity
What is a bell-clapper deformity?
Normally, the testicle is fixed posteriorly to the tunica vaginalis. A bell-clapper deformity is where the fixation between the testicle and the tunica vaginalis is absent. The testicle hangs in a horizontal position (like a bell-clapper) instead of the typical more vertical position. It is also able to rotate within the tunica vaginalis, twisting at the spermatic cord. As it rotates, it twists the vessels and cuts off the blood supply.
Testicular torsion management
Testicular torsion US can show which sign?
the whirlpool sign, a spiral appearance to the spermatic cord and blood vessels.
Epididymis-orchitis definition
Epididymitis is inflammation of the epididymis. Orchitis is inflammation of the testicle. Epididymo-orchitis is usually the result of infection in the epididymis and testicle on one side.
Causes of Epididymis-orchitis
Escherichia coli (E. coli)
Chlamydia trachomatis
Neisseria gonorrhoea
Mumps
TOM TIP: Think of mumps in patients with parotid gland swelling and orchitis. Mumps tends only to affect the testicle, sparing the epididymis. It can also cause pancreatitis.
Epididymis-orchitis presentation
The key differential diagnosis for epididymo-orchitis is
testicular torsion.
Both present similarly, with acute onset of pain in one testicle. Any doubt, treat it as testicular torsion until proven otherwise.
Diagnosis including investigations for Epididymis-orchitis
Complications of Epididymo-orchitis
Chronic pain
Chronic epididymitis
Testicular atrophy
Sub-fertility or infertility
Scrotal abscess
Management of Epididymo-orchitis
Quinolone antibiotics are used for which conditions? Which two important side effects should you warn patients about?
TOM TIP: Quinolone antibiotics such as ofloxacin, levofloxacin and ciprofloxacin are powerful broad-spectrum antibiotics, often used for urinary tract infections, pyelonephritis, epididymo-orchitis and prostatitis. They give excellent gram-negative cover. It is worth remembering two critical side effects, as these may be tested in exams and are essential to inform patients about:
- Tendon damage and tendon rupture, notably in the Achilles tendon
- Lower seizure threshold (caution in patients with epilepsy)
Nephrotic syndrome definition
occurs when the basement membrane in the glomerulus becomes highly permeable to protein, allowing proteins to leak from the blood into the urine.
Nephrotic syndrome is most common in which age group
most common between the ages of 2 and 5 years
Nephrotic syndrome presentation
frothy urine, generalised oedema and pallor
Nephrotic syndrome features a classic triad of: (investigations)
- Low serum albumin
- High urine protein content (>3+ protein on urine dipstick)
- Oedema
There are three other features that occur in patients with nephrotic syndrome:
- Deranged lipid profile, with high levels of cholesterol, triglycerides and low density lipoproteins
- High blood pressure
- Hyper-coagulability, with an increased tendency to form blood clots
Causes of nephrotic syndrome
Most common cause of nephrotic syndrome in children
minimal change disease, causing over 90% of cases in children under 10.
In minimal change disease, nephrotic syndrome occurs in isolation, without any clear underlying condition or pathology
Management of minimal change disease is
corticosteroids (i.e. prednisolone). The prognosis is good and most children make a full recovery, however it may reoccur.
Minimal change disease definition and investigation findings
Management of nephrotic syndrome
Complications of nephrotic syndrome
Vulvovaginitis definition and age group affected
inflammation and irritation of the vulva and vagina. It is a common condition often affecting girls between the ages of 3 and 10 years.
Vulvovaginitis cause
This irritation is caused by sensitive and thin skin and mucosa around the vulva and vagina in young girls. The vagina is more prone to colonisation and infection with bacteria spread from faeces.
Vulvovaginitis is exacerbated by:
Vulvovaginitis presentation and investigations
Vulvovaginitis management
Hydrocele definition
Simple Hydrocele description and which group it affects
common in newborn males. They occurs where fluid is trapped in the tunica vaginalis. Usually this fluid gets reabsorbed over time and the hydrocele disappears.
Communicating Hydrocele description
occur where the tunica vaginalis around the testicle is connected with the peritoneal cavity via a pathway called the processus vaginalis. This allows fluid to travel from the peritoneal cavity into the hydrocele, allowing the hydrocele to fluctuate in size.
Hydrocele Examination findings
The key differential diagnoses of a scrotal or inguinal swelling in a neonate are:
Hydrocele management
Risk factors for UTIs in children
Differential diagnoses of UTIs
Examination in UTIs
Diagnosis of UTI on M,C and S
UTI management
Further investigations for UTIs to identify structural problems, scars and VUR age based
What qualifies a UTI as atypical
UTIs prognosis in children
Glomerulonephritis definition
Glomerulonephritis refers to inflammation of the glomeruli in the kidneys.
The glomerulus is the first part of the nephron. It filters fluid out of the capillaries and into the renal tubule.
Nephritis definition
very generic term for inflammation in the kidneys. It is a descriptive term and is not a diagnosis.
Nephritic syndrome refers to
most common cause of primary glomerulonephritis….typical patient and histology findings
Membranoproliferative glomerulonephritis (or mesangiocapillary glomerulonephritis) presentation
typically affects patients under 30. It involves immune complex deposits and mesangial proliferation.
Membranous nephropathy definition, symtoms it cuases, histology findnigs. It can be secondary to…
Post-streptococcal glomerulonephritis presentation
Post-streptococcal glomerulonephritis tends to affect patients under 30. It presents 1-3 weeks after a streptococcal infection (e.g., tonsillitis or impetigo). Patients usually make a full recovery.
Rapidly progressive glomerulonephritis (or crescentic glomerulonephritis) presents with, histology findings
Rapidly progressive glomerulonephritis (or crescentic glomerulonephritis) presents with an acute severe illness but tends to respond well to treatment. Histology shows glomerular crescents.
Goodpasture syndrome pathophysiology, what it leads to and typical presentation
Systemic diseases that can cause glomerulonephritis include:
TOM TIP: If you come across a patient in your exams with significant acute kidney injury and haemoptysis, the top conditions to consider can be differentiated based on the antibodies:
- Anti-GBM antibodies – Goodpasture syndrome
- p-ANCA (or MPO antibodies) – microscopic polyangiitis
- c-ANCA (or PR3 antibodies) – granulomatosis with polyangiitis
Glomerulonephritis diagnosis and management
