Paeds - renal tings Flashcards
Postnatal management of congenital renal anomalies
- ABX prophylaxis
- USS - if bilateral hydronephrosis is seen, do MCUG
- Repeat USS in 2-3 months if first one is normal
Wtf is an MCUG
Micturating Cystourethrogram
Inject a die into the bladder via catheter.
Take images whilst child is urinating
3 most common organisms in a UTI in children
E. Coli
Proteus (boys)
Pseudomonas (structural problem)
which UTI is more common in boys
Proteus
which UTI is most common in children with a structural abnormality
Pseudomonas
Signs of atypical UTI
- Septicaemia
- No improvement after 48h of starting abx
- Pelvic/renal mass
- Reduced UO
- High serum Cr
Ddx for UTI? give 3
Vulvovaginitis
Balanitis
Sexual abuse!!!!!
which 1 urine dip result is most specific for UTI - leukocytes or nitrites?
Nitrites
When would you order a USS for a typical UTI?
any child <6 months. do a USS 6 weeks later
In a child with RECURRENT UTIs, which 2 investigations are always ordered?
which extra Ix would you do in a child under 6 months?
USS + DMSA
if <6 mnths, also do MCUG
management of a child <3 months with a lower UTI?
Admit and IV abx
Mx of child with upper UTI and >3months
7-10 days oral Abx = cipro/coamoxiclav
- consider specialist referral
Mx of child with lower UTI and >3 months
Oral trimethoprim for 3 days
what IS vesicoureteric reflux
Where ureters enter directly into bladder and not at an angle
- Either congenital OR acquired after recurrent infection/urethral obstruction/neuropathic bladder
Complications of vesicoureteric reflux
Renal scarring, HTN, recurrent UTIs
Ddx for secondary enuresis
UTI
DM
emotional upset
First Sx of nephrotic syndrome
Periorbital oedema
Is proteinuria always a problem?
Nah can occur in a febrile illness
- worry if it’s persistent
How is nephrotic syndrome classified in children?
Steroid resistant or non-resistant
What Ix are done to exclude Post strep GN as a cause of nephrotic sydnrome
ASO titre
Anti-DNAse B
Initial mx of nephrotic syndrome
Steroids: oral pred
If a child with nephrotic syndrome, doesn’t respond to oral prednisolone what do you do next?
Renal biopsy
How do you assess for hypovolemia in a child with nephrotic syndrome?
How is the hypovolemia managed?
Urinary sodium - if it is low, then child is hypovolemic
Treat child with IV albumin
What is a child with nephrotic syndrome at risk of? therefore how can this be prevented?
Thrombosis
Infection
Hypovolemia
Hypercholesterolemia
Prognosis of nephrotic syndrome
90% respond to steroids - the rest are at risk of ESRF
3 causes of steroid resistant nephrotic syndrome? which one is most common?
- Focal segmental glomerulosclerosis - most common
- Membranous nephropathy
- Mesangiocapillary GN
Useful investigation in a child with nephrotic syndrome and a recent travel Hx?
Malaria - thick and thin blood film or rapid Ag test
Glomerular causes of haematuria
Post-strep GN
IgA nephropathy
Vasculitis: HSP!! , wegener’s, SLE
In a child with rash and haematuria = list 3 Ddx?
Vasculitides:
HSP = number 1
SLE
Wegeners
In a child with brown blood in urine, name some useful Ix
SLE screen (ANAs - dsDNA, sm, histone)
ASO titre/antiDNAse B
ESR, complement levels
Top 3 causes of acute glomerulonephritis
IgA nephropathy
Post strep GN
HSP
Manifestations of acute glomerulonephritis
Haematuria
Proteinuria
Oedema
Hypertension –> SEIZURES
Clinical features of HSP
Preceding URTI
- Rash on buttocks (trunk spared)
- Glomerulonephritis
- Joint pain
- Abdo pain
Management of HSP - when would you admit?
Admit if abdo pain/renal probs
- Supportive
- NSAIDs for pain BUT careful if renal involvement
- Renal specialist review
Histology of IgA nephropathy
mesangial IgA deposition
Number one cause of renal stones in a child
Proteus infection, esp in boys!
What urine dip result would be suggestive of renal stones
pH>7
tx of renal stones
Treat the cause (eg proteus)
Lithotripsy
Best imaging for renal stones
USS
Most common renal cause of AKI
HUS
