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Passmed revision > Paeds - renal tings > Flashcards

Paeds - renal tings Flashcards

1
Q

Postnatal management of congenital renal anomalies

A
  1. ABX prophylaxis
  2. USS - if bilateral hydronephrosis is seen, do MCUG
  3. Repeat USS in 2-3 months if first one is normal
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2
Q

Wtf is an MCUG

A

Micturating Cystourethrogram

Inject a die into the bladder via catheter.
Take images whilst child is urinating

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3
Q

3 most common organisms in a UTI in children

A

E. Coli
Proteus (boys)
Pseudomonas (structural problem)

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4
Q

which UTI is more common in boys

A

Proteus

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5
Q

which UTI is most common in children with a structural abnormality

A

Pseudomonas

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6
Q

Signs of atypical UTI

A
  • Septicaemia
  • No improvement after 48h of starting abx
  • Pelvic/renal mass
  • Reduced UO
  • High serum Cr
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7
Q

Ddx for UTI? give 3

A

Vulvovaginitis
Balanitis
Sexual abuse!!!!!

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8
Q

which 1 urine dip result is most specific for UTI - leukocytes or nitrites?

A

Nitrites

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9
Q

When would you order a USS for a typical UTI?

A

any child <6 months. do a USS 6 weeks later

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10
Q

In a child with RECURRENT UTIs, which 2 investigations are always ordered?
which extra Ix would you do in a child under 6 months?

A

USS + DMSA

if <6 mnths, also do MCUG

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11
Q

management of a child <3 months with a lower UTI?

A

Admit and IV abx

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12
Q

Mx of child with upper UTI and >3months

A

7-10 days oral Abx = cipro/coamoxiclav

  • consider specialist referral
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13
Q

Mx of child with lower UTI and >3 months

A

Oral trimethoprim for 3 days

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14
Q

what IS vesicoureteric reflux

A

Where ureters enter directly into bladder and not at an angle

  • Either congenital OR acquired after recurrent infection/urethral obstruction/neuropathic bladder
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15
Q

Complications of vesicoureteric reflux

A

Renal scarring, HTN, recurrent UTIs

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16
Q

Ddx for secondary enuresis

A

UTI
DM
emotional upset

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17
Q

First Sx of nephrotic syndrome

A

Periorbital oedema

18
Q

Is proteinuria always a problem?

A

Nah can occur in a febrile illness

  • worry if it’s persistent
19
Q

How is nephrotic syndrome classified in children?

A

Steroid resistant or non-resistant

20
Q

What Ix are done to exclude Post strep GN as a cause of nephrotic sydnrome

A

ASO titre

Anti-DNAse B

21
Q

Initial mx of nephrotic syndrome

A

Steroids: oral pred

22
Q

If a child with nephrotic syndrome, doesn’t respond to oral prednisolone what do you do next?

A

Renal biopsy

23
Q

How do you assess for hypovolemia in a child with nephrotic syndrome?
How is the hypovolemia managed?

A

Urinary sodium - if it is low, then child is hypovolemic

Treat child with IV albumin

24
Q

What is a child with nephrotic syndrome at risk of? therefore how can this be prevented?

A

Thrombosis
Infection
Hypovolemia
Hypercholesterolemia

25
Q

Prognosis of nephrotic syndrome

A

90% respond to steroids - the rest are at risk of ESRF

26
Q

3 causes of steroid resistant nephrotic syndrome? which one is most common?

A
  1. Focal segmental glomerulosclerosis - most common
  2. Membranous nephropathy
  3. Mesangiocapillary GN
27
Q

Useful investigation in a child with nephrotic syndrome and a recent travel Hx?

A

Malaria - thick and thin blood film or rapid Ag test

28
Q

Glomerular causes of haematuria

A

Post-strep GN
IgA nephropathy
Vasculitis: HSP!! , wegener’s, SLE

29
Q

In a child with rash and haematuria = list 3 Ddx?

A

Vasculitides:
HSP = number 1
SLE
Wegeners

30
Q

In a child with brown blood in urine, name some useful Ix

A

SLE screen (ANAs - dsDNA, sm, histone)
ASO titre/antiDNAse B
ESR, complement levels

31
Q

Top 3 causes of acute glomerulonephritis

A

IgA nephropathy
Post strep GN
HSP

32
Q

Manifestations of acute glomerulonephritis

A

Haematuria
Proteinuria
Oedema
Hypertension –> SEIZURES

33
Q

Clinical features of HSP

A

Preceding URTI

  • Rash on buttocks (trunk spared)
  • Glomerulonephritis
  • Joint pain
  • Abdo pain
34
Q

Management of HSP - when would you admit?

A

Admit if abdo pain/renal probs

  • Supportive
  • NSAIDs for pain BUT careful if renal involvement
  • Renal specialist review
35
Q

Histology of IgA nephropathy

A

mesangial IgA deposition

36
Q

Number one cause of renal stones in a child

A

Proteus infection, esp in boys!

37
Q

What urine dip result would be suggestive of renal stones

A

pH>7

38
Q

tx of renal stones

A

Treat the cause (eg proteus)

Lithotripsy

39
Q

Best imaging for renal stones

A

USS

40
Q

Most common renal cause of AKI

A

HUS

Passmed revision (15 decks)

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