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PAEDS RENAL TO DO Flashcards

1
Q

PROTEINURIA
What is proteinuria?

A
  • Persistent proteinuria is significant + should be quantified by measuring the urine protein/creatinine ratio in an early morning sample
  • Protein should not exceed <20mg/mmol of creatinine
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2
Q

PROTEINURIA
What are some causes of proteinuria?

A
  • Transient (febrile illness, after exercise = no investigation)
  • Nephrotic syndrome
  • HTN
  • Tubular proteinuria
  • Increased glomerular perfusion pressure
  • Reduced renal mass
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3
Q

NEPHROTIC SYNDROME
What is nephrotic syndrome?
Who is it most common in?

A
  • Basement membrane in the glomerulus becomes highly permeable to protein, allowing proteins to leak from blood into the urine
  • 2–5y
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4
Q

NEPHROTIC SYNDROME
What are the signs needed in order to make a diagnosis of nephrotic syndrome?

A
  • Heavy proteinuria (>1g/m^2/24h)
  • Hypoalbuminaemia (<25g/L)
  • hypercholesterolaemia
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5
Q

NEPHROTIC SYNDROME
What is the pathophysiology of nephrotic syndrome?

A
  1. Inflammation – from immune cells (Ab’s, Ig’s - IgG), complement proteins, HTN, atherosclerosis, medications/immunisations, infection
  2. Damage to podocytes – protein leakage (albumin, Ab’s)
  3. Increased liver activity – to increase albumin, - Consequential increase in cholesterol + coagulation factors
  4. Reduced oncotic pressure – oedema - Consequential blood volume decrease, RAAS stimulation, exacerbation
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6
Q

NEPHROTIC SYNDROME
What are the 3 main types of nephrotic syndrome?

A
  • minimal change disease
  • membranous glomerulonephritis
  • focal segmental glomerulosclerosis
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7
Q

NEPHROTIC SYNDROME
What is minimal change disease?

A
  • Most common cause in children with no underlying pathology
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8
Q

NEPHROTIC SYNDROME
what is the main symptom of nephrotic syndrome?

A

Pitting oedema - periorbital, ascites, peripheral

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9
Q

NEPHROTIC SYNDROME
what can cause minimal change disease?

A
  • NSAIDs,
  • Hodgkin’s lymphoma,
  • infectious mononucleosis
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10
Q

NEPHROTIC SYNDROME
Who does minimal change disease present in?

A
  • M>F,
  • commoner in Asian children than Caucasians,
  • do not progress to renal failure
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11
Q

NEPHROTIC SYNDROME
What are the features of minimal change disease?

A
  • 1–10y
  • No macroscopic haematuria
  • Normal BP, complement levels, renal function
  • Often precipitated by resp infections
  • 1/3 resolve, 1/3 infrequent relapses, 1/3 frequent relapses
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12
Q

NEPHROTIC SYNDROME
what is the epidemiology of congenital nephrotic syndrome?

A
  • First 3m of life, rare, high mortality
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13
Q

NEPHROTIC SYNDROME
what is the inheritance pattern of congenital nephrotic syndrome?

A

Recessive inheritance with increased incidence in Finnish (UK = consanguinity)

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14
Q

NEPHROTIC SYNDROME
what are the clinical features of congenital nephrotic syndrome?

A

Albuminuria so severe may need unilateral nephrectomy then dialysis for renal failure until renal transplant

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15
Q

NEPHROTIC SYNDROME
What is the clinical presentation of nephrotic syndrome?

A
  • Frothy urine (significant proteinuria)
  • Generalised oedema (pitting + gravitational), can be periorbital (esp on waking)
  • May have scrotal, vulval, leg + ankle oedema too
  • Pallor, breathlessness (pleural effusions) + abdo distension (ascites)
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16
Q

NEPHROTIC SYNDROME
What are some investigations for nephrotic syndrome?

A
  • Urinalysis (proteinuria + microscopic haematuria)
  • Urine MC&S (infection)
  • Renal function (U+Es, creatinine, albumin, urinary Na+ concentration)
  • Lipid profile
  • Systemic disease screen
  • Antistreptolysin O or anti-DNAse B titres + throat swab
  • Renal biopsy for histology if no steroid response
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17
Q

NEPHROTIC SYNDROME
In nephrotic syndrome, what are you looking for with the lipid profile?

A

Deranged (hyperlipidaemia, hypercholesterolaemia)

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18
Q

NEPHROTIC SYNDROME
In nephrotic syndrome, what are you looking for with the systemic disease screen?

A

FBC, CRP/ESR, complement (C3/4) levels, autoimmune screen, hep B/C screen, malaria if abroad

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19
Q

NEPHROTIC SYNDROME
In minimal change disease, what are you looking for with the renal biopsy?

A

Minimal change disease shows normal glomeruli on light microscopy but fusion of podocytes + effacement of foot processes on electron

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20
Q

NEPHROTIC SYNDROME
What are some complications of nephrotic syndrome?

A
  • Hypovolaemia as fluid leaks from intravascular to interstitial space
  • Thrombosis due to loss of antithrombin III
  • Infection due to leakage of immunoglobulins, weakening the immune system + exacerbated by Tx with steroids
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21
Q

NEPHROTIC SYNDROME
What is the general management of nephrotic syndrome?

A
  • Strict fluid balance with restriction, no added salt
  • Tx hypovolaemia if present but albumin infusion is not routine
  • Diuretics if very oedematous + no evidence of hypovolaemia
  • Prophylactic PO penicillin V until oedema-free
  • PCV vaccine
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22
Q

NEPHRITIC SYNDROME
What is nephritic syndrome?

A
  • Acute nephritis is inflammation within the nephrons of the kidneys
  • This leads to reduction in kidney function, macroscopic haematuria + proteinuria
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23
Q

NEPHRITIC SYNDROME
What are some causes of nephritic syndrome?

A
  • Post-streptococcal glomerulonephritis
  • IgA nephropathy (Berger’s disease)
  • Vasculitis (HSP, SLE, Wegener’s, polyarteritis nodosa)
  • Goodpasture’s syndrome
  • Familial nephritis (Alport’s syndrome)
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24
Q

NEPHRITIC SYNDROME
What is post-streptococcal glomerulonephritis?

A
  • Nephritis after group A beta-haemolytic strep pyogenes illness (tonsillitis)
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25
NEPHRITIC SYNDROME What is the pathophysiology of post-streptococcal glomerulonephritis?
Immune complexes made up of streptococcal antigens, antibodies + complement proteins get stuck in glomeruli > inflammation
26
NEPHRITIC SYNDROME How does familial nephritis (Alport's syndrome) present?
- X-linked recessive - ESRF by early adult - Associated with nerve deafness + ocular defects - Mother may have haematuria
27
NEPHRITIC SYNDROME What is the clinical presentation of nephritic syndrome?
- Haematuria (often macroscopic) + proteinuria of varying degree - Impaired GFR (rising creatinine), decreased urine output + volume overload - Salt + water retention > HTN (?seizures) + oedema (eyes)
28
NEPHRITIC SYNDROME What are some investigations for nephritic syndrome?
- Urinalysis = haematuria, raised protein, (PCR, RBC casts on microscopy) - FBC, U+Es = raised urea) raised creatinine + hyperkalaemic acidosis - C3/4 may be low (post-strep, SLE) - Antistreptolysin O titre (may be raised), throat/skin swabs for strep - Renal biopsy
29
NEPHRITIC SYNDROME What is the general management of nephritic syndrome?
- Fluid + electrolyte balance, monitor UO + creatinine - Treat HTN + oedema with antihypertensives ± diuretics (ACEi/ARB, furosemide or prednisolone) - Nephritis usually settles alone, may need steroids
30
NEPHRITIC SYNDROME What is the management of post-strep glomerulonephritis?
Supportive, mostly full recovery (some have worsening renal function), penicillin if active infection
31
HSP What is Henoch-Schönlein purpura (HSP)?
- IgA mediated small vessel vasculitis leading to inflammation affecting the skin, joints, GI tract + kidneys
32
HSP What is the epidemiology of Henoch-Schönlein purpura (HSP)?
3-10y, M>F + peaks during winter, preceded by URTI or gastroenteritis
33
HSP What is the clinical presentation of HSP?
- Palpable purpuric rash affecting extensor surfaces of lower limbs + buttocks - Joint pain (knees + ankles, may be swollen + painful, reduced ROM) - Colicky abdo pain (GI haemorrhage > haematemesis + melaena, intussusception) - Renal involvement (IgA nephritis > haematuria + proteinuria)
34
HSP What are some investigations for HSP?
- Exclude DDx of non-blanching rash – FBC + blood film (thrombocytopenia, sepsis + leukaemia), CRP, cultures, HSP = afebrile - Urinalysis for proteinuria + haematuria - PCR to quantify proteinuria - Renal biopsy if severe renal issues to determine if Tx
35
HSP What might happen if proteinuria becomes severe in HSP? What would you monitor?
- Nephrotic syndrome - BP + serum albumin
36
HSP What is the management of HSP?
- Supportive = analgesia for arthralgia, inconsistent evidence for steroid use - Often good prognosis, self-limiting but 1/3 recur
37
HAEMOLYTIC URAEMIC SYNDROME What is haemolytic uraemic syndrome (HUS)?
- Thrombosis within small blood vessels throughout the body, usually triggered by a bacterial toxin (shiga)
38
HAEMOLYTIC URAEMIC SYNDROME What is the classic HUS triad?
- Microangiopathic haemolytic anaemia (due to RBC destruction) - AKI (kidneys fail to excrete waste products like urea) - Thrombocytopenia
39
HAEMOLYTIC URAEMIC SYNDROME What are some causes of HUS?
- Mostly E. Coli 0157 producing Shiga toxin, can be Shigella (?Petting zoo) - Use of Abx + antimotility agents to treat gastroenteritis caused by these pathogens can increase risk of HUS
40
HAEMOLYTIC URAEMIC SYNDROME What is the clinical presentation of HUS?
- Prodrome of bloody diarrhoea - Urine > reduced output, haematuria or dark brown - Abdo pain, lethargy - Oedema, HTN, bruising
41
HAEMOLYTIC URAEMIC SYNDROME What are some investigations for HUS?
- FBC (anaemia, thrombocytopenia), fragmented blood film - U+Es reveal AKI - Stool culture
42
HAEMOLYTIC URAEMIC SYNDROME What is the management of HUS?
- ABCDE as emergency - Often self-limiting so supportive > refer to paeds renal unit for ?dialysis - Anti-hypertensives, careful fluid balance, blood transfusions - Plasma exchange if severe + not associated with diarrhoea
43
HAEMATURIA How can you differentiate the source of haematuria based on its presentation?
- Glomerular = brown urine, deformed red cells, presence of casts, often with proteinuria - Lower urinary tract = red urine, occurs at beginning or end of stream, not accompanied by proteinuria
44
HAEMATURIA What is the most common cause of haematuria? What are the other 2 broad causes?
- UTI - Glomerular or non-glomerular
45
HAEMATURIA What are some glomerular causes of haematuria?
- Acute/chronic glomerulonephritis, - IgA nephropathy, - familial nephritis, - post-strep glomerulonephritis, - HSP, - goodpasture's
46
HAEMATURIA What are some non-glomerular causes of haematuria?
- Wilm's tumour, - trauma, - stones (esp if FHx), - sickle cell disease - other bleeding disorders
47
HAEMATURIA What investigations for haematuria should all patients get?
- Urinalysis + urine MC&S - FBC, platelets, clotting + sickle cell screen - U+Es, creatinine, albumin, Ca2+, phosphate - USS kidneys + urinary tract
48
HAEMATURIA What investigations would you do if you suspected glomerular haematuria?
- ESR, C3/4 + anti-DNA antibodies - Throat swab + antistreptolysin O/anti-DNAse B titres - Hepatitis B/C screen - Renal biopsy if recurrent haematuria, abnormal renal function/complement levels or significant persistent proteinuria
49
HYPOSPADIAS What is hypospadias?
- Urethral meatus is abnormally displaced posteriorly on the penis
50
HYPOSPADIAS What is epispadias?
Meatus displayed anteriorly on top of the penis
51
HYPOSPADIAS What is the clinical presentation of hypospadias?
- Ventral urethral meatus - Hooded prepuce - Chordee (ventral or downwards curvature of the penis in more severe forms) - Usually identified during NIPE
52
HYPOSPADIAS What is the management of hypospadias?
- Do NOT circumcise as foreskin often needed for later reconstructive surgery - Refer to paediatric specialist urologist - Mild cases may not require any treatment - Surgery done <2y to correct position of meatus + straighten penis
53
UTI What is a urinary tract infection (UTI)?
- Growth of bacteria within the urinary tract (>10^5 single organism/ml)
54
UTI How can UTIs be differentiated anatomically?
- Upper tract infection involves the kidneys (pyelonephritis) + associated with fever, loin pain/tenderness - Lower tract infection involves bladder (cystitis) + low-grade fever with urinary Sx
55
UTI When is a UTI classified as atypical?
- Septicaemia - Poor urine flow - Non-E. Coli - Failure to respond
56
UTI What are some causes of UTI?
- #1 = E. coli, often from bowel contamination - Proteus (M>F, predisposes to formation of phosphate stones in urine) - Pseudomonas (may indicates structural abnormality)
57
UTI What is a complication of E. Coli which might make it difficult to treat?
- Can become resistant to penicillin by producing beta-lactamase (ESBL E. Coli) which breakdown the beta lactam part of Abx making it ineffective
58
UTI What are some risk factors for UTI?
- Incomplete bladder emptying - Vesico-ureteric reflux - Structural abnormality (horseshoe kidney, ureteric strictures) - Inadequate toilet hygiene
59
UTI What is the clinical presentation of UTI in infants?
Non-specific = - fever, - irritable, - D+V, - prolonged neonatal jaundice, - failure to thrive, - septicaemia, - febrile convulsions (>6m)
60
UTI What is the clinical presentation of UTI in children?
- Loin/abdo (suprapubic) pain, - fever (± rigors), - febrile convulsions, - increased frequency, - dysuria, - haematuria, - recurrent enuresis, - offensive urine
61
UTI What are some investigations for UTI?
- Urinalysis for nitrites, leukocytes esterase - Urine sample MC&S = collection pads (babies), MSU clean catch, suprapubic aspiration from bladder under USS worse case
62
UTI In terms of performing ultrasounds scans in UTI, what are the guidelines?
- USS within 6w if 1st UTI + <6m but responds well to Tx - within 48h or during illness if recurrent or atypical bacteria
63
UTI What are some complications of UTI?
- Recurrent kidney infections can cause renal scarring predisposing to HTN, chronic renal failure + even pregnancy complications later in life
64
UTI What is the supportive management of UTI?
- Good fluid intake, analgesia - Wipe front>back - Regular voiding + ensure complete bladder emptying
65
UTI Admission criteria for UTI?
- Admission if <3m, systemically unwell or significant risk factors
66
UTI What is the management of children under 3m in UTI?
ALL children <3m + fever get immediate IV cefuroxime + full septic screen (blood cultures, FBC, CRP lactate, LP etc)
67
UTI What is the management of UTI for >3m with upper UTI?
?Admission for IV, if not PO co-amoxiclav for 7–10d
68
UTI What is the management of UTI for >3m with lower UTI?
3d PO trimethoprim, nitrofurantoin, amoxicillin or cephalosporin with follow-up if still unwell after 24-48h
69
UTI What is the management of UTI for ESBL E. Coli?
Meropenem
70
UTI What is a recurrent UTI?
- ≥2 UTIs with ≥1 with systemic Sx (or ≥3 without)
71
UTI What are the investigations for recurrent + atypical UTIs?
- USS within 6w in all children with recurrent UTIs - DMSA (dimercaptosuccinic acid) scan (renal scarring 4-6m) - Micturating cystourethrogram (<6m) if FHx of vesico-ureteric reflux, dilatation of ureter on USS, poor urinary flow (catheterise + inject contrast into bladder)
72
UT ABNORMALITIES Name 6 urinary tract abnormalities
- Renal agenesis - Multicystic dysplastic kidney - Polycystic kidney disease - Pelvic/horseshoe kidney - Posterior urethral valves - Prune-belly syndrome
73
UT ABNORMALITIES What is renal agenesis?
- Absence of both kidneys
74
UT ABNORMALITIES What is a serious complication of renal agenesis and how does that present?
- Absence of both kidneys causes severe oligohydramnios + hence foetal compression from reduced foetal urine excretion - this can cause Potter syndrome (fatal) - - Low-set ears, beaked nose, prominent epicanthic folds + downward slant to eyes
75
UT ABNORMALITIES What are some other consequences of oligohydramnios in renal agenesis?
- Pulmonary hypoplasia > respiratory failure - Limb deformities such as severe talipes
76
UT ABNORMALITIES What is multicystic dysplastic kidney?
- Non-functioning structure with large fluid-filled cysts with no renal tissue or connection with bladder
77
UT ABNORMALITIES What causes multicystic dysplastic kidney?
Failure of union of ureteric bud with nephrogenic mesenchyme
78
UT ABNORMALITIES What is the management of multicystic dysplastic kidney? What is a complication?
- Half involuted by 2y + nephrectomy only indicated if very large or HTN - No urine production so if bilateral > Potter syndrome
79
UT ABNORMALITIES How does polycystic kidney disease differ from MDK?
- Some renal function remained in polycystic kidney disease
80
UT ABNORMALITIES What are the two types of polycystic kidney disease?
- AD = HTN, haematuria in childhood with renal failure in adulthood - AR = defect on chromosome 6 that encodes fibrocystin, protein for normal renal tubule development
81
UT ABNORMALITIES How might autosomal recessive polycystic kidney disease present?
- Antenatal USS or with abdo masses or renal failure - Neonates may develop Potter syndrome secondary to oligohydramnios
82
UT ABNORMALITIES What are some complications of autosomal recessive polycystic kidney disease?
Often liver involvement with portal + interlobular fibrosis
83
UT ABNORMALITIES What is pelvic/horseshoe kidney?
- Abnormal caudal migration when the lower poles are fused in the midline
84
UT ABNORMALITIES What is a complication of pelvic/horseshoe kidney?
Abnormal position can predispose to infection or obstruction to urinary outflow
85
UT ABNORMALITIES What is posterior urethral valves? What is a consequence?
- Tissue at proximal end of urethra causes obstruction to urinary outflow, M>F - Back pressure into bladder, ureters + up to kidneys > hydronephrosis - Also prevents complete bladder emptying > risk of UTI
86
UT ABNORMALITIES How can posterior urethral valves present in utero? What is a complication of posterior urethral valves?
- Oligohydramnios + potentially pulmonary hypoplasia - Risk of dysplastic kidneys, at its worse if bilateral could lead to potter syndrome
87
UT ABNORMALITIES What is Prune-belly syndrome?
- Absent musculature leading to large bladder + Dilated ureters (megacystis-megaureters) + cryptorchidism
88
UT ABNORMALITIES What are the 2 first steps in management of urinary tract abnormalities? How is the management split after that?
- Antenatal Dx + start prophylactic Abx to prevent UTI - Bilateral hydronephrosis and/or dilated lower urinary tract in a male - Unilateral hydronephrosis in male or any anomaly in female
89
UT ABNORMALITIES What is the management of bilateral hydronephrosis and/or dilated lower urinary tract in a male?
- Bilateral seen in bladder neck obstruction or posterior urethral valves - USS within 48h of birth to exclude posterior urethral valves – Abnormal = MCUG + surgery if required (ablation during cystoscopy) – Normal = stop Abx, repeat USS after 2-3m
90
UT ABNORMALITIES What is the management of unilateral hydronephrosis in male or any anomaly in female?
- Unilateral seen in pelviureteric or vesicoureteric junction obstruction - Abnormal = further investigations - Normal = stop Abx, repeat USS after 2-3m
91
ACUTE KIDNEY INJURY What is acute kidney injury (AKI)? What is it characterised by?
- Spectrum of potentially reversible, reduction in renal function - Rapid rise in creatinine + development of oliguria (<0.5ml/kg/h)
92
ACUTE KIDNEY INJURY What are the 3 broad causes of AKI?
- Pre-renal (most common cause in children) - Renal - Post-renal
93
ACUTE KIDNEY INJURY What are some pre-renal causes of AKI?
- Hypovolaemia = nephrotic syndrome, haemorrhage, sepsis, burns - Circulatory failure
94
ACUTE KIDNEY INJURY What are some renal causes of AKI?
- Vascular = HUS, vasculitis, embolus) - Glomerular = glomerulonephritis - Interstitial = interstitial nephritis, pyelonephritis - Tubular = acute tubular necrosis
95
ACUTE KIDNEY INJURY What are some post-renal causes of AKI?
- Obstruction = congenital like posterior urethral valve or acquired like blocked urinary catheter
96
ACUTE KIDNEY INJURY What are some investigations for AKI?
- FBC, U+Es (high urea), high creatinine, USS to identify if obstruction - Can have hyperkalaemia, hyperphosphataemia + metabolic acidosis
97
ACUTE KIDNEY INJURY What is the management of AKI?
- Maintain strict fluid balance (IV fluids if hypovolaemic, restrict if overload) - If failure of conservative Mx, severe electrolyte disturbances or acidosis then ?dialysis
98
CHRONIC KIDNEY DISEASE What are some causes of chronic kidney disease (CKD)?
- Structural malformations (congenital dysplastic kidney) - Glomerulonephritis - Hereditary nephropathies - Systemic diseases
99
CHRONIC KIDNEY DISEASE What is the clinical presentation of CKD?
- Failure to thrive, anorexia + vomiting - HTN, acute-on-chronic renal failure, anaemia - Bony deformities from renal osteodystrophy - Incidental proteinuria, polydipsia + polyuria
100
CHRONIC KIDNEY DISEASE What are some investigations for CKD?
- Monitor growth - FBC = anaemia due to reduced EPO - U+Es + electrolytes (Ca2+ low, phosphate high)
101
CHRONIC KIDNEY DISEASE What is the management of CKD?
- Diet + NG or gastrostomy feeding may be needed for normal growth - Phosphate restriction + activated vitamin D to prevent renal osteodystrophy - May need recombinant growth hormone - Recombinant erythropoietin to prevent anaemia - Dialysis + transplantation if in ESRF (GFR <15ml/min/1.73m^2)
102
VESICOURETERIC REFLUX what is it?
retrograde flow of urine from the bladder into the upper urinary tract it is usually congenital
103
VESICOURETERIC REFLUX how is it graded?
graded using International Reflux Study grading system
104
VESICOURETERIC REFLUX how is it diagnosed?
- micturating cystourethrogram: radiocontrast medium introduced to catheterised bladder, reflux is detected on voiding - indirect cystogram
105
VESICOURETERIC REFLUX what is the management?
aim is to prevent renal scarring - antibiotic prophylaxis - surgery - not commonly recommended
106
PYELONEPHRITIS what are the risk factors?
- vesicoureteral reflux (VUR) = most common + most important - previous history of UTI - siblings with a history of UTI - female sex - indwelling urinary catheter - intact prepuce in boys - structural abnormalities of the kidneys and lower urinary tract
107
PYELONEPHRITIS what is the pathophysiology?
pyelonephritis occurs after faecal flora colonize the urethra and ascend into the bladder and kidney
108
PYELONEPHRITIS what is the most common causative organism?
E.coli = 80% of cases
109
PYELONEPHRITIS what is the clinical presentation?
- 25% have no clinical signs - 50% present with only flank pain toddlers = fever and irritability, poor feeding, lethargy, abdominal pain older children = fever, vomiting, flank pain, dysuria, urgency, increased frequency
110
PYELONEPHRITIS What are the investigations?
- urine microscopy and culture - CT KUB with contrast
111
PYELONEPHRITIS what is the management?
- empirical antibiotics then targeted based on cultures - severe = hospitalisation and IV antibiotics
112
PYELONEPHRITIS how can it be prevented?
children <2yrs diagnosed with a UTI should have a renal USS
113
PYELONEPHRITIS what are the complications?
- recurrence - renal scarring - hypertension
114
NOCTURNAL ENURESIS what is it?
bedwetting during sleep
115
NOCTURNAL ENURESIS what are the different types?
- Primary nocturnal enuresis = never been consistently dry at night - Secondary nocturnal enuresis = previously been dry for >6 months - Monosymptomatic = only has symptoms at night - Non-monosymptomatic = daytime wetting symptoms as well as night time wetting
116
NOCTURNAL ENURESIS what are the causes?
- not waking to bladder signals - inadequate levels of vasopressin (ADH) - overactive bladder - constipation - UTIs - Family history - Anxiety/stress - poor bedtime routines
117
NOCTURNAL ENURESIS what is the presentation of inadequate levels of vasopressin?
- large volumes of urine passed at night - wet in the early part of the night - wet more than once per night
118
NOCTURNAL ENURESIS what is the presentation of an overactive bladder?
- damp patches that occur at night also occur during the day - the volume of urine passed is variable - children often wake after wetting at night
119
NOCTURNAL ENURESIS what are the investigations?
- physical examination (back, genitalia + lower limbs) - urinalysis + MS&C - bladder scan - uroflowmetry - ultrasound
120
NOCTURNAL ENURESIS what supportive care can be given to help?
- motivation, support and patience - drinking enough - drinking regularly - stopping drinks before bed - avoid drinks that avoid the bladder - regular timed toileting - establish a bedtime routine - refrain from using nappies - avoid lifting child out of bed before they are awake - treat and prevent constipation
121
NOCTURNAL ENURESIS what is the medical management?
- antibiotics for infection - laxatives for constipation - alarms - desmopressin - anticholinergic medications (oxybutynin + tolterodine) for detrusor relaxation
122
ALPORT'S SYNDROME what is it?
A genetic disorder which damages glomeruli resulting in gradual loss of kidney function and CKD
123
ALPORT'S SYNDROME what are the 3 types?
X-linked Alport syndrome (XLAS) Autosomal recessive Alport syndrome (ARAS) Autosomal dominant Alport syndrome (ADAS)
124
ALPORT SYNDROME what is the clinical presentation?
- haematuria - oedema - hypertension - loss of kidney function - progressive hearing loss - proteinuria - vision problems
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ALPORT SYNDROME what is the management?
ACE inhibitors dialysis kidney transplant
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ALPORT SYNDROME what are the investigations?
- genetic testing - tissue biopsy - urinalysis - hearing tests

A TO REVISE - PHASE 3A (16 decks)

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