Paeds urinary tract

Question 1

Upper urinary tract infection sx

Answer 1

High fever >38.5
Loin pain
High CRP
Vomiting

Question 2

Lower urinary tract infection signs

Answer 2

Frequency
Urgency
Wetting
Cystitis

Question 3

Causes of UTI

Answer 3

E coli
Proteus mirabilis
Pseudomonas
Klebsiella

Question 4

What is a UTI by non E Coli bacteria suggestive of

Answer 4

structural abnormality

Question 5

Ix for recurrent UTIs

Answer 5

US
DMSA
MCUG

Question 6

MCUG

Answer 6

micturition cysto-urogram

dye in bladder- shows if there is a reflux (dye goes all the way up to kidneys if reflux present)

Question 7

DMSA

Answer 7

isotope scan

shows all the functional nephrons that pick up the dye

Question 8

Nephrotic syndrome

Answer 8

• Filtration barrier broken (podocytes)
• Leaking of a lot of albumin into urine
• Fluid retension

Question 9

Primary causes of nephrotic syndrome

Answer 9

genetics

idiopathic

Question 10

Secondary causes of nephrotic syndrome

Answer 10

SLE

Hep B, C

Question 11

Types of nephrotic syndrome

Answer 11

• minimum change nephrotic syndrome (MCD)
• focal segmental glumerulosclerosis (FSGS)
• Membranoproliferative glomerulonephritis (MPGN)
• membranous nephropathy

Question 12

Mx of nephrotic syndrome

Answer 12

• Steroids
• abx
• gastric protection
• immune modulators ( Tacrolimus, rituximab, levamisole)

Question 13

Clinical complications of nephrotic syndrome

Answer 13

thrombosis

infection

Question 14

Thrombosis complications of nephrotic syndrome

Answer 14

• Haemoconcentration (virchow’s triad)
• Increased fibrinogen factor 7, 8 and 10
• decreased anti-thrombin 3 and plasminogen

Question 15

Virchows triad

Answer 15

1. Hypercoagulability.
2. Haemodynamic changes (stasis, turbulence)
3. Endothelial injury/dysfunction.

factors increasing risk of DVTs

Question 16

Nephritic syndrome pathophysiology

Answer 16

Inflammation of glomerulus- shutting the glomerulus down

- renal failure

Question 17

Sx of nephrotic syndrome

Answer 17

• Blood: Low albumin, high lipids (cholesterol)
• Peripheral oedema
• Proteinuria

Question 18

Why high cholesterol in nephrotic syndrome

Answer 18

liver trying to compensate for lack albumin in blood

produces cholesterol at the same time

Question 19

Nephritic syndrome Sx

Answer 19

Haemoturia (cola-coloured urine) + proteinuria
Oliguria
HTN

Question 20

Commonest causes of nephritic syndrome

Answer 20

• Post infectious; group A beta strep
• HSP
• IgA
• SLE

Question 21

What type of infections commonly lead to nephritic syndrome

Answer 21

pharyngitis (7-10 day prior)
skin infection (eg impetigo 6 wks prior)

Question 22

Ix for post strep nephritic syndrome

Answer 22

Low C3
Elevated ASOT
Elevated anti-Dnase B

Question 23

Non blanching purpura rash DDx

Answer 23

Henoch-Sconlein Purpura

Meningococcal infection

Question 24

Haemolytic uraemic syndrome

Answer 24

• Haemolytic microangiopathic anaemia
• Thrombocytopenia
• Renal failure

Question 25

Management of haemolytic uraemic syndrome

Answer 25

Supportive in the majority: - Fluid restriction - Anti-hypertensives - Acute renal failure therapy

Question 26

Acute kidney injury

Answer 26

Urine output < 0.5-1 ml/Kg/hr

Question 27

Stages of chronic kidney failure

Answer 27

``` Stage 1: GFR > 90 ml/min/m2 Stage 2: 60–89 ml/min/m2 Stage 3: 30–59 ml/min/m2 Stage 4: 15–29 ml/min/m2 Stage 5: kidney failure GFR < 15 ml/min/m2 or dialysis ```

Question 28

Consequences of AKI

Answer 28

1. Hyperkalaemia 2. Acid –base 3. Fluid overload 4. Hypertension

Question 29

Treatment of high K

Answer 29

1. Calcium gluconate 2. HCO3 3. Salbutamol 4. Glucose / Insulin 5. Calcium resonium 6. Dialysis

Question 30

Why give calcium gluconate in low K

Answer 30

so bathes heart in Ca so it doesnt go into arrhythmia

Question 31

How does Calcium resonium work

Answer 31

Given orally Enters gut circulation K enters gut circulation from systemic circulation and gets bound to calcium resonium

Question 32

When to give fluids in renal failure

Answer 32

if pre-renal cause; fluid challange and frusemide if renal cause; fluid restrict; only give the bare minimum

Question 33

Bare minimum fluid requirements

Answer 33

Insensible loss (300mls/m2/day) + urine output

Question 34

Indications for dialysis

Answer 34

``` High K Fluid overload HTN Uncorrectable acidosis Removal of toxins ( uraemia) ```

Question 35

Types of dialysis

Answer 35

Peritoneal dialysis | Haemodialysis

Question 36

Causes of HTN in kids

Answer 36

``` Renal 80% Vascular Endocrine CNS Drugs Essential (primary) ```

Question 37

Renal causes of HTN

Answer 37

scarring vasculitis failure

Question 38

vascular causes of HTN

Answer 38

coarctation

Question 39

Endocrine causes of HTN

Answer 39

Cushings | Phaeochromocytoma

Question 40

CNS causes of HTN

Answer 40

Space occupying lesion

Question 41

Drug causes of HTN

Answer 41

steroids

Question 42

Malignant HTN mx

Answer 42

admission to ITU BP needs to be lowered slowly over a few days with continuous beat to beat BP monitoring otherwise causes watershed infarct

Question 43

Watershed infarct

Answer 43

sudden drop in BP, compromising blood supply to the outer layers of the cerebral cortex

Question 44

Enuresis mx

Answer 44

1. fluid intake (don't restrict) + toileting 2. reward chart 3. enuresis alarm 4. desmopressin