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MS4 - Paediatrics and Epidemiology > Paeds urinary tract > Flashcards

Paeds urinary tract Flashcards

1
Q

Upper urinary tract infection sx

A

High fever >38.5
Loin pain
High CRP
Vomiting

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2
Q

Lower urinary tract infection signs

A

Frequency
Urgency
Wetting
Cystitis

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3
Q

Causes of UTI

A

E coli
Proteus mirabilis
Pseudomonas
Klebsiella

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4
Q

What is a UTI by non E Coli bacteria suggestive of

A

structural abnormality

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5
Q

Ix for recurrent UTIs

A

US
DMSA
MCUG

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6
Q

MCUG

A

micturition cysto-urogram

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

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7
Q

DMSA

A

isotope scan

shows all the functional nephrons that pick up the dye

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8
Q

Nephrotic syndrome

A
  • Filtration barrier broken (podocytes)
  • Leaking of a lot of albumin into urine
  • Fluid retension
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9
Q

Primary causes of nephrotic syndrome

A

genetics

idiopathic

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10
Q

Secondary causes of nephrotic syndrome

A

SLE

Hep B, C

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11
Q

Types of nephrotic syndrome

A
  • minimum change nephrotic syndrome (MCD)
  • focal segmental glumerulosclerosis (FSGS)
  • Membranoproliferative glomerulonephritis (MPGN)
  • membranous nephropathy
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12
Q

Mx of nephrotic syndrome

A
  • Steroids
  • abx
  • gastric protection
  • immune modulators ( Tacrolimus, rituximab, levamisole)
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13
Q

Clinical complications of nephrotic syndrome

A

thrombosis

infection

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14
Q

Thrombosis complications of nephrotic syndrome

A
  • Haemoconcentration (virchow’s triad)
  • Increased fibrinogen factor 7, 8 and 10
  • decreased anti-thrombin 3 and plasminogen
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15
Q

Virchows triad

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

factors increasing risk of DVTs

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16
Q

Nephritic syndrome pathophysiology

A

Inflammation of glomerulus- shutting the glomerulus down

- renal failure

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17
Q

Sx of nephrotic syndrome

A
  • Blood: Low albumin, high lipids (cholesterol)
  • Peripheral oedema
  • Proteinuria
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18
Q

Why high cholesterol in nephrotic syndrome

A

liver trying to compensate for lack albumin in blood

produces cholesterol at the same time

19
Q

Nephritic syndrome Sx

A

Haemoturia (cola-coloured urine) + proteinuria
Oliguria
HTN

20
Q

Commonest causes of nephritic syndrome

A
  • Post infectious; group A beta strep
  • HSP
  • IgA
  • SLE
21
Q

What type of infections commonly lead to nephritic syndrome

A 
pharyngitis (7-10 day prior)
skin infection (eg impetigo 6 wks prior)
22
Q

Ix for post strep nephritic syndrome

A

Low C3
Elevated ASOT
Elevated anti-Dnase B

23
Q

Non blanching purpura rash DDx

A

Henoch-Sconlein Purpura

Meningococcal infection

24
Q

Haemolytic uraemic syndrome

A
  • Haemolytic microangiopathic anaemia
  • Thrombocytopenia
  • Renal failure
25
Q

Management of haemolytic uraemic syndrome

A

Supportive in the majority:

  • Fluid restriction
  • Anti-hypertensives
  • Acute renal failure therapy
26
Q

Acute kidney injury

A

Urine output < 0.5-1 ml/Kg/hr

27
Q

Stages of chronic kidney failure

A 
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
28
Q

Consequences of AKI

A
  1. Hyperkalaemia
  2. Acid –base
  3. Fluid overload
  4. Hypertension
29
Q

Treatment of high K

A
  1. Calcium gluconate
  2. HCO3
  3. Salbutamol
  4. Glucose / Insulin
  5. Calcium resonium
  6. Dialysis
30
Q

Why give calcium gluconate in low K

A

so bathes heart in Ca so it doesnt go into arrhythmia

31
Q

How does Calcium resonium work

A

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

32
Q

When to give fluids in renal failure

A

if pre-renal cause; fluid challange and frusemide

if renal cause; fluid restrict; only give the bare minimum

33
Q

Bare minimum fluid requirements

A

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

34
Q

Indications for dialysis

A 
High K
Fluid overload
HTN
Uncorrectable acidosis
Removal of toxins ( uraemia)
35
Q

Types of dialysis

A

Peritoneal dialysis

Haemodialysis

36
Q

Causes of HTN in kids

A 
Renal 80%
Vascular 
Endocrine 
CNS
Drugs
Essential (primary)
37
Q

Renal causes of HTN

A

scarring
vasculitis
failure

38
Q

vascular causes of HTN

A

coarctation

39
Q

Endocrine causes of HTN

A

Cushings

Phaeochromocytoma

40
Q

CNS causes of HTN

A

Space occupying lesion

41
Q

Drug causes of HTN

A

steroids

42
Q

Malignant HTN mx

A

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

43
Q

Watershed infarct

A

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

44
Q

Enuresis mx

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

MS4 - Paediatrics and Epidemiology (25 decks)

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