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Phase 3a - Paediactrics > Renal > Flashcards

Renal Flashcards

1
Q

Urinary Tract Infection

A

Common infection which is important to investigate properly in children due to potential for structural abnormalities in the urinary tract and scarring of the kidneys if pyelonephritis develops which can lead to renal failure.

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2
Q

Common organisms that cause UTI

A

: E coli, Klebsiella, Proteus, Pseudomonas

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3
Q

Symptoms of UTI in infants

A

Fever, vomiting, lethargy, poor feeding, jaundice, septicaemia, smelly urine and febrile convulsions

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4
Q

Symptoms of UTI in Older Children

A

Dysuria, abdominal pain, fever, lethargy, vomiting/diarrhoea, haematuria, smelly/cloudy urine

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5
Q

Ix for UTI

A

A clean catch urine sample needs to be collected for dipstick which often can be very difficult for children. - In the older child, a midstream urine sample can be used and cultured. - Ultrasound of urinary tract and kidneys

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6
Q

Management of UTI

A

Antibiotics - IV for all those <3 months e.g Cefotaxime

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7
Q

Atypical UTI Symptoms/Signs

A
  • Seriously ill/Septicaemia - Poor urine flow - Abdominal mas - Raised creatinine - Failure to respond to Abx within 48 hours - Infection with non E coli organism
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8
Q

What happens to people presenting with Atypical UTIs?

A

All those with an atypical UTI should undergo ultrasound to look for abnormalities with potential DMSA and MCUG scans to look for scarring and vesicoureteric reflux.

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9
Q

UTI Prevention

A
  • High fluid intake to produce a high urine output - Regular voiding - Ensuring complete bladder emptying - Prevention/Treatment of constipation - Prophylactic Abx can be considered
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10
Q

What is pediatric pyelonephritis?

A

Pediatric pyelonephritis is an infection of the kidneys in children, typically resulting from bacteria ascending from the bladder to the kidneys, leading to inflammation and potential kidney damage.

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11
Q

Which bacterium is most commonly responsible for pediatric pyelonephritis?

A) Klebsiella species

B) Escherichia coli

C) Pseudomonas aeruginosa

D) Enterococcus species

A

B) Escherichia coli

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12
Q

List common risk factors for developing pyelonephritis in children.

A

Bladder dysfunction

Bladder obstruction

Neurogenic bladder

Vesicoureteral reflux (VUR)

Use of urinary catheters

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13
Q

True or False: Fever and flank pain are specific indicators of pyelonephritis in children.

A

False. While fever and flank pain are common in pyelonephritis, they are neither sensitive nor specific indicators.

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14
Q

In infants, the most common presenting findings in pyelonephritis are _______ and _______.

A

Fever and irritability

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15
Q

Which imaging modality is considered the most reliable for diagnosing acute pyelonephritis in children?

A) Ultrasound

B) CT Scan

C) DMSA Scan

D) MRI

A

C) DMSA Scan

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16
Q

What laboratory findings are commonly associated with pediatric pyelonephritis?

A

Elevated peripheral white blood cell counts

Elevated nonspecific markers of inflammation

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17
Q

Which of the following is an appropriate oral antibiotic for treating acute pyelonephritis in children?

A) Amoxicillin/clavulanate

B) Ciprofloxacin

C) Doxycycline

D) Azithromycin

A

A) Amoxicillin/clavulanate

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18
Q

True or False: A 5-day course of antibiotics is sufficient for treating acute pyelonephritis in children.

A

False. A 10-day treatment regimen is recommended for children with suspected pyelonephritis.

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19
Q

Name potential complications of untreated pyelonephritis in children.

A

Kidney scarring

High blood pressure

Reduced kidney function

Sepsis

Meningitis (in infants)

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20
Q

Prompt medical care for children with a UTI and _______ is critical to prevent possible permanent kidney damage.

A

Fever.

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21
Q

True or False: Acute pyelonephritis is a rare bacterial illness during childhood.

A

False. Acute pyelonephritis is one of the most serious bacterial illnesses during childhood.

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22
Q

Which of the following ultrasound findings may indicate pyelonephritis?

A) Kidney enlargement

B) Loss of corticomedullary differentiation

C) Abscess formation

D) All of the above

A

D) All of the above

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23
Q

Define pyelonephritis.

A

Pyelonephritis is inflammation of the kidney, typically due to a bacterial infection, leading to symptoms such as fever, flank tenderness, and urinary abnormalities.

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24
Q

What are the long-term management strategies for children with recurrent pyelonephritis?

A

Investigate for underlying anatomical abnormalities

Consider long-term preventive antibiotic treatment

Monitor kidney function regularly

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25
Q

Nocturnal Enuresis

A

Known as ‘bed wetting’, this is a common problems of middle childhood

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26
Q

Causes of Nocturnal Enuresis

A

There is a genetically determined delay in acquiring sphincter competence and emotional stress can cause secondary enuresis however underlying disorders should always be considered: 1. UTI 2. Faecal retention which is severe enough to reduce bladder volume and cause bladder dysfunction 3. Polyuria from osmotic diuresis

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27
Q

Management of Nocturnal Enuresis

A

Explanation to the child and the parent that this is common and beyond conscious control - Star charts - Enuresis Alarm -Desmopressin

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28
Q

What is the function of an enuresis alarm ?

A

sounds when it becomes wet to awaken the child

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29
Q

Desmopressin function

A

used to provide short term relief from bedwetting

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30
Q

Acute Kidney Injury (AKI)

A

Acute renal failure with oliguria (<0.5ml/kg/hour) is usually present

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31
Q

Prerenal causes of AKI

A

Hypovolaemia caused by infections such as gastroenteritis, burns, sepsis, haemorrhage and nephrotic syndrome

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32
Q

Renal causes of AKI

A

HUS, vasculitis, renal vein thrombosis, acute tubular necrosis, glomerulonephritis, pyelonephritis

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33
Q

Post Renal causes of AKI

A

obstructions such as posterior urethral valves, blocker catheters

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34
Q

Management of AKI

A
  1. Regular monitoring of circulation and fluid balance 2. Ultrasound scan to identify any obstruction of the urinary tract 3. Treatment depending upon the cause e.g. fluid replacement, assessment of the site of obstruction, renal biopsy 4. Dialysis in severe cases
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35
Q

What is the most common cause of AKI in children?

A

Pre renal causes

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36
Q

Chronic Renal Failure

A

eGFR < 15ml/min

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37
Q

Causes of Chronic Renal Failure

A
  • Structural malformations - Glomerulonephritis - Hereditary nephropathies - Systemic diseases
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38
Q

Symptoms of Chronic Renal Failure

A
  • Symptoms generally do not develop until renal function falls to less than ⅓ of normal and is often picked up on antenatal ultrasound - Anorexia and lethargy - Polydipsia and polyuria - Faltering growth
  • HTN
  • Acute-on-chronic renal failure precipitated by infection/dehydration
  • Incidental finding of proteinuria
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39
Q

Managment of Chronic Renal Failure

A
  • Sufficient feeding with good protein intake to maintain growth -> this can supplemented with NG/gastrostomy feeding if necessary - Phosphate restriction and activated vit D to prevent renal osteodystrophy - Bicarbonate supplements to prevent acidosis - EPO to prevent anaemia - Growth hormone - Dialysis and transplantation if necessary
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40
Q

Nephrotic Syndrome

A

When the basement membrane in the glomerulus becomes highly permeable to protein resulting in protein leaking into the urine

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41
Q

Nephrotic Syndrome - 3 key features

A

Proteinuria, Hypoalbuminaemia, Oedema

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42
Q

Nephrotic Syndrome - Proteinuria values

A

Proteinuria with 3+/4+ on urine dipstick or a urine protein:creatinine ratio of >200mmg/mol

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43
Q

Nephrotic Syndrome - Hypoalbuminaemia value

A

Hypoalbuminaemia <25g/l

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44
Q

Primary causes of Nephrotic Syndrome

A

Primary is generally an idiopathic cause (80-90%)

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45
Q

Most common cause of Nephrotic Syndrome in children

A

Minimal change disease

46
Q

Secondary causes of Nephrotic Syndrome

A

systemic diseases such as HSP, SLE

47
Q

Other causes of Nephrotic Syndrome

A

●drugs: NSAIDs, rifampicin ●Hodgkin’s lymphoma, thymoma ●infectious mononucleosis

48
Q

Symptoms of Nephrotic Syndrome

A

Periorbital oedema, often on awakening - Scrotal, vulval, leg and ankle oedema -Ascites
- SOB due to presence of pleural effusions and abdominal distension

49
Q

Ix for Nephrotic Syndrome

A

Urine dipstick - Urine protein:creatinine ratio - Urine microscopy - Urine cultures - Bloods - FBC, U+E, albumin, bone profile

50
Q

Definitive dx for Nephrotic Syndrome

A

Renal biopsy (avoided in children)

51
Q

Medical Management of Nephrotic Syndrome

A
  1. Corticosteroid therapy: - Prednisolone 60 mg/m2 /day in a single morning dose (maximum 80mg/day) for 28 days. - Then reduce dosage to 40mg/m2 /alternate day (maximum 50mg/alternate day) given once daily, for 28 days and then stop without tapering. 2. Diuretics may be needed to control oedema whilst the steroids are taking effect: furosemide 1-2mg/kg/day 3. Diet with reduced salty food diet 4. Pneumococcal immunisations - 23 valent pneumococcal polysaccharide vaccine
52
Q

Complications of Nephrotic Syndrome

A

-Risk of relapses -Hypovolaemia -Thrombosis -Infection -Renal failure

53
Q

Relapses of Nephrotic Syndrome

A

Most children will have remissions and relapses however the relapses will generally become less frequent and may stop once they are in teenage years.

54
Q

What is Steroid-Resistant Nephrotic Syndrome

A

this is a potential complication of nephrotic syndrome and requires specialist paediatric nephrologist involvement.

55
Q

Steroid-Resistant Nephrotic Syndrome is common in ___

A

Asian boys

56
Q

What can Steroid-Resistant Nephrotic Syndrome cause

A

It can lead to hypovolaemia, thrombosis, infection and hypercholesterolaemia - It may resolve or can cause relapses and can progress to renal failure

57
Q

Tx for Steroid-Resistant Nephrotic Syndrome

A

Some patients may respond to cyclophosphamide, tacrolimus or rituximab

58
Q

Causes of Steroid-Resistant Nephrotic Syndrome

A

focal segmental glomerulosclerosis (most common) and membranous nephropathy.

59
Q

Nephritic Syndrome

A

Inflammation within the nephrons on the kidneys

60
Q

3 Key features of Nephritic Syndrome

A

Reduction in kidney function - Haematuria - Proteinuria

61
Q

Causes of Nephritic Syndrome

A

Post Strep Glomerulonephritis, IgA nephropathy

62
Q

What is Post Strep Glomerulonephritis ?

A

Occurs 1-3 weeks after a B-haemolytic streptococcus infection such as tonsillitis Immune complexes made up of streptococcal antigens, antibodies and
complement proteins get lodged in the glomeruli and cause inflammation and
AKI

63
Q

What is IgA Nephropathy?

A

This condition is related to HSP which is an IgA vasculitis - IgA deposits in the nephrons of the kidneys causing inflammation

64
Q

Ix for Nephritic Syndrome

A
  • Urine microscopy - Protein and calcium excretion - Kidney and urinary tract ultrasound - Bloods including FBC, U+E, creatinine
65
Q

Management for Nephritic Syndrome

A
  • Supportive therapy of the renal failure - Diuretics and antihypertensive medications can be used for complications like HTN and oedema - Immunosuppressant medications such as steroids
66
Q

Hypospadias

A

A condition affecting males where the urethral meatus (opening of the urethra) is abnormally displaced to the underside of the penis towards the scrotum. Hypospadias is a congenital condition where the urethral opening (meatus) is located on the underside of the penis instead of at the tip.

67
Q

When is Hypospadias diagnosed?

A

It is a congenital condition which affects babies from birth and is usually diagnosed on NIPE exam

68
Q

Managment of Hypospadias

A

Management is surgery which is usually performed after 3-4 months of age and aims to correct the position of the meatus and straighten the penis.

69
Q

True or False: Hypospadias affects approximately 1 in 150 male infants.

A

t

70
Q

Which of the following is a type of hypospadias?

A) Anterior (distal) hypospadias

B) Middle hypospadias

C) Posterior (proximal) hypospadias

D) All of the above

A

D) All of the above

Explanation: Hypospadias is classified based on the location of the urethral opening:

Anterior (distal) hypospadias: Opening near the tip of the penis.

Middle hypospadias: Opening located midway up the penis.

Posterior (proximal) hypospadias: Opening near the scrotum or perineum

71
Q

What are common symptoms of hypospadias?

A

Abnormal location of the urethral opening

Downward urinary spray

Downward curve of the penis (chordee)

Hooded appearance of the penis

72
Q

How is hypospadias typically diagnosed?

A) Physical examination

B) Blood tests

C) Imaging studies

D) Genetic testing

A

A) Physical examination

Explanation: Hypospadias is usually diagnosed at birth through a physical examination.

73
Q

Which of the following is a common treatment for hypospadias?

A) Observation

B) Surgical correction

C) Both A and B

D) None of the above

A

B) Surgical correction

Explanation: Surgical repair is often performed between 6 to 24 months of age to correct the urethral opening and any associated abnormalities.

74
Q

True or False: Most children with hypospadias have normal urinary and sexual function after surgical correction.

A

True. With appropriate surgical intervention, most children achieve normal urinary and sexual function.

75
Q

What are potential complications of untreated hypospadias?

A

Urinary tract infections

Fertility issues

Psychological impact due to appearance

76
Q

There is no known way to prevent hypospadias, as it is a congenital condition.

A

t

77
Q

After surgical correction of hypospadias, how often should follow-up evaluations occur?

A) Annually

B) Every 6 months

C) As recommended by the healthcare provider

D) No follow-up needed

A

C) As recommended by the healthcare provider

Explanation: Follow-up care is individualized based on the surgical outcome and the child’s development.

78
Q

What is pediatric phimosis?

A

Pediatric phimosis is a condition where the foreskin of the penis cannot be retracted over the glans (head) of the penis.

79
Q

Which of the following is a type of phimosis?

A) Physiologic phimosis

B) Pathologic phimosis

C) Both A and B

D) None of the above

A

C) Both A and B Explanation: Phimosis is categorized into two types:

Physiologic phimosis: A normal condition in infants and young children where the foreskin is non-retractable due to natural adhesions.
PMC

Pathologic phimosis: Occurs when the foreskin becomes non-retractable due to scarring, infection, or other pathological causes.

80
Q

True or False: Phimosis is uncommon in newborn boys.

A

False. Phimosis is a normal occurrence in newborn boys.

81
Q

What are common symptoms of phimosis in children?

A

Difficulty retracting the foreskin

Pain during urination

Ballooning of the foreskin during urination

82
Q

How is phimosis typically diagnosed?

A) Blood tests

B) Physical examination

C) Ultrasound

D) MRI

A

B) Physical examination

Explanation: A careful physical examination by a healthcare provider is usually sufficient to diagnose phimosis.

83
Q

Which of the following is a recommended treatment for pathologic phimosis?

A) Topical steroid creams

B) Oral antibiotics

C) Observation

D) None of the above

A

A) Topical steroid creams

Explanation: Topical steroid creams can be effective in treating phimosis and should be considered before surgical options.

84
Q

Which surgical procedure involves making a limited dorsal slit with transverse closure to treat phimosis?

A) Circumcision

B) Preputioplasty

C) Dorsal slit

D) Ventral slit

A

B) Preputioplasty

Explanation: Preputioplasty is a surgical procedure that involves making a limited dorsal slit with transverse closure to widen a narrow non-retractile foreskin.

85
Q

What are potential complications of untreated phimosis?

A

Recurrent infections

Urinary retention

Paraphimosis

Scarring

86
Q

To prevent phimosis, it is important to avoid _______ the foreskin in infants and young children.

A

forcibly retracting

87
Q

True or False: Most cases of physiologic phimosis resolve without intervention by age 3.

A

True. Physiologic phimosis often resolves naturally as the child grow

88
Q

What are pediatric renal malformations?

A

Pediatric renal malformations are congenital anomalies of the kidney and urinary tract (CAKUT) that result from disruptions in normal kidney and urinary tract development during fetal life.

89
Q

Which of the following is a type of pediatric renal malformation?

A) Horseshoe kidney

B) Polycystic kidney disease

C) Renal agenesis

D) All of the above

A

D) All of the above

Explanation: Common congenital kidney anomalies include:

Horseshoe kidney: A condition where the kidneys are fused together.

Polycystic kidney disease: A condition where one or both kidneys are filled with cysts.

Renal agenesis: A condition where a baby is born with one or no kidneys.

90
Q

True or False: Renal malformations are the most common cause of chronic kidney disease in children.

A

True. Congenital malformations of the kidney and urinary tract are the most common cause of chronic kidney disease in children.

91
Q

What are common symptoms of pediatric renal malformations?

A

Frequent urinary tract infections (UTIs)

Persistent fatigue

Loss of appetite

Nausea and vomiting

Stunted growth

Edema/swelling of the belly, hands, feet, or face

Unexplained fever

92
Q

How are pediatric renal malformations typically diagnosed?

A) Blood tests

B) Physical examination

C) Ultrasound

D) MRI

A

C) Ultrasound

Explanation: Congenital malformations of the kidney and urinary tract can usually be diagnosed by ultrasound during pregnancy.

93
Q

Which of the following is a recommended treatment for pediatric renal malformations?

A) Observation

B) Surgical correction

C) Both A and B

D) None of the above

A

C) Both A and B

Explanation: Treatment depends on the specific malformation and its severity. Options may include observation, surgical correction, or other interventions as needed.

94
Q

What are potential complications of pediatric renal malformations?

A

Chronic kidney disease

Hypertension

Recurrent urinary tract infections

Renal failure

95
Q

True or False: The prognosis for children with renal malformations depends on the type and severity of the malformation.

A

True. The prognosis varies based on the specific malformation and its impact on kidney function.

96
Q

Vesicoureteric reflux

A

Vesicoureteric reflux: Developmental abnormality where the ureters are displaced and enter directly into the bladder rather than at an angle causing reflux of urine into the renal pelvis and can cause scarring with UTI

97
Q

What is pediatric vesicoureteral reflux (VUR)?

A

VUR is a condition where urine in the bladder flows backward into the ureters and kidneys, increasing the risk of urinary tract infections (UTIs) and potential kidney damage.

98
Q

True or False: Vesicoureteral reflux is uncommon in infants and children.

A

False. VUR affects approximately 1-3% of all infants and children.

99
Q

What are common symptoms of VUR in children?

A

Recurrent urinary tract infections (UTIs)

Fever

Painful urination

Abdominal or back pain

Incontinence

100
Q

Which diagnostic test is commonly used to confirm VUR?

A) Abdominal ultrasound

B) Voiding cystourethrogram (VCUG)

C) Blood tests

D) MRI

A

B) Voiding cystourethrogram (VCUG)

Explanation: VCUG is the gold standard for diagnosing VUR, as it allows visualization of urine flow and reflux during bladder filling and voiding

101
Q

How is the severity of VUR classified?

A) Grade I to V

B) Stage 1 to 5

C) Mild to severe

D) None of the above

A

A) Grade I to V

Explanation: VUR is graded from I to V, with Grade I being the mildest (reflux into the non-dilated ureter) and Grade V being the most severe (gross dilatation of the ureter, pelvis, and calyces; ureteral tortuosity; loss of papillary impressions).

102
Q

Which of the following is a common treatment for VUR?

A) Prophylactic antibiotics

B) Surgical correction

C) Both A and B

D) None of the above

A

C) Both A and B

Explanation: Treatment may include prophylactic antibiotics to prevent UTIs and, in some cases, surgical correction to reimplant the ureter and prevent reflux.

103
Q

True or False: Most cases of VUR resolve spontaneously.

A

True. Approximately 85% of Grade I and II VUR cases resolve spontaneously

104
Q

What are potential complications of untreated VUR?

A

Recurrent UTIs

Kidney scarring

Hypertension

Renal failure

105
Q

To prevent UTIs in children with VUR, it is important to maintain proper _______ hygiene.

A

perineal

106
Q

How often should children with VUR be monitored?

A) Annually

B) Every 6 months

C) Every 3 months

D) As recommended by a healthcare provider

A

D) As recommended by a healthcare provider

Explanation: Follow-up care depends on the severity of VUR and the child’s response to treatment. Regular monitoring is essential to assess kidney function and detect any complications.

107
Q

Haemolytic Uraemic Syndrome 3 Key features

A

A triad of acute renal failure (AKI), microangiopathic anaemia and thrombocytopenia.

108
Q

Causes of Haemolytic Uraemic Syndrome

A

Usually occurs secondary to GI infection, contact with farm animals or eating uncooked beef. (E.coli, Shigella,)

109
Q

Pathophysiology of Haemolytic Uraemic Syndrome

A

Toxin enters the GI mucosa and localises to the endothelial cells in the kidney causing activation of the clotting cascade and consumption of platelets. - Anaemia is caused by damage to RBC as they circulate

110
Q

Symptoms of Haemolytic Uraemic Syndrome

A
  • Reduced urine output - Haematuria - Abdominal pain - Lethargy and irritability - Confusion - Oedema - HTN
111
Q

Managment of Haemolytic Uraemic Syndrome

A
  • Early supportive therapy including dialysis usually gives a good prognosis - Anti hypertensives if needed - Careful maintenance of fluid balance - Blood transfusions if needed

Phase 3a - Paediactrics (17 decks)

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