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Paeds > Renal > Flashcards

Renal Flashcards

1
Q

Signs and symptoms of UTI if able to verbalise

A
  • Lower abdo pain
  • Increased freq and dysuria
  • Enuresis/incontinence
  • Rigors/chills
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2
Q

Symptoms and signs of UTI if not able to verbalise

A
  • Fever
  • Vomiting
  • Lethargy/irritability
  • Poor feeding and failure to thrive
  • Smelly nappies
  • Haematuria
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3
Q

What other symptoms are you interested in with a UTI hisotory

A 
Constipation (pressure on bladder)
Neuro deficits (spinal cord defect)
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4
Q

When is an MC&S done on urine?

A

Always in an under 3yr old
If over 3 yr olds have leucocytes or nitrites on urine dip
If over 3 month olds have signs of pyelonephritis
If over 3 months, lower UTI that doesn’t resolve after 48hrs

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5
Q

When are IV antibiotics used to treat a UTI?

A

If its upper UTI

If under 3 months old

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6
Q

What needs to monitored if severe UTI?

A

Dehydration
Monitor blood pressure and kidney function if severe
30% get scarring
Renal abscess, hydronephrosis

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7
Q

What children are more susceptible to UTIs?

A 
Nappy wearing (faecal->perineal->urethral)
Anatomical abnormalities
Voiding dysfunction (mass/constipation/poor flow)
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8
Q

What is an MCUG?

A

Micturating cystourethrogram

Catheter insertion and die, diagnosis of reflux.

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9
Q

Risk factors for congenital renal abnormalities

A

Maternal diet of low protein and high salt, IUGR, vitamin A, maternal diabetes, ACEi, cocaine, foetal alcohol syndrome

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10
Q

What is the difference between agenesis and hypoplasia in kidney abnormalities

A
  • Agenesis (no kidney, you die if bilateral, most common unilateral and asymptomatic)
  • Hypoplasia (smaller kidney, less nephrons)
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11
Q

What is meant by congenital dysplasia of the kidney

A

• Dysplasia (to do with differentiation of layers of kidney, decreased nephron number, narrowed ureter. Most serious is multicystic dysplastic kidney, non functioning)

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12
Q

What does an ectopic kidney mean?

A

Ectopy (pelvic kidney/crossed with both on same side)

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13
Q

Autosomal dominant polycystic kidney disease:

A

Renal failure in 40% by age of 60

Adult disease

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14
Q

What are posterior urethral valves?

A

Posterior urethral valves (only boys, obstruction below bladder, enlarged bladder, UTIs, dysuria and frequency. Catheterise to relieve retention)

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15
Q

Urine dipsticks can show presence of what 10 things? What does presence of each show?

A
  • Blood
  • Protein
  • Leucocytes (infection)
  • Nitrites (infection in and around urinary tract)
  • Glucose (diabetes, contamination, kidneys)
  • Ketones (Dka, starvation)
  • PH (renal tubular acidosis)
  • Bilirubin (obstructive jaundice)
  • Urobilinogen
  • Specific Gravity (density)
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16
Q

Classifications of haematuria

A
  • Frank/visible /non visible

* Persistent/ intermittent

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17
Q

Name an autoimmune cause of renal failure

A

Glomerulonephritis (post streptococcus, IgA, hSP)

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18
Q

What tumour can cause renal failure in children

A

Wilms tumour

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19
Q

What is seen in nephrotic syndrome?

A

Loosing lots of protein in urine (>200mg/mmol creatinine)
Hypoalbuminaemia (<25g/l)
Oedema (pedal, periorbital, genital)
Hypercholesterolaemia

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20
Q

What is PCR? Used for?

A

PCR: protein creatinine ratio, helps us know if it is just dehydration or an issue

21
Q

Signs of glomerulonephritis

A

Haematuria, proteinuria, glycosuria, electrolytes, fluids, BP

22
Q

Causes of hypertension in children

A

Cardiac (coarctation)

  • Kidneys (glomerulonephritis)
  • Endocrine (Cushing’s)
23
Q

Sequelae of nephrotic syndrome

A
  • Can lead to infections (eg peritonitis/cellulitis) and hypovolaemia
  • Thrombosis can occur due to haemoconcentration, hyperaggregable platelets and loss of anti-thrombin III in urine
  • Can cause acute renal failure due to dehydration and infection
24
Q

Treatment of nephrotic syndrome

A
  • Maintain hydration
  • IV albumin
  • Low salt diet
  • Minimise oedema
  • Immunisations
  • Prednisolone 2mg/kg/day initial long course
  • Alkylating agents
  • Cyclosporin, rituximab (anti lymphocyte)
25
Q

What is enuresis?

A

Involuntary voiding/incontinence of urine at least 2 nights a month beyond the age of 5

26
Q

Difference between primary and secondary enuresis?

A

Primary: Incontinence occurs after continence should have been achieved. Never been dry. 85% of cases
Secondary: Incontinence occurs after previously being dry.

27
Q

Who is affected by enuresis?

A

Continuous enuresis: anatomical defects
Intermittent: Occurs in 1/15 7yr olds, 1/75 teenagers. Prevalence decreases with age. Boys more than girls for nocturnal enuresis.

28
Q

When is daytime continence usually acquired? How does this work?

A

By 3 years of age
When receptors detect stretching of bladder, impulse sent to spinal cord. This elicits need to void/discomfort
By aged 3, able to defer micturition reflex

29
Q

What happens when urinating? Which nerves and nerve roots are involved?

A
  1. Contract bladder detrusor (PNS, splanchnic nerves)
  2. Relax sphincters
    Internal (sm, invol, PNS S2-S4, inferior hypogastric plexus)
    External (skeletal, vol control, somatic/pudendal nerve)
  3. Relax pelvic floor muscles (vol, skeletal) pull detrusor downwards – voluntary
  4. Urination and complete emptying of bladder
  5. Midbrain inhibition of micturition
30
Q

How is urination stopped?

A
  1. Relax detrusor (involuntary, SNS)
  2. Bladder neck/internal sphincter closes (invol, SNS)
  3. Urethral/external sphincter closure (voluntary)
  4. Suppression of micturition reflex (CNS inhibition)
31
Q

Why does nocturnal enuresis occur?

A
  • Normal mechanism of ADH to concentrate urine further at night does not occur
  • Therefore urine exceeds functional capacity of bladder
  • AND child does to respond to signal to wake up to void
32
Q

List 7 neuro causes of nocturnal enuresis

A
  • Lack of ADH
  • Neurological impairment of signaling
  • Seizures
  • Sleep arousal difficulties
  • Spina bifida/spinal cord problem
  • Psychogenic (sexual abuse/emotional instability)
  • Neuromuscular (disability, immobility, weak pelvic floor muscles)
33
Q

List 4 urinary tract causes for enuresis

A
  • Congenital malformation (ectopic ureter)
  • UTI
  • Urethral obstruction/renal calculi
  • Chronic renal failure
34
Q

List 2 bladder causes for enuresis and 2 examples of each

A
  • Functional (underdeveloped bladder/diabetes/constipation pressing on bladder)
  • Neurological (dysfunctional bladder/reduced filling awareness, overactive/twitchy bladder)
35
Q

Effects of enuresis on child

A
  • Embarrassment, shame, unhappiness, low self esteem, guilt
  • Perineal soreness, rash and dysuria
  • Bullying
  • Disturbed sleep
  • Reduced participation in activities e.g. sleepovers
  • Family disharmony
  • Abuse
36
Q

Effects of enuresis on parent

A

Increased costs, buying nappies
• More laundry!
• Embarrassment, guilt or intolerance!
• Reduced participation in some areas e.g. family holidays
• Disturbed sleep
• Worry about underlying pathology or prognosis.

37
Q

What is the 1st line treatment of nocturnal enuresis?

A

Lifestyle:
• Reduce evening intake, avoid caffeine, fizz, squash
• Avoid constipation

38
Q

What is the 1st line drug for nocturnal enuresis?

A

Desmopressin (ADH analogue)

39
Q

What is the 2nd line treatment for nocturnal enuresis

A

Enuresis alarm

40
Q

What is the 2nd line drug for nocturnal enuresis?

A

Oxybutinin for overactive bladder, antispasmodic effect

41
Q

What is the 3rd line drug for nocturnal enuresis?

A

Imipramine (TCA)
Reduced REM sleep
Stimulates ADH
Relaxes detrusor

42
Q

SE of imiprimine

A

TCA used 3rd line for nocturnal enuresis
OD profile
SE: sleep disorders and nervousness

43
Q

How does Wilm’s present?

A 
Abdominal mass (asymptommatic/abdo pain/haematuria) that doesn't cross the midline
Hypertension
44
Q

Differentials to Wilm’s (11)

A 
Mesoblastic nephroma - Most common renal tumor in the first month of life
Renal cell carcinoma
Clear cell sarcoma of the kidney
Rhabdoid tumor of the kidney
Nonmalignant mass
Hydronephrosis
Multicystic kidney disease
Renal cyst
Renal thrombosis
Dysplastic kidney
Renal hemorrhage
45
Q

What can cause voiding dysfunction?

A 
Constipation
Mass
Enlraged bladder
Poor flow
Anatomical abnormalities
46
Q

When are USS clinically indicated in UTIs?

A

An ultrasound scan should be organised during the acute admission when there are signs of an atypical UTI in infants under 6 months. Eg
• Seriously ill
• Poor urine flow
• Abdominal or bladder mass
• Raised creatinine
• Septicaemia
• Failure to respond to treatment with suitable antibiotics within 48 hours

Infants and children who have had a lower urinary tract infection should undergo ultrasound (within 6 weeks) only if they are younger than 6 months or have had recurrent infections.

47
Q

Define DMSA scan

A 
Dimercaptosuccinic acid (DMSA) scan
A nuclear medicine study. This test takes advantage of the filtration function of the kidneys to help identify areas that are not functioning correctly. It will show the size, shape and position of the kidneys and demonstrate areas of scarring or abnormal development.
48
Q

Who needs a DMSA scan?

A

A DMSA scan 4–6 months following the acute infection should be used to detect renal parenchymal defects.

49
Q

Main causes of nephrotic syndrome in children

A

• MCNS (minimal change nephrotic syndrome, nephrons look normal/not damaged (most common cause! Responds to steroids
• Diabetic nephropathy
Post streptococcal infection

Paeds (14 decks)

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