Renal

Question 1

Atypical / recurrent UTI

Answer 1

Atypical - seriously ill, poor urine flow, abdominal / bladder mass, raised creatinine, septicaemia, not E.coli , failure to respond in 48 hours

Recurrent - 2 or more upper UTI / 1 upper and 1 or more lower / 3 or more lower

Further investigations… RUSS / micturating cystourethrogram / DMSA (depending on age and reason)

Question 2

Vesicoureteric Reflux

Answer 2

Backflow of urine from the bladder into the ureter and kidney

Common abnormality and predisposes to UTI

Can be mild or severe - risk of scarring, shrunken, poorly functioning kidneys, increased risk of HTN

Question 3

Causes of vesicoureteric reflux

Answer 3

Familial
Secondary to bladder pathology - neuropathic bladder / urethral obstruction
Temporarily after UTI

Investigations - MCUG (visualises dilated anatomy of the urinary tract), DMSA scan

Question 4

Measures for preventing UTI

Answer 4

High fluid intake
Regular voiding
Complete bladder emptying
Treatment / prevention of constipation
Good perineal hygiene 
Lactobacillus acidophilus - probiotic 
Abx prophylaxis

Question 5

Enuresis

Answer 5

Involuntary discharge of urine (day or night) in a child aged 5 or over - in the absence of congenital / acquired defect of nervous or urinary system

Question 6

Nocturnal enuresis

Answer 6

Primary or secondary (prev dry for > 6 months)

Investigate for underling cause e.g. DM, UTI, constipation

Advice on diet and toilet behaviours, rewards system, enuresis alarm, desmopressin

Question 7

Daytime enuresis

Answer 7

Possible causes
Developmental / psychogenic problems
Bladder instability / neuropathy
UTI / constipation / ectopic ureter

Question 8

Nephrotic Syndrome

Answer 8

1. Proteinuria > 200 mg / mmol (frothy urine)
2. Hypoalbuminaemia < 25 mmol / L
3. Oedema

Signs - periorbital oedema, scrotal / ankle oedema, ascites, breathlessness, infection

Minimal change disease, HSP, SLE, infections (malaria)

Question 9

Tx of nephrotic syndrome

Answer 9

1. Steroids - 8 weeks of high dose dexamethasone (if steroid sensitive then minimal change disease, if not responsive then refer to paed nephrologists)
2. Abx - penicillin prophylaxis as at high risk of infections whilst nephrotic
3. Cytotoxic therapy

Question 10

Minimal Change Disease

Answer 10

Commonest cause of NS in children
Associations: drugs (NSAIDs), paraneoplastic (Hodgkin’s)

Biopsy: normal under light microscopy, podocyte layer damaged under electron microscopy

Cyclophosphamide if not responsive to steroids