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Paeds > Renal > Flashcards

Renal Flashcards

1
Q

What are the classical symptoms of UTI?

A

dysuria, frequency and loin pain

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2
Q

Besides the classical symptoms of UTI, what are some symptoms of UTI?

A

fever, vomiting, lethargy or irritability, poor feeding, jaundice, septicaemia, recurrence of enuresis, offensive cloudy urine

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3
Q

How would you diagnose typical UTI?

A

MSU

SPA

‘Clean-catch’ sample into waiting clean pot (recommended method)

Analysis of urine - visual inspection, dipstick - nitries and leucocyte esterase, urine culture

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4
Q

How would you interpret dipstick results for nitrite and leucocytes?

A

Nitrite +ve = useful as very likely to indicate UTI,

Leucocyte +ve = MAY be present in children with UTI but also with febrile illness w/o UTIs

Nitrite positive and Leucocyte positive = regard as UTI

Nitrite negative and Leucocyte positive = only start abx if clinical signs or if positive culture

Nitrite positive and Leucocyte Negative = start abx

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5
Q

What are common organisms responsible for UTI?

A

E.Coli > Klebsiella > Proteus (more common in boys) > Pesudomonas (may indicate structureal abnorm)

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6
Q

Management of UTI?

A
  • < 3 months old - refer immediately to a paediatrician
  • > 3 months old and upper UTI - consider admission

not admitted oral antibiotics such as cephalosporin or co-amoxiclav should be given for 7-10 days

  • > 3 months old and lower UTI - 3 days trimethoprim, nitrofurantoin, cephalosporin or amoxicillin. bring after 24-48 hours if still ill
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7
Q

What are some causes of incomplete bladder emptying?

A

Infrequent voiding

vulvitis

incomplete micturition

constipation

neuropathic bladder

vesicoureteric reflux

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8
Q

What is vesicoureteric reflux?

A

developmental anomaly of vesicoureteric junctions - ureters enter directly into bladder directly, rather than at an angle

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9
Q

What is the consequence of severe vesicoureteric reflux?

A

intrarenal reflux - backflow of urine from renal pelvis into the papillar collecting ducts

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10
Q

What are complications of vesicoureteric reflux?

A

intra-renal reflux

incomplete bladder emptying

pyelonephritis

renal damage and scarring

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11
Q

How would you investigate an atypical UTI?

A

USS kidneys and urinary tract

micturating cystourethrogram

DMSA to look for renal scarring

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12
Q

What is an atypical UTI?

A

seriously ill or septicaemia

poor urine flow

abdominal/bladder mass

raised creatinine

failure to respond to abx with 48 hrs

infection w/ non - E.coli

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13
Q

What can be done for UTI prevention?

A

high fluid intake

regular voiding

ensuring complete bladder emptying (double micturition)

prevention of constipation

good perineal hygience

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14
Q

What is daytime enuresis?

A

lack of bladder control during day in child who’s old enough to be continent (3-5 years old)

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15
Q

What can cause daytime enuresis?

A

lack of attention to bladder sensation (developmental, psychogenic, distracted)

destrusor instability

bladder neck weakness

neuropathic bladder (spina bifida)

UTI

constipation

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16
Q

How would you investigate enuresis?

A

Urine sample MC&S

USS

urodynamic studies

x-ray spine

17
Q

How would you manage enuresis?

A

< 7 : an enuresis alarm is first-line

> 7 : desmopressin particularly if short-term control is needed or an enuresis alarm has been ineffective/is not acceptable to the family

star charts, bladder training

18
Q

What would you suspect if a child was previously continent but now has loss continence?

A

emotional upset

UTI

Polyuria (diabetes)

19
Q

What are some causes of proteinuria?

A

transient (febrile/after exercise)

orthostatic proteinuria

glomerular abnormality (minimal change)

reduced renal mass

hypertension

20
Q

What is Nephrotic Syndrome?

A

proteinuria (> 1 g/m^2 per 24 hours)

hypoalbuminaemia (< 25 g/l)

oedema

21
Q

How does Neprotic Syndrome present?

A

Periorbital Oedema

Scrotal, Vulval, Leg and Ankle oedema

Ascites

Breathlessness

22
Q

What investigations would you carry out in suspected nephrotic syndrome?

A

Urine Dipstick

FBC

U&E

Creatinine

Albumin

23
Q

How would you manage nephrotic syndrome?

A

corticosteroid therapy

prednisolone - 60mg/m2 then after 4 weeks - 40mg/m2 for 4 weeks

24
Q

What is a complication of nephrotic syndrome?

A

Hypovolaemia - caused by initial phase of oedema

abdo pain

urinary sodium retention

requires IV albumin

Infection, Thrombosis, Hypercholesteromia

25
Q

What are some causes of nephritis?

A

post-infection

vasculitis (Henoch-schonlein, SLE)

IgA nephropathy

Goodpastures

26
Q

How would Henoch-Schonlein purpura present?

A

Purpuric rash over bum and extensor surfaces of arms and legs

Fever

Polyarthritis

Abdominal Pain

features of IgA nephropathy may occur e.g. haematuria, renal failure

27
Q

What are some common non-symptomatic features of Henoch-Schonlein?

A

3-10 years old

twice as common in boys

peaks during winter months

preceded by URTI often

28
Q

Treatment for Henoch-Schonlein?

A

analgesia for arthralgia

treatment of nephropathy is generally supportive

29
Q

What is an example of familial nephritis?

A

Alport syndrome

X-linked recessive

assoc. with deafness and ocular defects

30
Q

How would you define hypertension for children?

A

BP > than 95th percentile for height, age and sex

31
Q

Causes for hypertension?

A 
renal parenchymal disease
renal vascular disease
coarctation of the aorta
phaeochromocytoma
congenital adrenal hyperplasia
essential or primary hypertension (becomes more common as children become older)
32
Q

How does Fanconi syndrome present?

A 
type 2 (proximal) renal tubular acidosis
polyuria
aminoaciduria
glycosuria
phosphaturia
osteomalacia
33
Q

What are the commonest causes of AKI in children in the UK?

A

Haemolytic Uraemic Syndrome

Acute tubular necrosis - multisystem failure following cardiac surgery

34
Q

How does Haemolytic Uraemic Syndrome present? What causes it?

A

acute renal failure
microangiopathic haemolytic anaemia
thrombocytopenia

usually secondary to GI infection with E.coli from farm animals

35
Q

How does HUS present? How would you treat?

A

bloody diarrhoea

AKI

intravascular thrombogenesis

treatment is supportive e.g. Fluids, blood transfusion and dialysis if required

Paeds (13 decks)

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