Renal Flashcards
What are the classical symptoms of UTI?
dysuria, frequency and loin pain
Besides the classical symptoms of UTI, what are some symptoms of UTI?
fever, vomiting, lethargy or irritability, poor feeding, jaundice, septicaemia, recurrence of enuresis, offensive cloudy urine
How would you diagnose typical UTI?
MSU
SPA
‘Clean-catch’ sample into waiting clean pot (recommended method)
Analysis of urine - visual inspection, dipstick - nitries and leucocyte esterase, urine culture
How would you interpret dipstick results for nitrite and leucocytes?
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
What are common organisms responsible for UTI?
E.Coli > Klebsiella > Proteus (more common in boys) > Pesudomonas (may indicate structureal abnorm)
Management of UTI?
- < 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
What are some causes of incomplete bladder emptying?
Infrequent voiding
vulvitis
incomplete micturition
constipation
neuropathic bladder
vesicoureteric reflux
What is vesicoureteric reflux?
developmental anomaly of vesicoureteric junctions - ureters enter directly into bladder directly, rather than at an angle
What is the consequence of severe vesicoureteric reflux?
intrarenal reflux - backflow of urine from renal pelvis into the papillar collecting ducts
What are complications of vesicoureteric reflux?
intra-renal reflux
incomplete bladder emptying
pyelonephritis
renal damage and scarring
How would you investigate an atypical UTI?
USS kidneys and urinary tract
micturating cystourethrogram
DMSA to look for renal scarring
What is an atypical UTI?
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
What can be done for UTI prevention?
high fluid intake
regular voiding
ensuring complete bladder emptying (double micturition)
prevention of constipation
good perineal hygience
What is daytime enuresis?
lack of bladder control during day in child who’s old enough to be continent (3-5 years old)
What can cause daytime enuresis?
lack of attention to bladder sensation (developmental, psychogenic, distracted)
destrusor instability
bladder neck weakness
neuropathic bladder (spina bifida)
UTI
constipation
How would you investigate enuresis?
Urine sample MC&S
USS
urodynamic studies
x-ray spine
How would you manage enuresis?
< 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
What would you suspect if a child was previously continent but now has loss continence?
emotional upset
UTI
Polyuria (diabetes)
What are some causes of proteinuria?
transient (febrile/after exercise)
orthostatic proteinuria
glomerular abnormality (minimal change)
reduced renal mass
hypertension
What is Nephrotic Syndrome?
proteinuria (> 1 g/m^2 per 24 hours)
hypoalbuminaemia (< 25 g/l)
oedema
How does Neprotic Syndrome present?
Periorbital Oedema
Scrotal, Vulval, Leg and Ankle oedema
Ascites
Breathlessness
What investigations would you carry out in suspected nephrotic syndrome?
Urine Dipstick
FBC
U&E
Creatinine
Albumin
How would you manage nephrotic syndrome?
corticosteroid therapy
prednisolone - 60mg/m2 then after 4 weeks - 40mg/m2 for 4 weeks
What is a complication of nephrotic syndrome?
Hypovolaemia - caused by initial phase of oedema
abdo pain
urinary sodium retention
requires IV albumin
Infection, Thrombosis, Hypercholesteromia
What are some causes of nephritis?
post-infection
vasculitis (Henoch-schonlein, SLE)
IgA nephropathy
Goodpastures
How would Henoch-Schonlein purpura present?
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
What are some common non-symptomatic features of Henoch-Schonlein?
3-10 years old
twice as common in boys
peaks during winter months
preceded by URTI often
Treatment for Henoch-Schonlein?
analgesia for arthralgia
treatment of nephropathy is generally supportive
What is an example of familial nephritis?
Alport syndrome
X-linked recessive
assoc. with deafness and ocular defects
How would you define hypertension for children?
BP > than 95th percentile for height, age and sex
Causes for hypertension?
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)
How does Fanconi syndrome present?
type 2 (proximal) renal tubular acidosis polyuria aminoaciduria glycosuria phosphaturia osteomalacia
What are the commonest causes of AKI in children in the UK?
Haemolytic Uraemic Syndrome
Acute tubular necrosis - multisystem failure following cardiac surgery
How does Haemolytic Uraemic Syndrome present? What causes it?
acute renal failure
microangiopathic haemolytic anaemia
thrombocytopenia
usually secondary to GI infection with E.coli from farm animals
How does HUS present? How would you treat?
bloody diarrhoea
AKI
intravascular thrombogenesis
treatment is supportive e.g. Fluids, blood transfusion and dialysis if required
