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PEADS > Renal > Flashcards

Renal Flashcards

1
Q

causes of enuresis

A

Biological - UTI, urinary tract abnormalities, lack of vasopressin during sleep.
Psychosocial - inability to wake to full bladder, psychosocial trauma, developmental delay.

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2
Q

Investigations of enuresis

A

rule out infections and pathological cause
urinalysis
USS of bladder
use diary to track fluid intake and toilet patterns.

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3
Q

definition of enuresis

A

lack of bladder control when child is believed to be continent.

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4
Q

Risk factors for enuresis

A

boys, FH, developmental delay, stress, neurological disease

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5
Q

Management of enuresis

A

Conservative: renal explanation and reassurance, behavioural therapy (stra charts for agreed behaviours, do not criticise bad behaviours), adequate fluid intake.

alarm training - for those below age of 7, senor in underwear or under the sheets.

Medications: Desmopressin (antidiuretic) - for aged 7 and above
Anticholinergic if daytimes symptoms and unresponsive to desmopressin
Imipramine - a TCA.

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6
Q

causes of UTI

A

Most common - E.coli

Other - Proteus, pseudomonas, Klebsiella.

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7
Q

Presentation of UTI in infants and children

A

Infants: vomiting, diarrhoea, reduced feeding, prolonged jaundice, irritability, reduced growth, wet but foul smelling nappies.

Children: dysuria, frequency, bed wetting, urgency, fevers, lethargy, abdominal pain

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8
Q

Investigations for UTI + criteria for further imaging

A

1) urinalysis, send for microscopy and culture
2) renal USS if recurrent UTI, <6months old or signs of serious illness.
3) Dependent on USS will need a MCUG and DMAS if <1yr, only a DMSA if <3yrs.

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9
Q

what is the difference between a DMSA and a MCUG?

A

DMSA - dimerrcaptosuccinic acid scan which looks at the activity and function of the kidneys using isotopes and CT

MCUG - micturating cyst urethrogram - a scan to show the shape and structure of the kidneys and bladder injecting dye through a catheter

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10
Q

Management of UTI in infants under 3 months

A

always hospital admission with IV antibiotics. Referral o a paediatrician.

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11
Q

management of UTI in infants over 3 months

A

depended on clinical status.

for lower UTI oral trimetiprim for 7 days or if an upper UTI IV co-amoxiclav followed by oral trimethrprim

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12
Q

older children with lower UTI management

A

oral abx (trimethoprim) for 3 days.

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13
Q

structural abnormality associated with recurrent UTI? how is it diagnosed and what is the management?

A

vesoureteric reflex - can be congenital, or due to balder pathology, diagnosed by MCUG scan.
will need prophylactic antibiotics, high risk of renal scarring and recurrent UTI.

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14
Q

Causes of haematuria

A 
UTI - bacterial, viral. TB or schistosomiasis
Stones (hypercalceamia)
Tumour (Wilms tumour)
bleeding disorders
acute glomerulonephritis
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15
Q

medications which can cause haematuria

A

senna, rifampicin, nitrofuintoin, (beetroot!)

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16
Q

red flags for presentation of haematuria

A

abdominal mass
significant proteinuria
hypertension
signs of fluid overload

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17
Q

investigations for presentation of heamaturia

A

Examination: palpate abdomen, look for signs of fluid overload, check BP
urinalysis, culture
Bloods: FBC, U&Es, eGFR, clotting, ANA (for SLE)
may need a renal or abdominal USS

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18
Q

what is haemolytic uraemic syndrome

A

microangiopathic haemolytic anaemia, thrombocytopenia and acute renal failure

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19
Q

what is the commenst cause of acute renal failure in children?

A

haemolytic ureamic syndrome

20
Q

causes of haemolytic uremic syndrome

A

Shiga tocin produced by E.coli O157

gastroenteritis and then the bacteria produced this toxin which causes HUS

toxin localises in the kidney, causes intravascular thrombogenesis, aneamia (due to RBC damage)

21
Q

Presentation of HUS

A

Follows a gastroenteritis illness
dehydration, high fever, may have collapse, abdominal/back pain
can have liver and pancreas complications - can present with glucose intolerance and jaundice.

22
Q

Investigations for presentation of haemolytic ureamic syndrome - and what would the blood results show?

A

Bloods: FBC (wcc increased low platelets), U&Es (raised creatinine and urea), LFTs (high LDH), CRP, Clotting (reduced)
Blood film
Stool culture
urinalysis and culture

23
Q

what would you see on a blood film for haemolytic uraemia syndrome?

A

haemolytic anaemia, thrombocytopenia, schistocytes (breakdown parts of RBC)

24
Q

Management of HUS

A

supportive therapy - fluid management, antihypertensive, dialysis if needed.
correction of metabolite abnormalities

Notifiable disease - inform Public Health England

25
Q

metabolite abnormalities that you may see in HUS

A

metabolic acidosis
Hyperphosphatemia
Hyperkalaemia

26
Q

What is nephrotic syndrome?

A

when the glomeruli leak proteins into the urine, increasing osmotic pressure in the renal tubule resulting in proteinuria, hypoalbuminemia and oedema.

27
Q

risk factors for nephrotic syndrome

A

Males (2X more common), ages 2-5, NSAID use, diabetes, SLE, amyloidosis, HIC, malaria, hepatitis

28
Q

causes of nephrotic syndrome

A

90% are idiopathic

secondary to systemic illness eg HSP

29
Q

Complications / associated conditions with nephrotic syndrome

A 
NAPHROTIC
N - hypernatraemia
A - hypoalbuminaemia
P - protienuria
H - hyperlipidaemia
R- Renal vein thrombosis
O - Oedema
T - thromboembolism
I - Infection
C -coagulopathy
30
Q

Presentation of nephrotic syndrome

A

signs of oedema - either pre-orbital or sacral pitting oedema.
weight gain
may have decreased urine output
signs of pleural effusions.

31
Q

Investigations of nephrotic syndrome

A

urinalysis
bloods - U&Es, serum albumin, clotting (raised APTT)
USS for sites of damage - pleural effusions, kidney damage, ascities

32
Q

urinalysis findings in nephrotic syndrome

A

visibly frothy, small volume, very high protein, may have microscopic haematuria

33
Q

management of nephrotic syndrome

A

High dose corticosteroids for 4 weeks
Symptomatic control of oedema (diuretics and salt restriction)
May need prophylactic antibiotics (due to increased risk of infection - Ig lost in urine)

34
Q

what is the difference between nephrotic and nephritic syndrome?

A

nephrotic - children and adults, significant proteinuria with oedema

nephritis - mainly adults, haematuria as well as proteinuria, red cell casts in urine, uraemia symptoms

35
Q

When does Wilms tumours most commonly present? what is the presentation?

A

common in boys, aged between 3-5. risk factors if there is a family history.

present with painless haematuria, an abdominal mass, flank pain, reduced appetite, fever.

36
Q

when and why to refer children with a new abdominal /renal mass and haematuria?

A

Wilms tumour, refer urgently for a USS.

20% of wilms tumour patient have mets (lung)

37
Q

what is Bartters syndrome?

A

Inherited condition causing severe hypokalemia due to defective chloride absorption in the loop of henle.

Presents with weakness, FFT, polyuria, polydipsia, normotension

38
Q

What is glomerulonephritis?

A

immune mediated inflammation (IgA) of the glomerulus, either primacy or secondary (with signs of systemic disease)

39
Q

what are the causes of glomerulonephritis?

A

Primary: inflammation following a strep throat or skin infection, which produced IgA complexes.
Secondary causes: autoimmune disease (SLE), vasculitis (HSP, polyaertitis nodosa), Alport syndrome (inherited glomerulonephritis with high BP)

40
Q

Presentation of glomerulonephritis

A

can be asymptomatic
Malaise, high BP, loin pain, oedema, headache
change in colour of urine to a dark brown ‘cola’ colour

41
Q

Investigations of glomerulonephritis - urinalysis findings

A

urinalysis - gross haematuria, proteinuria, red cell casts.
Low c3 serum levels
throat swab for streptococcus
Renal USS

42
Q

Management of glomerulonephritis

A

symptomatic management:
monitor fluid balance and creatinine clearance.
if due to strep - need abx (most commonly penecillin, also give to family)

43
Q

complications of glomerulonephritis

A

hypertension, nephrotic syndrome, renal failure, heart failure, seizures.

44
Q

What is hydrospadias? how common is it?

A 
congenital disorder where the opening of the urethra is not at the usual location. Effects 1/300 males, second most common congenital  anomaly.
Either distal (meatus is near head of the penis) or proximal (meatus is within the scrotum)
45
Q

Management of hypospadias

A

mild - no treatment needed

if need correction - surgery between 4-18 months. Must not be circumcised! foreskin is used to make a new urethra.

PEADS (6 decks)

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