Renal Flashcards
causes of enuresis
Biological - UTI, urinary tract abnormalities, lack of vasopressin during sleep.
Psychosocial - inability to wake to full bladder, psychosocial trauma, developmental delay.
Investigations of enuresis
rule out infections and pathological cause
urinalysis
USS of bladder
use diary to track fluid intake and toilet patterns.
definition of enuresis
lack of bladder control when child is believed to be continent.
Risk factors for enuresis
boys, FH, developmental delay, stress, neurological disease
Management of enuresis
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.
causes of UTI
Most common - E.coli
Other - Proteus, pseudomonas, Klebsiella.
Presentation of UTI in infants and children
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
Investigations for UTI + criteria for further imaging
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.
what is the difference between a DMSA and a MCUG?
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
Management of UTI in infants under 3 months
always hospital admission with IV antibiotics. Referral o a paediatrician.
management of UTI in infants over 3 months
depended on clinical status.
for lower UTI oral trimetiprim for 7 days or if an upper UTI IV co-amoxiclav followed by oral trimethrprim
older children with lower UTI management
oral abx (trimethoprim) for 3 days.
structural abnormality associated with recurrent UTI? how is it diagnosed and what is the management?
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.
Causes of haematuria
UTI - bacterial, viral. TB or schistosomiasis Stones (hypercalceamia) Tumour (Wilms tumour) bleeding disorders acute glomerulonephritis
medications which can cause haematuria
senna, rifampicin, nitrofuintoin, (beetroot!)
red flags for presentation of haematuria
abdominal mass
significant proteinuria
hypertension
signs of fluid overload
investigations for presentation of heamaturia
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
what is haemolytic uraemic syndrome
microangiopathic haemolytic anaemia, thrombocytopenia and acute renal failure
what is the commenst cause of acute renal failure in children?
haemolytic ureamic syndrome
causes of haemolytic uremic syndrome
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)
Presentation of HUS
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.
Investigations for presentation of haemolytic ureamic syndrome - and what would the blood results show?
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
what would you see on a blood film for haemolytic uraemia syndrome?
haemolytic anaemia, thrombocytopenia, schistocytes (breakdown parts of RBC)
Management of HUS
supportive therapy - fluid management, antihypertensive, dialysis if needed.
correction of metabolite abnormalities
Notifiable disease - inform Public Health England
