Renal Flashcards
what should be considered in children presenting with a fever
Urinary tract infection
which children should receive USS in the context of UTIs
babies under 6 months with their first UTI (within 6 weeks)
children with Recurrent UTIs (within 6 weeks)
children with atypical UTIs at time of illness
what is Visico-Ureteric Reflux
urine has a tendency to flow from bladder back to ureters
- predisposes to upper urinary tract infections + consequent renal scarring
how is visico-ureteric reflux investigated
micturating cystourethogram (MCUG) - Involves catheterising the child, injecting contrast into bladder and taking series of X-rays to determine whether contrast is refluxing into ureters
what is vulvovaginitis
inflammation + irritation of vulva / vagina
- common in young girls pre-puberty
presentation of vulvovaginitis
soreness, itching, erythema, dysuria
what is nephrotic syndrome
basement membrane of glomerulus becomes highly permeable to protein – protein leaks from blood into urine
triad of features in nephrotic syndrome
low serum albumin
high urine protein content
oedema
other features include: HTN, hypercoaguability, high cholesterol / triglycerides
symptoms of nephrotic syndrome
frothy urine (due to high protein content)
oedema
pallor
most common cause of nephrotic syndrome in children
minimal change disease
pathology behind minimal change disease
damage to podocytes causing foot process fusion
mediated by T cells
tx minimal change disease
prednisolone
what is nephritic syndrome
inflammation in the kidneys causing a reduction in kidney function
- haematuria ( visible or non visible)
- proteinuria (less than in nephrotic)
what are the most common causes of nephritis in children
post-streptococcal glomerulonephritis
IgA nephropathy
what is post-streptococcal glomerulonephritis
nephritic syndrome 1-2 weeks post strep. infection
- haematuria
- HTN
- proteinuria
- low complement
what is IgA nephropathy
nephritic syndrome 1-2 days post upper respiratory tract infection
- most common in young males
- macroscopic haematuria
what causes haemolytic uraemic syndrome
Shiga toxin from E.Coli 0157
- causes thrombosis in small blood vessels throughout the body
triad of features in haemolytic uraemic syndrome
haemolytic anaemia
AKI
thrombocytopenia
symptoms of haemolytic uraemic syndrome
onset 5 days after diarrhoea
- reduced urine output
- haematuria
- abdo pain
- HTN
what is cryptorchidism
undescended testes
management of undescended tests
watch + wait – most will descend by 3-6 months
if they have not descended by 6 months then they should undergo a orchidopexy
what is hypospadias
urethral meatus (opening of the urethra) is displaced posteriorly on the penis - corrective surgery 3-4 months old
what is a posterior urethral valve
tissue at proximal end of urethra (closest to bladder) causes obstruction of urine output
- creates back pressure leading to hydronephrosis
- extra tissue can be ablated during cystoscopy
testicular swelling that transilluminates with light
hydrocele
- soft smooth non tender swelling
difference between
- simple hydrocele
- communicating hydrocele
simple hydrocele - fluid trapped in tunica vaginalis. Size does not fluctuate.
communicating hydrocele - tunica vaginalis connected to peritoneal cavity via processus vaginalis. Size will fluctuate.
what is enuresis
bed wetting
abnormal if persists past 5 years
1st line management of enuresis
decrease fluid before bed
toilet pre bed
reward charts
2nd line management of enuresis
in children < 7 try an enuresis alarm
in children > 7 trial of desmopressin
how long should a child with an upper urinary tract infection receive antibiotics for
> 3 months: 3 days of antibiotics
- children < 3 months need immediate hospital admission
what imaging modality looks for renal scarring
DMSA
