Renal Flashcards
What are the conditions for a diagnosis of acute pyelonephritis to be made?
Either
A temp above 38 degrees
Loin pain or tenderness
What do nitrites show on urine dip?
Bacteria break down nitrates to nitrites so their presence indicates bacteria
What do leukocytes on urine dip indicate?
Leukocytes indicate infection or inflammation
Nitrites are a better indication of bacterial infection so if there are nitrites but no leukocytes then treat as an infection
What management should a child under 3 months witha fever recieve?
IV antibiotics e.g. ceftriaxone
Septic screen and lumbar puncture should be considered
When should children be investigated further for utis?
If under 6 months should have an abdominal ultrasound within 6 weeks
Children with recurrent utis within 6 weeks
Children with atypical uti during the illness
When should dmsa scans be used?
In children with recurrent or atypical utis
DMSA scans show the renal uptake so will show areas of scarring
How is vesico-uteric reflux investigated?
a micturating cystourethrogram
This involves catheterisation and using contrast medium to image the urinary system
How is vesico-uteric reflex managed?
Avoiding constipation
avoid excessively full bladder
prophylactic antibiotics
Surgical input from paediatric urology
What age is vulvovaginitis most common?
Girls 3-10 due to the thin skin and mucosa being more prone to colonisation
This usually resolves after puberty as oestrogen is protective
What are the exacerbating factors for vulvovaginitis?
Wet nappies Strong chemicals Threadworms Poor toilet hygiene Tight clothing trapping moisture
What are the oresenting features of volvovaginitis?
Erythema Itching Discharge Dysuria Dipstick may show leukocytes
What is the management of vulvovaginitis?
General advice regarding risk factors
In severe cases oestrogen cream can be given
What age is nephrotic syndrome most common in children?
Between 2-5
What are the triad of features in nephrotic syndrome?
Proteinuria
Low albumin
Oedema
What is the most common cause of nephrotic syndrome in children?
Minimal change disease
Hyline casts on unrinalysis
Managed with corticosteroids
What are the secondary causes of nephrotic syndrome in children?
Intrinisic kidney disease: -Focal segmental glomerulosclerosis -Membranoproliferative glumerulonephritis Systemic illness: -Henoch-schonlein purpura -Diabetes -Infection
What is the general management of nephrotic syndrome?
High dose steroids e.g. prednisolone Low salt diet Diuretics may be used for oedema Albumin infusions for hypoalbuminaemia Phrophylactic antibiotics in severe cases
What are the complications of nephrotic syndrome?
Hypovolaemia as fluid moves into the interstitium and intracellular spaces
Thrombosis as anticlotting proteins are lost
Infection as immunoglobulins are lost through the kidneys
Acute or chronic renal failure
What are the 2 most common causes of nephritis in children?
Post streptococcal glomerulonephritis buergers disease (IgA nephropathy)
What is the pathophysiology of post streptococcal glomerulonephritis? How is it investigated?
Following a strep pyogenes tonsillitis there is deposition of immune complexes in the glomeruli causing damage to the kidneys
A positive throat swab and antistreptolysin antibody titres are diagnostic
What is the pathophysiology of berguers disease?
IgA deposition in the nephrons
This is linked to HSP and will show IgA deposits on biopsy
What is the management of nephritis in children?
Mainly supportive treatment
Can use antihypertensives if hypertension present
Can use immunosupressants such as steroids or cyclophosphamide in IgA nephropathy
What is the pathophysiology of haemolytic ureamic syndrome?
This is when there are thrombi in the small blood vessels
this is usually triggered by the shiga toxin which is released by e coli and shigella
What are the triad of features in haemolytic ureamic syndrome?
small vessel thrombosis caused by the shiga toxin leads to:
Ureamia - due to AKI and lack of urea secretion
Anamiea - due to haemolysis
Thrombocytopenia - due to the thrombosis
What are the symptoms of haemolytic ureamic syndrome?
Symptoms typically start 5 days after onset of diahorrea due to an e coli gastroenteritis:
- Reduced urine output
- Haematuira or dark urine
- Abdo pain
- Lethargy
- Oedema
- Hypertension
- Bruising
What is the management of haemolytic ureamic syndrome?
It is a medical emergency with 10% mortality The anagement is mainly supportive Urgent referral for dialysis if required Antihypertensives if required Careful fluid maintenance balance Transfusion if required
What age do most children stop nighttime enuresis?
3-4 years
What are the causes of nocturnal enuresis?
Normal development Bladder overactivity Drinking too much Psychological stress Failure to wake Constipation/UTI
What is the management of nocturnal enuresis?
useful to keep a 2 week diary to track intake, tioleting and bedwetting episodes, helps rule out medical causes
If under 5 reassure that will probably resolve by itself
Lifestyle changes: reduced fluid intake in the evenings, pass urine before bed and ensure easy access to a toilet
Encouragement and reinforcement of agreed behaviours e.g. star chart
Treat underlying causes e.g. constipation
Enuresis alarm
Pharmacoloigcal treatment e.g. desmopressin
What is secondary nocturnal enuresis and what are the causes?
This is when the child has previously been dry for 6 months and starts wetting the bed again This inidicates an underlying illness: -UTi -Diabetes -Constipation -Psychosocial problems -Maltreatment also consider safeguarding
What are the pharmacological options for nocturnal enuresis?
Desmopressin - ADH analogue taken at night
Oxybutinin - anticholinergic medication helpful in overactive bladder urge incontinence
