Renal and Urinary Flashcards
What is nocturnal enuresis
Involuntary discharge of urine during sleep
What is the treatment of nocturnal enuresis for those under 5
reassurance and advice should be given on fluid intake, diet, toileting behaviour, and use of reward systems.
What medication is first line for nocturnal enuresis
Desmopressin
What is the standard management of nocturnal enuresus in children over 5
Reassurance and advice
then Enuresis alarm
then Desmopressin
What is the definition of a UTI
Presence of leucocytes and nitrites on Urine dip stick.
What are the symptoms of a lower tract UTI/ acute cystitis in a child over 5
• Dysuria • Urinary frequency/ urgency • Incontinence • Lower abdominal pain • haematuria vulvitis
How would you diagnose a UTI
Clean catch urine sample bag sample pad sample catheter suprapubic aspirate
How would you treat an acute UTI in a child
- Antibiotics – cefuroxime in neonates, amoxicillin and gentamycin in infants, then trimethoprim in children
- Fluids
- Analgesia
What further investigations could you order for a UTI
: Imaging for underlying abnormality – dependent on age and type of infection
• USS – used to size and drainage of kidneys and bladder, can assess for obstruction - structural abnormality
• Vesicoureteric reflux
-Retrograde flow of urine from bladder into ureter/ pelvicalyceal system/intrarenal
-Severity graded on level of reflux and associated dilatation, clubbing
-Associated with UTI, renal abnormality
• DMSA scan
-radionuclide imaging, used to assess relative renal function and renal scarring
What is Pyelonephritis
An infection of the upper urinary tract
What are the symptoms of pyelonephritis
• Fever, septicaemic illness (with meningitis in infancy) • General malaise, vomiting • Loin/abdominal pain – older child • Failure to thrive, jaundice - infancy foul smelling urine - pus in urine
How to diagnose an UTI
Urine sample!!! • MSU • Suprapubic aspirate (SPA) • Catheter • “clean” catch/bag sample/ pad sample Analysis of urine: • Visual inspection • Dipstick – nitrites, leucocyte esterase • M,C and S
What is steroid resistant nephrotic syndrome
when there is still proteinuria over 4 weeks later
How to manage steroid resistant nephrotic syndrome
fluid balance, daily weighing and salt restriction
What characteristics is nephrotic syndrome identified by
proteinuria, hypoalbuminaemia, hyperlipidaemia and oedema
What is the main cause of nephrotic syndrome
minimal change disease
What are the clinical features of nephrotic syndrome
facial puffiness, leg and feet swelling, gross scrotal oedema, ascites, pleural effusions
What diagnostic tests should be done for nephrotic syndrome
Urine dipstick, 24-hour urine collection to measure protein levels (or protein/creatinine ratio), urine microscopy, blood tests including FBC, clotting, ESR, U&Es, albumin, cholesterol and blood glucose (checking diabetes as a cause). The patient should be weighed regularly.
How do you treat steroid sensitive nephrotic disease
• Standard course of prednisolone for first episode: o 60mg/m2 for 4 weeks o 40mg/m2 on alternate days for 4 weeks • Other considerations: o Na & water moderation o Diuretics o Pen V o Measles & varicella immunity & pneumococcal immunisation
What are the different renal causes of AKI
vascular
tubular
glomerular
interstitial
What are the vascular causes of AKI
Haemolytic uraemic syndrome (HUS) – Vasculitis – Embolus – Renal vein thrombosis
What is the commonest renal cause of AKI
haemolytic -uraemic syndrome
What are the characteristics of glomerulonephritis
haematuria reduced renal functional hypertension protienuria oedema
What is the triad of characteristics in haemolytic uraemic syndrome
acute renal failure
Haemolytic anaemia
thrombocytopenia
What are the investigations for glomerulonephritis
urine dip urine microscopy abdominal imaging throat swab anti-DNase B complement levels renal biopsy if severe
Management of glomerulonephritis
control of fluid and electrolyte balance
use of diuretics and antihypertensives
treat underlying cause
What would you ask about if you suspected post-streptococcal glomerulonephritis
usually follows a streptococcal sore throat or skin infection
What would confirm post-streptococcal glomerulonephritis
Throat swab - culture of organism, raised ASO/anti-DNase B titres and low complement C3 levels
how would you treat post-streptococcal glomerulonephritis
oral penicillin
What clinical signs may indicate post-streptococcal glomerulonephritis
cola coloured urine hypertension headache, vomiting, dizziness and seizures swelling of face and feet proteinuria
What is haemolytic uraemic syndrome pathophysiology
infection with shigella or e.coli. Toxin causes intravascular thrombogenesis. Platelet activation and aggregation occurs, and RBCs get damaged which causes microangiopathic haemolytic anaemia and damage to the capillary walls. Blood clots and damage to the blood vessels cause acute kidney failure
Clinical features of haemolytic uremic syndrome
Bloody diarrhoea Vomiting (sometimes) Severe abdominal pain Reduced urine production Tiredness Poor appetite Swelling Bruising
What is the treatment of haemolytic uraemic syndrome
Dialysis
Blood transfusions
Medication to reduce high blood pressure
Plasma exchange
