Renal and urinary Flashcards
Who are UTIs more common in?
<3 months boys >3 months girls
What is the presentation of a UTI?
Infants: poor feeding, vomiting, irritability
Younger children: abdominal pain, fever, dysuria
Older children: dysuria, frequency, haematuria
Features which may suggest an upper UTI include: temperature > 38ºC, loin pain/tenderness
What features favour an atypical UTI?
- Seriously ill
- Poor urine flow
- Abdominal or bladder mass
- Raised creatinine
- Septicaemia
- Failure to respond to treatment with suitable antibiotics within 48 hours
- Infection with non-E. coli organisms.
What is the management of a UTI?
Infants less than 3 months old
Referral immediately to a paediatrician
Children aged more than 3 months old with an upper UTI
Cephalosporin or co-amoxiclav should be given for 7-10 days
Children aged more than 3 months old with a lower UTI Trimethoprim, nitrofurantoin, cephalosporin or amoxicillin
What is nocturnal enuresis?
Bed wetting at night
What are the causes of nocturnal enuresis?
- Hormonal problems
- Bladder problems
- Genetics
- Sleep problems
- Caffeine
- Psychological problems
Medical conditions
- Diabetes
- Urinary tract abnormalities
- Constipation
- Urinary tract infections (UTIs).
What are the different types of nocturnal enuresis?
Someone with primary nocturnal enuresis has wet the bed since he or she was a baby. This is the most common type of enuresis.
Secondary enuresis is a condition that develops at least 6 months — or even several years — after a person has learned to control their bladder.
What is the management of nocturnal enuresis?
- Look for possible underlying causes/triggers
- Advise on fluid intake, diet and toileting behaviour
- Reward systems (e.g. Star charts)
- An enuresis alarm is first-line for children under the age of 7 years
- Desmopressin may be used first-line for children over the age 7 years
Desmopressin also used for short term use
What is nephrotic syndrome?
Nephrotic syndrome is a kidney disorder that causes your body to pass too much protein in your urine.
What are the causes of nephrotic syndrome?
Diabetic kidney disease
Minimal change disease
Congenital nephrotic syndrome
Membranous nephropathy
What are the symptoms of nephrotic syndrome?
- Severe swelling (edema), particularly around your eyes and in your ankles and feet
- Foamy urine, a result of excess protein in your urine
- Weight gain due to fluid retention
- Fatigue
- Loss of appetite
What is the triad of diagnosis for nephrotic syndrome?
Proteinuria (> 1 g/m^2 per 24 hours)
Hypoalbuminaemia (< 25 g/l)
Oedema
What is the cause of minimal change disease?
- idiopathic, but in around 10-20% a cause is found:
- drugs: NSAIDs, rifampicin
- Hodgkin’s lymphoma, thymoma
- infectious mononucleosis
What is the treatment for nephrotic syndrome?
- Oral corticosteroids
- Diuretics
- ACE Inhibitors
What is hypospadius?
Hypospadias is a congenital abnormality of the penis which occurs in approximately 3/1,000 male infants
what are the symptoms of hypospadius?
- A ventral urethral meatus
- A hooded prepuce
- Chordee (ventral curvature of the penis) in more severe forms
- The urethral meatus may open more proximally in the more severe variants. However, 75% of the openings are distally located.
What is the treatment for hypospadius?
Corrective surgery is performed before 2 years of age.
- It is essential that the child is not circumcised prior to the surgery as the foreskin may be used in the corrective procedure.
- In boys with very distal disease no treatment may be needed.
What is vescicoureteric reflux?
Vesicoureteric reflux (VUR) is the abnormal backflow of urine from the bladder into the ureter and kidney
What is the pathophysiology of vescicoureteric reflux?
- Ureters are displaced laterally, entering the bladder in a more perpendicular fashion than at an angle
- Therefore shortened intramural course of ureter
- Vesicoureteric junction cannot therefore function adequately
What are the different grades of vescicoureteric reflux?
I Reflux into the ureter only, no dilatation
II Reflux into the renal pelvis on micturition, no dilatation
III Mild/moderate dilatation of the ureter, renal pelvis and calyces
IV Dilation of the renal pelvis and calyces with moderate ureteral tortuosity
V Gross dilatation of the ureter, pelvis and calyces with ureteral tortuosity
How is vescicoureteric reflux diagnosed?
- Micturating cystourethrogram
- DMSA scan may also be performed to look for renal scarring
What is Henoch-Schonlein purpura?
IgA mediated small vessel vasculitis
HSP is usually seen in children following an infection
What are the symptoms of Henoch-Schonlein purpura?
Palpable purpuric rash (with localized oedema)
over buttocks and extensor surfaces of arms and legs
Abdominal pain
Polyarthritis
- *Features of IgA nephropathy may occur**
e. g. haematuria, renal failure
What is the treatment of Henoch-Schonlein purpura?
- Analgesia for arthralgia
- Treatment of nephropathy is generally supportive
- There is inconsistent evidence for the use of steroids and immunosuppressants
WHAT IS PYELONEPHRITIS?
Infection of the renal parenchyma and soft tissues of renal pelvis /upper ureter
What is the epidemology of pyelonephritis?
Predominantly affects
women <35
What are the symptoms of pyelonephritis?
Classical triad
Loin pain
Fever
Pyuria
What is the most causative organism in pyelonephritis?
E. coli
What are the investigations for pyelonephritis?
Mainly clinical
- Urinalysis
- Bloods including cultures
- X-ray - stone in upper tract
What is the treatment for pyelonephritis?
Cefalexin - can give in pregnant women and children too
OR
Ciprofloxacin
OR
Co-amoxiclav
Surgery if needed
What are the pyelonephritis complications?
- Sepsis
- Renal abscess
- Progression to chronic pyelonephritis
WHAT IS POST=STREPTOCOCCAL GLOMERULONEPHRITIS?
Post streptococcal glomerulonephritis characteristically occurs 7 to 14 days after infection with group A beta haemolytic streptococcus, usually after a sore throat.
What is the causative organism for post-steptococcal glomerulonephritis?
Strep pyogenes
What are the clinical features of post streptococcal glomerulonephritis?
Often asymptomatic
Features include:
-
General
headache
malaise - Visible haematuria - pepsi coloured
-
Proteinuria
this may result in oedema - Hypertension
- Oliguria
-
Bloods:
low C3
raised ASO titre
What are the investigations for post streptococcal glomerulonephritis?
Renal biopsy features
- Endothelial proliferation with neutrophils
- Electron microscopy: subepithelial ‘humps’ caused by lumpy immune complex deposits
- Immunofluorescence: granular or ‘starry sky’ appearance
What is the management for post-streptococcal glomerulonephritis?
- Throat swab to measure antistreptolysin
- Supportive measures
Fluid restriction
Diet high in carbohydraters
WHAT IS ALPORT SYNDROME?
Alport’s syndrome is a hereditary disease of basement membranes which is characterised by sensorineural deafness and renal failure
What is the inheritence pattern of alport’s syndrome?
X-linked dominant pattern
What are the clinical features of Alport syndrome?
- Kidneys - Microscopic haematuria and progressive renal failure
- Ears - Bilateral sensorineural deafness
- Eyes - Lenticonus: protrusion of the lens surface into the anterior chamber and retinitis pigmentosa
What are the investigations for Alport syndrome?
- Molecular genetic testing
- Renal biopsy
Electron microscopy: characteristic finding is of the longitudinal splitting of the lamina densa of the glomerular basement membrane, resulting in a ‘basket-weave’ appearance
What is the management of Alport syndrome?
No treatment is curative
- Blood pressure control
- Support treatment of renal failure
- Renal dialysis and transplant
WHAT ARE THE SYMPTOMS OF SLE IN THE KIDNEYS?
- Haematruia
- Proteinuria
WHAT IS A HORSESHOE KIDNEY?
Horseshoe kidneys is a congenital condition of the kidneys which produces a characteristic IVP picture where the upper poles are further from the midline than the lower poles.
What are the clinical feautres of horseshoe kidneys?
- This congenital abnormality may result in hydronephrosis due to PUJ obstruction
What is the treatment for horseshoe kidney?
Pyeloplasty
WHAT IS INFANTILE POLYCYSTIC KIDNEY DISEASE?
WHAT CHROMOSOME DOES IT AFFECT?
Autosomal recessive condition with the presence of numerous renal cysts throughout the cortex and medulla
Bilateral condition
Chromosome 6
What are the clinical features of infantile polycystic disease?
- Nomrally presents on ultrasound in pregnancy
- Mass in abdomen
- Poor renal function
What is the management of infantile polycystic kidney disease?
- Managaing complication of CKD and portal hypertension
- Most children die in infancy or childhood
WHAT IS THE TRIAD OF HAEMOLYTIC URAEMIC SYNDROME?
- AKI
- Microangiopathic haemolytic anaemia
- Thrombocytopenia
What are the cuases of haemolytic uraemic syndrome?
- Shiga toxin-producing Escherichia coli (STEC)
- Pneumococcal infection
What are the clinical features of haemolytic uraemic syndrome?
- Most common following diarrhoeal illness
- Blood in stool
- AKI - Haematuria
- Dehydration
- Thrombocytopenia
What are the investigations for haemolytic uraemic syndrome?
-
Stool culture
looking for evidence of STEC infection
PCR for Shiga toxins - Full blood count: anaemia, thrombocytopaenia, fragmented blood film
- U&E: acute kidney injury
What is the management for haemolytic uraemic syndrome?
- Treatment is supportive e.g. Fluids, blood transfusion and dialysis if required
- VOLUME PLASMAPHERESIS
- There is no role for antibiotics
- Eculizumab can be useful
WHAT IS PHIMOSIS?
Non-retractile foreskin
What is the management of phimosis before 2 years of age?
In children less than 2 years of age, phimosis (a non-retractable foreskin) is normal and will most likely resolve with time
