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Paeds: Acute Presentation > Renal and urinary tract disease > Flashcards

Renal and urinary tract disease Flashcards

1
Q

What are 3 causative organisms of UTI in children?

A
  1. E. coli
  2. Proteus
  3. Pseudomonas
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2
Q

What should UTI in children prompt, unlike in adults?

A

investigation for possible underlying causes and damage to the kidneys

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3
Q

What are 3 types of predisposing factors to urinary tract infection in children?

A
  1. Incomplete bladder emptying
  2. Vesicoureteric reflux
  3. Poor hygiene e.g. not wiping from front to back in girls
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4
Q

What are 4 causes of incomplete bladder emptying?

A
  1. Infrequent voiding
  2. Hurried micturition
  3. Obstruction by full rectum due to constipatoin
  4. Neuropathic bladder
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5
Q

What proportion of children who present with UTI have vesicoureteric reflux?

A

35%

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6
Q

What is the gender split in urinary tract inections before 3 months of age?

A

More common in boys (due to more congenital abnormalities)

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7
Q

What is the gender split in urinary tract inections after 3 months of age?

A

substantially higher in girls

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8
Q

What are 3 presenting features of UTI in infants?

A
  1. Poor feeding
  2. Vomiting
  3. Irritability
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9
Q

What are 3 presenting features of UTI in younger children?

A
  1. Abdominal pain
  2. Fever
  3. Dysuria
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10
Q

What are 3 presenting features of UTI in older children?

A
  1. Dysuria
  2. Frequency
  3. Haematuria
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11
Q

What are 2 features of UTI in children that may suggest an upper UTI?

A
  1. Temperature >38
  2. Loin pain/ tenderness
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12
Q

According to NICE what are 3 situations when you should perform a urine sample in a child?

A
  1. if any symptoms or signs suggestive of UTI
  2. unexplained fever of 38 or higher (test urine after 24h at the latest)
  3. with an alternative site of infection but who remain unwell (consider urine test after 24h at the latest)
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13
Q

What are 3 methods for urine collection method in children?

A
  1. Clean catch preferable
  2. If not possible, urine collection pads should be used
  3. Invasive methods such as suprapubic aspiration should only be used if non-invasive methods are not possible
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14
Q

What is the management of children <3 months old with UTI?

A

Refer immediately to paediatrician

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15
Q

What are 2 aspects of management of children aged >3 months with an upper UTI?

A
  1. consider for admission to hospital
  2. if not admitted, oral antibiotics such as cephalosporin or co-amoxiclav should be given for 7-10 days
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16
Q

What are 2 aspects of the management of children aged >3months with a lower UTI?

A
  1. Oral antibiotics for 3 days according to local guidelines, usually trimethoprim, nitrofurantoin, cephalosporin or amoxicillin
  2. Parents should be asked to bring the children back if they remain unwell after 24-48 hours
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17
Q

When shoudl you consider antibiotic prophylaxis for UTI in children?

A

not given after first UTI but should be considered with recurrent UTIs

18
Q

What is vesico-ureteric reflux?

A

abnormal backflow of urine from the bladder into the ureter and kidney

19
Q

What is a common complication of vesicoureteric reflux?

A

UTI and also renal scarring

20
Q

Why is it important to investigate for VUR following a UTI?

A

because of risk of renal scarring

21
Q

What proportion of children with VUR develop renal scarring?

A

35%

22
Q

What is the pathophysiology of VUR?

A
  • ureters are displaced laterally, entering the bladder in a more perpendicular fashion than at an angle
  • shortened intramural course of ureter
  • vesicoureteric junction cannot function adequately
23
Q

What is grade I vesicoureteric reflux?

A

Reflux into the ureter only, no dilatation

24
Q

What is grade II vesicoureteric reflux?

A

reflux into the renal pelvis on micturition, no dilatation

25
Q

What is grade III vesicoureteric reflux?

A

Mild/moderate dilatation of the ureter, renal pelvis and calyces

26
Q

What is grade IV vesicoureteric reflux?

A

Dilation of the renal pelvis and calyces with moderate ureteral tortuosity

27
Q

What is grade V vesicoureteric reflux?

A

Gross dilatation of the ureter, pelvis and calyces with ureteral tortuosity

28
Q

What is used to diagnose vesicoureteric reflux?

A

micturating cystourethrogram

29
Q

What is used to look for renal scarring form VUR?

A

Dimercaptosuccinic acid (DMSA) scan

30
Q

What is reflux nephropathy?

A

term used for chronic pyelonephritis secondary to vesico-uretic reflux

31
Q

When doe sscarring usually occur in reflux nephropathy?

A

in first 5 years

32
Q

What causes reflux nephropathy?

A

secondary to VUR; stong genetic disposition

33
Q

How is a diagnosis of reflux nephropathy made?

A

micturating cystography

34
Q

What can occur secondary to reflux nephropathy?

A

renal scar may produce increased quantities of renin causing hypertension

35
Q

What is the triad of haemolytic uraemic syndrome?

A
  1. Acute kidney injury
  2. Microangiopathic haemolytic anaemia
  3. Thrombocytopenia
36
Q

What usually causes HUS?

A
  • secondary to GI infection with verocytotoxin-producing E. coli O157:H7, acquired through contact with farm animals or eating uncooked beef (or shigella)
  • follows prodrome of bloody diarrhoea
  • toxin from these organisms enters GI mucosa and preferentially localises to the endothelial cells of the kidney where it causes intravascular thrombogenesis
  • coagulation cascade activated and clotting normal (unlike DIC)
37
Q

What causes microangiopathic haemolytic anaemia in HUS?

A

damage to red blood cells as they circulate through the microcirculation, which is occluded

38
Q

What is the management of haemolytic uraemic syndrome? 2 key aspects

A
  1. early supportive therapy, including dialysis
  2. long-term follow up necessary to detect persistent proteinuria or development of hypertension and progressive CKD
39
Q

How does atypical HUS differ from typical HUS?

A

has no diarrhoeal prodrome, may be familial, and frequently relapses

40
Q

What are 3 risks of atypical HUS?

A
  1. Hypertension
  2. Progressive CKD
  3. High mortality
41
Q

What is a new treatment that has improved the prognosis of atypical HUS?

A

monoclonal anti-terminal complement antibody eculizumab

42
Q

What does the treatment of atypical HUS usually involve?

A

plasma exchange (especially cerebral atypical HUS)

sometimes eculizumab

Paeds: Acute Presentation (14 decks)

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