Renal and Urology Flashcards
Children under 6 months with a UTI require what scan
USS within 6 weeks
Children under 6 months with atypical or recurrent UTIs require which scans
USS during illness
DMSA 6 months later
MCUG
Does a 7 month old child require a USS following a UTI
No unless recurrent or atypical
What do all children with recurrent UTI need?
DMSA scan 4-6 months after infection
USS within 6 weeks
What children with atypical or recurrent UTI need a MCUG
Under 6 months
Features that make a UTI aytipical
Non E Coli Sepsis Poor urine flow/ abdominal mass Raised creatine Failure to respond to treatment within 48 hours
Definition of a recurrent UTI (2)
2 or more (if one systemic)
3 or more (if none systemic)
A diagnosis can be made for acute pyelonephritis if either two are present:
Temperature greater than 38C
Loin pain or tenderness
Why are nitrites present in UTI dipstick
Gram negative bacteria (e coli) break down nitrates -> nitrites
What should all children under 3 months with a fever have
IV antibiotics
Septic screen - cultures, bloods, lactate, LP
What do children with aytipical UTIs require
All need an USS during infection
<6 months: DMSA and MCUG
6 months - 3 years: DMSA
What is a DMSA used to identify
How well the kidneys are working and if there is any scaring
What is a MCUG used to diagnosed.
What is MCUG full name
VUR
Micturating cystourethrogram
Management of VUR (4)
Avoid constipation
Frequent urination
Prophylactic ABX
Surgery
Why is vulvovaginitis most common in children 3-10
Post puberty, oestrogen helps keep skin healthy and resistant to infection
Urine dipstick result for vulvovaginitis
Leukocytes but no nitrites
Risk factors for vulvovaginitis
3-10 years, wet nappies, chemicals, tight clothing, poor hygiene, constipation, threadworms, pressure (horse riding), heavily chlorinated pools
What 2 other conditions do patients with vulvovaginitis usually have a history of (misdiagnosed)
Thrush and UTIs
Management of vulvovaginitis
Mainly supportive:
Avoid chemicals, emollients, loose clothing, good hygiene
Oestrogen cream may help
Triad of nephrotic syndrome
Low serum albumin
High urine protein
Oedema
Other than low serum albumin, high urine protein and oedema what 3 other features are common in this syndrome
Nephrotic syndrome
Raised lipid profile
HTN
Hypercoaguable
Most common cause of nephrotic syndrome in children
Minimal change disease
Secondary to renal disease or secondary to systemic illness: HSP, DM, infections
Management of minimal change disease
Steroids
Low salt diet
What causes 90% of nephrotic syndrome
Minimal change disease
Nephritis definition
Inflammation of the kidneys which causes haematuria, reduced GFR and proteinuria (although less than nephrotic)
Two most common causes of nephritic syndrome in kids
Post-streptococcal glomerulonephritis IgA nephrophathy (Bergers disease)
What infection is Post-streptococcal glomerulonephritis possible after
What blood test to confirm
Tonsilitis
Throat swab for anti-streptolysin antibodies
What is anti-streptolysin antibodies used to determine
Severity and immune response to recent streptococcus infection
Used for post-strep glomerulenphitis and RF
What is IgA nephropathy (Bergers disease)
And what condition is it linked to
IgA depostis in kideny cause inflammation
Henoch-Schonlein pupura (IgA vasculitis)
What is management for Bergers disease
Steroids and immunosuppressant medications to slow progression
What toxin causes HUS
Shiga
HUS triad
Haemolytic anaemia
AKI
Thrombocytopenia
What bacteria produces the Shiga toxin
e coli 0157 and shigella
What increases the risk of developing HUS
Antibiotics and anti-motility agents like loperamide
is HUS dangerous?
10% of kids die
Low threshold for dialysis
How to manage HUS
Dialysis
Anti-HTN
Fluid balance
Blood transfusions
What is enuresis
Bed wetting
When should children be dry by day and by night
2 at day
3-4 at night
Common and important condition to rule out in enuresis
Constipation
UTI, learning disability, CP
5 causes of secondary enuresis (wetting bed that had previously been dry)
UTI, constipation, T1DM, new psychological problems, maltreatment
Common pharmacological management of enuresis
Desmopressin (ADH) given at bedtime to reduce fluid in bladder
What is Imipramine used for
TCA used for enuresis
Unsure how it works but believes to relax bladder
Why type of incontinence is oxybutinin used for
Overactive bladder causing urge incontinence
Anticholinergic medication
Two types of PKD
AR - presents in kids with oligohydramnios
AD - presents in later life
What is Potter syndrome and what condition normally causes it
Lack of amniotic fluid (oligohydramnios) causes dysmorphic features such as low set ears, flat nasal bridge. Also causes pulmonary hypoplasia. Will need dialysis and most will have end stage renal failure by adulthood.
ARPKD
What is a Wilms tumour
Nephroblastoma
What should be ruled out in all children under 5 with an abdominal mass
Wilms tumour
Diagnosis of Wilms tumour
US
Core biopsy
Management of Wilms tumour
Nephrectomy
Where is the issue in children with posterior urethral valve
Proximal end of urethra
Only occurs in newborn boys
How may a posterior urethral valve be diagnosed prenatally
Hydronephrosis
Oligohydramnios -> underdeveloped fetal lungs (pulmonary hypoplasia) -> resp failure
5 RF for undescended testicles
FH, low birth weight, SGA, premature, smoking in pregnancy
How long to watch and wait in undescended testicles in newborns?
3-6 months -> seen by surgeon
Orchidoplexy -? 6-12 months
Age of hypospadias treatment
3-4 months
Where is fluid in hydrocele
Tinica vaginalis
What is the developmental origins of the tunica vaginalis
Connected with peritoneal cavity
So if not separated will allow fluid from peritoneal cavity to drain
Difference between the 2 types of hydrocele
Simple - fluid trapped in tunica vaginallis (not connected to abdo)
Communicating - connected to peritoneal cavity via processus vaginalis
Key examination finding of hydrocele
Transilluminates with light (whole testicle will brighten up like a bulb)
How to manage a simple hydrocele
Will resolve within 2 years without needing any surgery
How is a communicating hydrocele managed
Ligate the connection between peritoneal cavity and hydrocele (soon but not urgent)
