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Paediatrics > Renal and urology > Flashcards

Renal and urology Flashcards

1
Q

What is cystitis?

A

Inflammation of the bladder

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2
Q

What is pyelonephritis?

A

Inflammation of the kidneys

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3
Q

How do UTIs present in children?

A

Fever may be the only symptoms - especially in young children.

Dysuria - painful stinging / burning when urinating
Suprapubic pain or discomfort
Frequency / Urgency
Haematuria
Nocturia / incontinence
Cloudy / foul smelling urine

In babies - irritability, poor feeding

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4
Q

How is a UTI diagnosed?

A

Ideally clean catch urine sample.
Urine dip looking at
- nitrites (gram negative bacteria bake down nitrates which are normally in the urine into nitrites)
- leukocytes - WBCs
Midstream urine sample for microscopy, culture and sensitivity testing

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5
Q

How are UTIs managed?

A

Oral antibiotics if otherwise well. If not IV can be considered.
Follow local guidelines but commonly give
- trimethoprim
- nitrofurantoin
- cefalexin
- amoxicillin

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6
Q

What investigations are done for investigating recurrent UTIs in children?

A
  • Ultrasound scans
  • DMSA (dimercaotisuccinic acid) scan - inject radioactive material and use a gamma camera to assess how well it is taken up by the kidney. If not this may indicate areas of scarring)
  • Micturating cystourethrogram - looking for Vesico-ureteric reflux
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7
Q

What is vesico-ureteric reflux?

A

When the urine has a tendency to flow from the bladder back up into the ureters

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8
Q

What are complications of vesico-ureteric reflux?

A

Recurrent upper UTIS / pyelonephritis and subsequent renal scarring.

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9
Q

How is vesico-ureteric reflux managed?

A
  • avoid constipation
  • avoid an excessively full bladder
  • prophylactic antibiotics
  • surgical input from paeds urology
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10
Q

When is a micturating cystouretrogram (MCUG) done?

A
  • investigate atypical or recurrent UTIs in children under 6 months
  • family history of vesico-ureteric reflux
  • dilation of the ureter on ultrasound
  • poor urinary flow
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11
Q

How is a micturating cystourethrogram done?

A

Catheterising the child, injecting contrast into the bladder and taking a series of xray films.
Prophylactic antibiotics are often given for 3 days around this investigation

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12
Q

What is vulvovaginitis?

A

inflammation and irritation of the vulva and vagina.

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13
Q

Who is normally affected by vuvlovaginitis?

A

Girls between the ages 3-10 (pre puberty)

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14
Q

What can cause / exacerbate vulvovaginitis?

A

Irritation of the sensitive and skin thin
- wet nappies
- use of chemicals and soaps in that area
- tight clothing trapping moisture
- poor toilet hygiene
- constipation
- threadworms
- pressure on that area - e.g. horseriding
- heavily chlorinated pools

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15
Q

Why is vulvovaginitis less common after puberty?

A

As oestrogen helps keep the skin and vaginal mucosa healthy and resistant to infection

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16
Q

How does vulvovaginitis present?

A
  • soreness
  • itching
  • erythema around the labia
  • vaginal discharge
  • dysuria (burning/stinging on urination)
  • constipation
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17
Q

What may vuvlovaginitis be misdiagnosed for?

A

A UTI - as dipstick may show leukocytes but no nitrites

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18
Q

How is vuvovaginitis managed?

A
  • normally symptomatic management (however they are often unnecessarily treated for UTIs or thrush)
  • avoid washing with soaps and chemicals
  • avoid perfumed/antispeetic products
  • good toilet hygiene - wipe from front to back
  • keep area dry
  • emollients can sooth the area
  • loose cotton clothing
  • treating constipation and worms where appropriate
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19
Q

How is vuvovaginitis managed?

A
  • normally symptomatic management (however they are often unnecessarily treated for UTIs or thrush)
  • avoid washing with soaps and chemicals
  • avoid perfumed/antiseptic products
  • good toilet hygiene - wipe from front to back
  • keep area dry
  • emollients can sooth the area
  • loose cotton clothing
  • treating constipation and worms where appropriate
  • if severe a specialist may prescribe oestrogen cream
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20
Q

What is hypospadias?

A

A congenital condition - Where a males urethral meatus (opening) is on the ventral side (underneath) of the penis towards the scrotum.
There may also be chordee - ventral (downwards) curvature of the penis.

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21
Q

How is hypospadias managed?

A
  • mild may not require treatment

Surgery - usually at 3/4 months old
Urethroplasty - Aims to correct the position of the meatus and straighten the penis.
Circumcision or reconstruction of foreskin may also be done.

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22
Q

What are some complications of hypospadias?

A

Difficulty directing urine
Cosmetic + psychological concerns
Sexual dysfunction

Post surgery - risk of urethral fistula or urethral stenosis

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23
Q

Describe the normal descent of the testes (embryologically)?

A

Testes develop in the abdomen
Migrate down, through the inguinal canal into the scrotum (normally have reached here prior to birth)

(should i go into more detail - go over proper embryology)

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24
Q

What is cryptorchidism?

A

Undescended testes

25
Q

What are risk factors for cryptorchidism?

A

Family history of undescended testes
Low birth weight
Small for gestational age
Prematurity
Maternal smoking during pregnancy

26
Q

What are some complications of cryptorchidism?

A

At puberty there is a higher risk of
- testicular torsion
- infertility
- testicular cancer

27
Q

How is cryptorchordism managed?

A

Watch in first 6 months as often descend themselves.

After 6 months refer to a urologist.
Orchidopexy (surgical correction) should be done between 6 + 12 months of age

28
Q

What is orchidopexy?

A

The surgery involved in correcting undescended testes.

29
Q

What is a hydrocele?

A

A collection of fluid in the tunica vaginalis that surrounds the testicles.

30
Q

How will a hydrocele present?

A

Usually painless
Soft, scrotal swelling
Testicle is palpable within
Irreducible
Transilluminates by shining a torch through the skin

31
Q

How is a hydrocele managed?

A

Normally conservative
Surgery (hydrocelectomy) or aspiration + sclerotherapy if large / symptomatic.

In children may do a surgery - ligation of the patent processus vaginalis

32
Q

What is Wilms tumour?

A

A specific type of tumour affecting the kidneys in children (particularly <5 years)

33
Q

How do Wilms tumours present?

A
  • mass in abdomen
  • abdominal pain
  • haematuria
  • lethargy
  • fever
  • hypertension (headaches)
  • weight loss
34
Q

How is Wilms tumour diagnosed?

A
  • initially ultrasound
  • CT or MRI to stage the tumour
  • biopsy is required to make a definitive diagnosis
35
Q

How is Wilms tumour managed?

A
  • surgical excision along with the affected kidney (nephrectomy)
  • adjuvant treatment depends on stage, histology and if it has metastised
  • can be chemo or radiotherapy
36
Q

What is the prognosis of Wilms tumour?

A

Early stage have good chance of cure >90%.
Metastatic = poorer prognosis.

37
Q

What is haemolytic uraemic syndrome and what triad does it cause?

A

A condition where there is thromosis within small blood vessels throughout the body.
It causes
- haemolytic anaemia
- AKI (acute kidney injury)
- thrombocytopenia

38
Q

What causes haemolytic uraemic syndrome?

A

A bacterial toxin - shiga toxin. This is produced by e.coli or shigella.
The risk is increased when antibiotics or anti motility drugs (loperamide) are used to treat gastroenteritis.

39
Q

How does haemolytic uraemic syndrome present?

A

Preceded with gastroenteritis (often w. bloody diarrhoea).
Symptoms of HUS normally after 5 days
- reduced urine output
- haematuria / dark brown urine
- abdominal pain
- lethargy and irritability
- confusion
- oedema
- hypertension
- bruising

40
Q

How is haemolytic uraemic syndrome managed?

A

Medical emergency.
Self limiting - so supportive management.
Patients may require
- dialysis
- antihypertensives
- careful maintenance of fluid balance
- blood transfusions

41
Q

What is enuresis?

A

Involuntary urination

42
Q

What is diurnal enuresis?

A

Inability to control bladder function in the daytime

43
Q

At which age do children get control of daytime and nighttime urination?

A

Daytime by 2 years.
Nighttime by 3-4 years

44
Q

What is primary nocturnal enuresis?

A

Where the child has never managed to be consistently dry at night.

45
Q

What can cause primary nocturnal enuresis?

A
  • variation on normal development (<5 years)
  • overactive bladder
  • fluid intake (prior to bedtime - fizzy drinks, juice or caffeine have diuretic effect)
  • psychological distress
  • secondary causes - chronic constipation, UTI, learning disability, cerebral palsy.
46
Q

How is primary nocturnal enuresis managed?

A
  • 2 week diary of toileting, fluid intake and bedwetting episodes.
  • reassure parents of children <5
  • lifestyle changes
  • encouragement and positive reinforcement
  • pharmacological management
47
Q

What is secondary nocturnal enuresis?

A

when a child begins wetting the bed when they have previously been dry for at least 6 months

48
Q

What can cause secondary nocturnal enuresis?

A
  • UTI
  • constipation
  • type 1 diabetes
  • psychosocial problems
  • maltreatment / abuse
49
Q

What can cause diurnal enuresis?

A
  • urge incontinence - overactive bladder
  • stress incontinence
  • psychosocial problems
  • recurrent UTIs
  • constipation
50
Q

What pharmacological management can be used for enuresis and how do they work?

A
  • desmopression - vasopressin analogue - reduced volume of urine produced by the kidneys (taken before bed for nocturnal)
  • oxybutinin - anticholinergic - reduces contractility of the bladder
  • imipramine - tricyclic antidepressant. Mechanism is unknown
51
Q

What is a proximal urethral valve?

A

Where there is extra tissue at the proximal end of the urethra (near the bladder) that causes obstruction of urine output. This causes a build up of pressure and hydronephrosis.

52
Q

How does a proximal urethral valve present?

A

Can vary in severity
- difficulty urinating
- weak urinary stream
- chronic urinary retention
- palpable bladder
- recurrent UTIs
- impaired kidney function

53
Q

How can severe proximal urethral valve affect the developing fetus?

A

Obstruction causing bilateral hydronephrosis and oligohydramnios. This leads to underdeveloped lungs (respiratory hypoplasia) with respiratory failure shortly after birth

54
Q

How is a proximal urethral valve investigated?

A
  • prenatally may be picked up on antenatal scans (oligohydramnious and hydronephrosis)
  • abdominal ultrasound - enlarged thickened bladder and bilateral hydronephrosis
  • MCUG - micturating cystourethrogram
  • cystoscopy - insert camera into urethra to view extra tissue. Can also then ablate or remove extra tissue
55
Q

How is a proximal urethral valve managed?

A
  • mild cases may just be observed and monitored
  • may insert a temporary urinary catheter
  • definitive management - ablation or removal of extra tissue - usually during cystoscopy
56
Q

When does polycystic kidney disease present?

A

Autosomal dominant presents in adults.
Autosomal recessive presents in neonates

57
Q

What does the pathology in autosomal recessive polycystic kidney disease (ARPKD) cause ?

A
  • cystic enlargement of the renal collecting ducts
  • oligohydramnios, pulmonary hypoplasia and Potter syndrome
  • congenital liver fibrosis = liver failure = portal hypertension
  • progressive renal failure = hypertension
  • chronic lung disease
58
Q

What is the prognosis for autosomal recessive polycystic kidney disease (ARPKD)?

A

Poor prognosis
- 1/3rd die in neonatal period.
- 1/3rd will survive to adulthood

59
Q

What is multicystic dysplastic kidney?

A

Where one of the baby’s kidneys has multiple cysts whilst the other is normal. Usually survive on a single kidney and the other one will atropy before 5 years of age.

Paediatrics (14 decks)

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