Renal and urology Flashcards
What is the management of a UTI/ pyelonephritis in children
Children under 3 months with a fever- IV antibiotics (ceftriazone)
Oral abx if over 3 months and otherwise well
Trimethoprim, nitrofuratonin, cefalexin, amoxicillin
Any features of sepsis IV abx
When should an USS be carried out if a child has a UTI
When should a DMSA scan be carried out
Children under 6 months with 1st UTI/ recurrent UTI/ Atypical bacterial
- USS within 6 weeks
DMSA- 4- 6 months after illness to assess for damage
What are the features of Vesico-ureteric reflux
Urine flows from bladder back into ureters
Predisposes to upper urinary tract infections and renal scarring
Diagnosed using a micturating cystourethrogram - Investigates atypical/ recurrent UTIs in under 6 months
Management
Avoid constipation
Avoid excessively full bladder
Prophylactic abx
Surgical input from paediatric urology
What are the features and management of vulvovaginitis in children
Inflam/ irritation of vulva and vagina
Ages 3-10
Risk factors
Wet nappies, chemicals and soaps. tight clotting, poor toilet hygiene, constipation, threadworms, pressure on area (horse riding), chlorinated pools
Presentation
Pain itching, erythema around labia, vaginal discharge, constipation
Leukocytes on dipstick but no nitrates
Management
Avoid soaps and perfumes
Good toilet hygiene- front to back wiping
Keep area dry
Sudocream
Loose clothing
What are the features and of nephrotic syndrome in children
Protein leakage into urine
Ages 2-5- frothy urine, oedema and pallor
Nephrotic syndrome triad
-Low serum albumin (more in urine)
-High urine protein +++
-Oedema
Will also have
-Deranged lipid profile (Cholesterol, triglycerides and LDLs)
-HTN
-Hypercoagulability- increased clot forming
Most common cause in children
Minimal change disease
Could also be secondary to underlying kidney disease
-Focal segmental glomerulonephritis
-Membranoproliferative glomerulonephritis
Or systemic illness
Henoch Schonlein Purpur
Diabetes or infection
What is minimal change disease
Most common cause nephrotic syndrome in children
Oedema, urinary protein, low serum albumin
Treat with oral prednisone
2/3 will reoccur
Urinalysis will show small molecular weight proteins and hyaline casts
What is the management of nephrotic syndrome in children
High dose steroids
Given for 4 weeks then weaned over next 8 weeks
If children are steroid resistance can give ACE inhibit or immunosuppressants
Low salt diet
Diuretics for oedema
Albumin infusions
Antibiotic prophylaxis
What are the features of nephritis in children
Inflammation of nephrons
Reduced kidney function
Haemoaturia
Proteinuria (less than nephrotic)
Two most common causes
Post strep glomerulonephritis
Berger’s disease (IgA nephropathy)
What are the features of post strep glomerulonephritis
1-3 weeks after B-haemolytic strep infection- like tonsillitis from strep progenies
Immune complexes get stuck in kidney glomeruli and cause inflam
This causes an AKI
Diagnosis if evidence of tonsillitis caused by strep- positive that swab and anti-streptolysin antibodies titres
Supportive management
If severe complications of HTN- antihypertensive meds and diuretics
What are the features of IgA nephropathy
Berger’s disease
Related to Henoch-Schonlein purpura
IgA vasculitis
IgA deposits in the nephrons cause inflam
Renal biopsy will show IgA deposits and glomerular mesangial proliferation
Teens and young adults
Supportive treatments
Immhnosuppresant meds- steroids and cyclophosphamide to slow disease progression
What are the features of haemolytic uraemic syndrome
Thrombosis in small blood vessels
Triggered by Shiga toxin from E.Coli or Shigella
Following gastroenteritis
Use of abx during this can increase it’s risk
Triad of
Microangiopathic haemolytic anaemia (RBCs breaking down in small vessels)
AKI
Thrombocytopenia (Low plts)
Formation of blood clots uses up platelets
Presentation
Fever, abdo pain, lethargy, pallor, reduced urine output, haematuria, HTN, Bruising, jaundice, confusion
Management
Medical emergency
Treat hypovolaemia
HTN
Severe anaemia- transfuse
Severe renal failure- haemdialysis
What are the causes of primary nocturnal enuresis
-Most common - variation on normal development (when younger than 5) - perhaps fam history
Other causes
-Overactive bladder
-Fluid intake before bed (fizzy drinks, caffeine)
-Failure to wake
-Psychological distress- pressure in home/ at school
Chronic constipation, UTI, learning disability, cerebral palsy
What is the management of primary nocturnal enuresis
2 week diary of fluid intake, toilet and bedwetting
Reassure if under 5 that will likely resolve
Lifestyle changes- reduced fluid intake and pass urine before bed
Encouragement and positive reinforcement
Treat underlying conditions- constipation/ UTI etc
Enuresis alarms
What are the causes of secondary nocturnal enuresis
Bed wetting after being dry for at least 6 months
UTI
Constipation
T1DM
Psychosocial issue
Maltreatment (abuse etc)
Treat underlying cause
What are the causes of diurnal enuresis
Daytime incontinence
Urge incontinence- overactive bladder gives little warning before emptying
Stress incontinence- leakage of urine during physical exertion, laughing and coughing
Recurrent UTIS
Psychosocial issues
Constipation
