Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 4 - Paediatrics > Renal and Urology > Flashcards

Renal and Urology Flashcards

1
Q

Define:

a) cystitis

b) pyelonephritis

A

a) inflammation of the bladder, usually a result of a bladder infection.

b) inflammation of the kidney, usually as a result of a kidney infection. It can lead to scarring and consequent reduction in kidney function.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

UTI symptoms.

A
  • fever
  • lethargy
  • irritability
  • vomiting
  • voiding
  • poor feeding
  • urinary frequency
  • suprapubic pain
  • dysuria
  • incontinence

NB: fever may be the only symptom of a UTI, especially in young children. Always exclude a UTI in a child with a fever.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pyelonephritis symptoms.

A
  • fever >38*C
  • loin pain or tenderness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Investigations for UTI.

A

Clean catch urine dipstick.

If nitrites are present, treat as UTI.

If nitrites and leukocytes are present, treat as UTI and send MSU for culture and sensitivities.

If leukocytes are present alone, do not treat as UTI unless there is clinical evidence.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Management of a fever in children:

a) under 3 months

b) over 3 months

A

a) immediate IV antibiotic prescription (e.g. ceftriaxone) and have a full septic screen (i.e. lumbar puncture, bloods, lactate). Consider lumbar puncture.

b) consider oral antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Treatment for cystitis:

a) children 3 months to 12 years

b) children 12-17 years

A

a) Cefalexin 3/7 PO

b) Nitrofurantoin 100mg BD 3/7 PO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Treatment of pyelonephritis in children over 3 months.

A

Cefalexin 10/7 PO

or

Co-amoxiclav 10/7 PO (only if culture results available and susceptible)

or

IV Cefuroxime + Gentamicin (switch to oral abx for 10/7 once apyrexial for 24hrs).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which investigations should be considered in patients with recurrent UTIs?

A
  • abdominal ultrasound scan
  • DMSA
  • micturating cystourethrogram
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Outline the role of DMSA in the investigation of recurrent UTIs.

A

DMSA scans should be used 6 months after the infection to assess for damage from recurrent or atypical UTIs.

This involves injecting a radioactive material - DMSA - and using a gamma camera to assess how well the material is taken up by the kidneys.

Where there are patches of kidney that have not taken up the material, this indicates scarring that may be the result of previous infection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Outline the role of micturating cystourethrogram in the investigation of recurrent UTIs.

A

Used to investigate recurrent UTIs in children:
- under 6 months
- family history of vesico-ureteric reflux
- dilatation of the ureter on ultrasound
- poor urinary flow

Catheterise the child and inject contrast into the bladder. A series of xray films are taken to determine whether the contrast is refluxing into the ureters.

Children are usually given prophylactic antibiotics for 3 days around the time of the investigation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is vesico-ureteric reflux?

A

VUR is where the urine has a tendency to flow from the bladder back into the ureters, predisposing the patient to developing upper UTIs and subsequent renal scarring.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Management of vesico-ureteric reflux.

A
  • avoid constipation
  • regular voiding
  • prophylactic antibiotics
  • surgical input from paediatric urology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is vulvovaginitis?

A

Inflammation and irritation of the vulva and vagina, commonly affecting girls between the ages of 3 and 10 years.

The irritation is caused by sensitive and thin skin and mucosa around the vulva and vagina.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Risk factors for vulvovaginitis.

A
  • wet nappies
  • use of chemicals or soaps in cleaning the vagina
  • tight clothing that traps moisture
  • poor toilet hygiene
  • constipation
  • threadworms
  • pressure on the area
  • heavily chlorinated pools
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Presentation of vulvovaginitis.

A
  • soreness
  • itching
  • erythema around the labia
  • vaginal discharge
  • dysuria
  • constipation

A urine dipstick may show leukocytes but no nitrites - this is NOT a UTI.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Management of vulvovaginitis.

A
  • avoid washing with soap and chemicals
  • avoid perfumed or antiseptic products
  • good toilet hygiene, wipe from front to back
  • keep the area dry
  • emollients, such as sudacrem
  • loose cotton clothing
  • treating constipation and worms where applicable
  • avoiding activities that exacerbate the problem

In severe cases, paediatricians may recommend oestrogen creams to improve symptoms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Triad of nephrotic syndrome.

A
  • hypoalbuminaemia
  • proteinuria
  • oedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Presentation of nephrotic syndrome.

A
  • frothy urine
  • generalised oedema
  • pallor

Most common between the ages of 2 and 5 years.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pathophysiology of nephrotic syndrome.

A

Occurs when the basement membrane in the glomerulus becomes highly permeable to protein, allowing proteins to leak from the blood into the urine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Aside from the classic triad of nephrotic syndrome, what are the three other typical features?

A
  • dyslipidaemia
  • hypertension
  • hyper-coagulability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Causes of nephrotic syndrome.

A
  • minimal change disease (~90%)
  • focal segmental glomerulosclerosis
  • membranoproliferative glomerulonephritis
  • Henoch-schonlein purpura (HSP)
  • diabetes
  • infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is minimal change disease?

A

The most common cause of nephrotic syndrome in children, with increased basement membrane permeability of the glomerulus due to no other identifiable cause.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Diagnostic workup for minimal change disease.

A
  • renal biopsy with microscopy (normal)
  • urinalysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Renal biopsy findings in minimal change disease.

A

NAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Urinalysis findings in minimal change disease.

A

Small molecular weight proteins and hyaline casts.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Management of minimal change disease.

A

Corticosteroids (i.e. prednisolone).

The prognosis is good and most children will make a full recovery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is nephritis?

A

Inflammation of the nephrons of the kidneys, leading to:
- AKI
- haematuria
- proteinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Commonest causes of nephritis in children.

A
  • post-streptococcal glomerulonephritis
  • IgA nephropathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Pathophysiology of post-streptococcal glomerulonephritis.

A

Following infection with b-haemolytic streptococcus infection, immune complexes get deposited in the glomeruli of the kidney and cause inflammation.

This inflammation leads to an acute deterioration in kidney function (AKI).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Management of post-streptococcal glomerulonephritis.

A

Management is supportive and around 80% of patients will make a full recovery.

Some patients may need treatment with antihypertensive medications and diuretics if they develop complications, such as hypertension or oedema.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Pathophysiology of IgA nephropathy.

A

IgA gets deposited in the nephrons of the kidneys causing inflammation, usually presenting in young adults and teenagers.

32
Q

Biopsy findings of IgA nephropathy.

A

IgA deposits and glomerular mesangial proliferation.

33
Q

Management of IgA nephropathy.

A

Supportive treatment of the renal failure.

Immunosuppressant medications (e.g. steroids) can slow the progression of the disease.

34
Q

What is haemolytic uraemic syndrome (HUS)?

A

A complication of gastroenteritis caused by Shigella or E. coli 0157.

Shiga toxin results in thrombosis in small blood vessels throughout the body.

35
Q

Triad of haemolytic uraemic syndrome (HUS).

A
  • microangiopathic haemolytic anaemia
  • AKI
  • thrombocytopenia
36
Q

Presentation of HUS.

A

Prodrome of diarrhoea for around 1 week, then:
- fever
- abdominal pain
- lethargy
- pallor
- reduced urine output
- haematuria
- hypertension
- bruising
- jaundice
- confusion

37
Q

Define:

a) enuresis

b) nocturnal enuresis

c) diurnal enuresis

A

a) involuntary urination

b) bed wetting

c) inability to control bladder function during the day

38
Q

At what age do most children get control of:

a) daytime urination?

b) nighttime urination?

A

a) 2 years

b) 3-4 years

39
Q

What is primary nocturnal enuresis?

A

The child has never managed to be consistently dry at night, commonly caused by variation in normal development.

40
Q

Causes of primary nocturnal enuresis.

A
  • developmental variation
  • overactive bladder
  • increased fluid intake
  • psychological distress
41
Q

Management of primary nocturnal enuresis.

A
  • reassurance it is likely to resolve without treatment
  • reduced fluid intake
  • bladder voiding before bed
  • encouragement and positive reinforcement
  • avoid punishment
  • treat underlying causes
  • enuresis alarms
  • pharmacological management
42
Q

What is secondary nocturnal enuresis?

A

Child begins bed wetting when they have previously been dry for at least 6 months.

43
Q

Causes of secondary nocturnal enuresis.

A
  • UTI
  • constipation
  • T1DM
  • new psychosocial problems
  • maltreatment
44
Q

What are the common types of diurnal enuresis?

A

Urge incontinence - overactive bladder that gives little warning before emptying.

Stress incontinence - involuntary leakage of urine during physical exertion, coughing or laughing.

45
Q

Causes of diurnal enuresis.

A
  • recurrent UTIs
  • psychosocial problems
  • constipation
46
Q

What is the pharmacological treatment for nocturnal enuresis?

A

Desmopressin - analogue of ADH, therefore reduces the volume of urine produced by the kidneys.

It is taken at bedtime.

47
Q

What is the pharmacological treatment for diurnal enuresis?

A

Oxybutinin - anticholinergic medication that reduces detrusor contractility.

48
Q

What are the two types of polycystic kidney disease (PKD)?

A
  • autosomal recessive PKD (ARPKD); childhood onset
  • autosomal dominant PKD (ADPKD); adulthood onset
49
Q

Features of ARPKD.

A
  • cystic enlargement of renal collecting ducts
  • oligohydramnios
  • pulmonary hypoplasia
  • congenital liver fibrosis
50
Q

Presentation of ARPKD.

A

Oligohydramnios and polycystic kidneys seen on antenatal scans.

Oligohydramnios leads to pulmonary hypoplasia.

51
Q

Complications of ARPKD.

A
  • liver failure secondary to fibrosis
  • portal hypertension
  • progressive renal failure
  • hypertension
  • chronic lung disease
52
Q

Prognosis of ARPKD.

A

Poor - around 30% die in the neonatal period.

Only 30% will survive to adulthood.

53
Q

What is multicystic dyslplastic kidney (MCDK)?

A

One of the baby’s kidneys is made up of many cysts, while the other kidney is normal.

It can usually be diagnosed on antenatal ultrasound scans.

54
Q

Complications of MCKD.

A

The cystic kidney will atrophy and disappear before 5 years of age.

Having a single kidney will put the person at increased risk of UTI, hypertension and chronic kidney disease.

55
Q

What is a Wilms’ tumour?

A

A specific type of tumour affecting the kidneys in children, typically under the age of 5 years.

56
Q

Presentation of Wilm’s tumour.

A

Child aged <5 years with an abdominal mass.

  • abdominal pain
  • haematuria
  • lethargy
  • fever
  • hypertension
  • weight loss
57
Q

Diagnostic workup of a Wilms’ tumour.

A

Ultrasound first line.

CT or MRI to stage the tumour.

Biopsy with histology required to make a definitive diagnosis.

58
Q

Management of Wilms’ tumour.

A

Surgical excision of the tumour and affected kidney (nephrectomy).

Adjuvant chemotherapy or radiotherapy is given after surgery as deemed necessary.

59
Q

Prognosis of Wilms’ tumour.

A

Early stage tumours with favourable histology hold 90% cure rate.

Metastatic disease has a poorer prognosis.

60
Q

What is posterior urethral valve?

A

Tissue at the proximal end of the urethra causes obstruction of urine output.

This creates pressure in the bladder, ureters and kidneys, causing hydronephrosis.

It also prevents the bladder from fully emptying, leading to an increased risk of UTIs.

61
Q

Presentation of posterior urethral valve.

A
  • difficulty urinating
  • weak urinary stream
  • chronic urinary retention
  • palpable bladder
  • recurrent UTIs
  • impaired kidney function

Serious cases can result in bilateral hydronephrosis and oligohydramnios. This can lead to pulmonary hypoplasia.

62
Q

Diagnostic workup for posterior urethral valve.

A

Severe cases may be detected on antenatal scans as oligohydramnios and hydronephrosis.

After birth, symptoms can be investigated by:
- abdominal ultrasound
- micturating cystourethrogram
- cystoscopy

63
Q

Management of posterior urethral valve.

A

Mild cases can be observed and monitored.

Temporary urinary catheter can be inserted to bypass the valve whilst awaiting definitive management.

Definitive management is by ablation during cystoscopy.

64
Q

Describe the development of the testes in utero.

A

The testes develop in the abdomen then gradually migrate down, through the inguinal canal and into the scrotum.

They are guided by the gubernaculum.

65
Q

Complications of undescended testes.

A

Higher risk of:
- testicular torsion
- infertility
- testicular cancer

66
Q

Risk factors for undescended testes.

A
  • family history
  • low birth weight
  • small for gestational age
  • prematurity
  • maternal smoking
67
Q

Management of undescended testes.

A

In most cases, the testes will descend in the first 3-6 months after birth. Watching and waiting is therefore appropriate in newborns.

Between 6 and 12 months, orchidopexy should be performed to surgically correct the undescended testes.

68
Q

What are retractile testicles?

A

A normal variant in pre-pubertal boys where the cremasteric reflex causes the testicles to temporarily elevate.

Occasionally they may fully retract, which requires surgical correction with orchidopexy.

69
Q

What is hypospadias?

A

The urethral meatus on males is abnormally displaced to the ventral side of the penis, towards the scrotum.

70
Q

Management of hypospadias.

A

Mild cases may not require treatment.

Surgical correction can be performed at 3-4 months of age, aiming to correct the position of the meatus.

71
Q

Complications of hypospadias.

A
  • difficulty directing urination
  • cosmetic and psychological concerns
  • sexual dysfunction
72
Q

What is a hydrocele?

A

A collection of fluid within the tunica vaginalis of the testes.

73
Q

What are the features of

a) simple hydrocele?

b) communicating hydrocele?

A

a) common in newborn males, with fluid trapped in the tunica vaginalis. The fluid usually gets reabsorbed over time and the hydrocele disappears.

b) tunica vaginalis is connected with the peritoneal cavity by the processus vaginalis, allowing fluid to travel from the peritoneal cavity to the hydrocele.

74
Q

Hydrocele signs.

A
  • soft, smooth, non-tender swelling
  • transilluminates
  • simple is fixed in size
  • communicating fluctuates in size
75
Q

Differentials for inguinal swelling in a neonate.

A
  • hydrocele
  • partially descended testes
  • inguinal hernia
  • testicular torsion
  • haematoma
  • tumours
76
Q

Management of

a) simple hydrocele

b) communicating hydrocele

A

Ultrasound of testes to confirm diagnosis.

a) resolve within 2 years without lasting negative effects.

b) surgically treated by removing or ligating the processus vaginalis.

Year 4 - Paediatrics (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions