Renal and Urology Flashcards
What are the causes of UTI?
MC - E.coli
Other:
* Klebsiella
* Proteus
* Staph. Saprophyticus
Sx of UTI depedning on the age of the child:
* Infants under 3 mths
* Infants aged 3-12 mths
* Children over 1 yrs
Infants under 3 mths:
* Fever
* Vomiting
* Lethargy and irritability
* Poor feeding
* Failure to thrive
* Offensive urine
Infants aged 3-12 mths:
* Fever
* Poor feeding
* Abdo pain
* Vomiting
Children over 1 yrs:
* Frequency
* Dysuria
* Abdo pain
* Fever less common
Ix for UTI?
- Urine dipstick - leukocytes + nitrites
- Urine culture
Mx of UTI?
- If child under 3 mths + fever = immediate IV antibiotics (e.g. ceftriaxone)
- If over 3 mths = oral antibiotics:
1. Trimethoprim
2. Nitrofurantoin
3. Cefalexin
4. Amoxicillin
What is pyelonephritis?
Inflammation of the kidney resulting from bacterial infx.
What are RF for pyelonephritis?
- Female
- Structural urological abnormalities
- Vesico-ureteric reflux (urine refluxing from the bladder to the ureters – usually in children)
- Diabetes
Causes of pyelonephritis?
MC - E.coli
Other:
* Klebsiella pneumoniae
* Enterococcus
* Pseudomonas aeruginosa
* Staphylococcus saprophyticus
Sx of pyelonephritis?
- Fever
- N+V
- Loin or back pain
- Loss of appetite
- Haematuria
Ix of pyelonephritis?
- Urine dipstick
- Midstream urine (MSU) for microscopy, culture and sensitivity
- Bloods - high CRP
Mx of pyelonephritis?
Oral abx:
* Cefalexin - 1st line
* Co-amoxiclav - 2nd line
* Trimethoprim
If severe - IV abx (e.g. ceftriaxone)
What is meant by the terms:
1. Enuresis
2. Primary nocturnal enuresis
3. Secondary nocturnal enuresis
4. Diurnal enuresis
- Involuntary urination
- When child has never managed to be consistently dry at night
- When child begins wetting the bed when they have previously been dry for atleast 6 mths
- Inability to control bladder function during the day
What are causes of primary nocturnal enuresis?
- Fhx
- Overactive bladder
- Fluid intake
- Failure to wake
- Psychological stress
- Secondary causes i.e. UTI
Mx of nocturnal enuresis?
- Lifestyle changes - i.e. reduce fluid intake in evenings
- Treat any underlying causes or exacerbating factors i.e. constipation
- Enuresis alarms
- Encouragement and positive reinforcement. Avoid blame or shame.
Medications:
* Desmopressin - reduces volume of urine produced by kidneys
* Oxybutinin - anticholinergic = reduces contractility of bladder
Causes of secondary nocturnal enuresis?
- UTI
- Constipation
- Type 1 diabetes
- New psychosocial problem + maltreatment
What is nephrotic syndrome?
When the basement membrane of glomerulus becomes highly permeable to protein, allowing protein to leak from blood ito urine.
Sx of nephrotic syndrome?
- Frothy urine
- Generalised oedema
- Pallor
What is the classic triad for nephrotic syndrome?
- Low serum albumin
- High urine protein content (>3+ protein on urine dipstick)
- Oedema
Ix for nephrotic syndrome?
- GS - needle biopsy and microscopy
- Dipstick
- USS kidney
Examination and investigation results for nephrotic syndrome?
- Low serum albumin
- High urine protein content (>3+ protein on urine dipstick)
- Deranged lipid profile (high levels of cholesterol, triglycerides and low density lipoproteins)
- High BP
- Hyper-coagulability
Causes of nephrotic syndrome?
MC - minimal change disease
Other:
* Secondary to intrinsic kidney disease - focal segmental glomerulosclerosis, Membranous glomerulonephritis
* Secondary to underlying illness - Diabetes, Infx such as HIV etc
Tx of nephrotic syndrome?
- High dose steroids (i.e. prednisolone)
- Low salt diet
- Diuretics - oedema
- Albumin infusions - hypoalbuminaemia
If steroid resistant - ACE inhibitors and immunosuppressants such as cyclosporine, tacrolimus or rituximab
What is nephritic syndrome?
Glomerulonephritic pathologies that cause both haematuria and proteinuria as glomeruli increases permeability of RBCs into filtrate.
Sx of nephritic syndrome?
- Proteinuria
- Haematuria
- High BP
- Oliguria (reduced urine output)
- Oedema
Define the following terms:
1. Hypospadias
2. Epispadias
3. Chordee
- Cdtn affecting males where urethral meatus is abnormally displaced to the ventral side (underside) of the penis towards scrotum.
- Where meatus (opening) is displaced to the dorsal (top) side of the penis
- Where head of penis bends downwards
Mx of hypospadias?
If mild - no tx
Surgery - at 3-4 mths which corrects position of meatus + straighten penis
Complications of hypospadias?
- Difficulty directly urinating
- Sexual dysfunction
- Cosmetic/psychological concerns
Define the following:
1. Phimosis
2. Paraphimosis
- When foreskin is too tight to be retracted over penis glans. Usually resolves naturally overtime.
- Urologic emergency in uncircumcised males - Inability to return foreskin to its original position after it has been retracted leading to venous congestion and potentially causing oedema and ischaemia of glans penis often occurs in adults.
What can cause phimosis in adults?
- STIs
- Eczema
- Psoriasis
- Lichen sclerosis
- Balanitis
Tx of phimosis?
- Steroid cream - reduce inflammation
- If severe - circumcision
What is vesicouretric reflux?
Abnormal backflow of urine from bladder into ureter and kidney and predisposes to UTI.
How does a vesicouretric reflux present?
- Recurrent childhood UTIs
- Reflux nephropathy - chronic pyelonephiritis
Ix of vesicouretric reflux?
USS - hydronephrosis
GS - micturating cystogram (MCUG)
- Hydrpnephrosis - a condition where one or both kidneys become stretched and swollen as a result of a build-up of urine inside them.
- MCUG - used to look at your urinary system (bladder & kidneys)
What is haemolytic uraemic syndrome?
Thrombosis in small blood vessels throughout the body. Often affects children after an episode of gastroenteritis.
Formation of blood clots = platelet consumption = thrombocytopenia = affects blood flow through kidney = acute kidney injury.
What usually triggers haemolytic uraemic syndrome?
Shiga toxins from either E. coli 0157 or shigella.
Sx of haemolytic uraemic syndrome?
Diarrhoea which turns blood within 3 days then after a week:
* Fever
* Abdo pain
* Oliguria + Haematuria
* Pallor (anaemia)
* Bruising (low platelets)
* Jaundice (hameolysis)
* Confusion (uraemia)
Mx of haemolytic uraemic syndrome?
Medical emergency = hospital admission:
* IV fluids - hypovolaemia
* Blood transfusions - severe anaemia
* Haemodialysis - severe renal failure
Self-limiting + pts recover w/good support
