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Phase 3a - Paediatrics > Renal and Urology > Flashcards

Renal and Urology Flashcards

1
Q

What are the causes of UTI?

A

MC - E.coli
Other:
* Klebsiella
* Proteus
* Staph. Saprophyticus

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2
Q

Sx of UTI depedning on the age of the child:
* Infants under 3 mths
* Infants aged 3-12 mths
* Children over 1 yrs

A

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

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3
Q

Ix for UTI?

A
  • Urine dipstick - leukocytes + nitrites
  • Urine culture
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4
Q

Mx of UTI?

A
  • 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
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5
Q

What is pyelonephritis?

A

Inflammation of the kidney resulting from bacterial infx.

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6
Q

What are RF for pyelonephritis?

A
  • Female
  • Structural urological abnormalities
  • Vesico-ureteric reflux (urine refluxing from the bladder to the ureters – usually in children)
  • Diabetes
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7
Q

Causes of pyelonephritis?

A

MC - E.coli
Other:
* Klebsiella pneumoniae
* Enterococcus
* Pseudomonas aeruginosa
* Staphylococcus saprophyticus

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8
Q

Sx of pyelonephritis?

A
  • Fever
  • N+V
  • Loin or back pain
  • Loss of appetite
  • Haematuria
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9
Q

Ix of pyelonephritis?

A
  • Urine dipstick
  • Midstream urine (MSU) for microscopy, culture and sensitivity
  • Bloods - high CRP
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10
Q

Mx of pyelonephritis?

A

Oral abx:
* Cefalexin - 1st line
* Co-amoxiclav - 2nd line
* Trimethoprim

If severe - IV abx (e.g. ceftriaxone)

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11
Q

What is meant by the terms:
1. Enuresis
2. Primary nocturnal enuresis
3. Secondary nocturnal enuresis
4. Diurnal enuresis

A
  1. Involuntary urination
  2. When child has never managed to be consistently dry at night
  3. When child begins wetting the bed when they have previously been dry for atleast 6 mths
  4. Inability to control bladder function during the day
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12
Q

What are causes of primary nocturnal enuresis?

A
  • Fhx
  • Overactive bladder
  • Fluid intake
  • Failure to wake
  • Psychological stress
  • Secondary causes i.e. UTI
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13
Q

Mx of nocturnal enuresis?

A
  • 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

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14
Q

Causes of secondary nocturnal enuresis?

A
  • UTI
  • Constipation
  • Type 1 diabetes
  • New psychosocial problem + maltreatment
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15
Q

What is nephrotic syndrome?

A

When the basement membrane of glomerulus becomes highly permeable to protein, allowing protein to leak from blood ito urine.

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16
Q

Sx of nephrotic syndrome?

A
  • Frothy urine
  • Generalised oedema
  • Pallor
17
Q

What is the classic triad for nephrotic syndrome?

A
  1. Low serum albumin
  2. High urine protein content (>3+ protein on urine dipstick)
  3. Oedema
18
Q

Ix for nephrotic syndrome?

A
  • GS - needle biopsy and microscopy
  • Dipstick
  • USS kidney
19
Q

Examination and investigation results for nephrotic syndrome?

A
  • 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
20
Q

Causes of nephrotic syndrome?

A

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

21
Q

Tx of nephrotic syndrome?

A
  • 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

22
Q

What is nephritic syndrome?

A

Glomerulonephritic pathologies that cause both haematuria and proteinuria as glomeruli increases permeability of RBCs into filtrate.

23
Q

Sx of nephritic syndrome?

A
  • Proteinuria
  • Haematuria
  • High BP
  • Oliguria (reduced urine output)
  • Oedema
24
Q

Define the following terms:
1. Hypospadias
2. Epispadias
3. Chordee

A
  1. Cdtn affecting males where urethral meatus is abnormally displaced to the ventral side (underside) of the penis towards scrotum.
  2. Where meatus (opening) is displaced to the dorsal (top) side of the penis
  3. Where head of penis bends downwards
25
Q

Mx of hypospadias?

A

If mild - no tx
Surgery - at 3-4 mths which corrects position of meatus + straighten penis

26
Q

Complications of hypospadias?

A
  • Difficulty directly urinating
  • Sexual dysfunction
  • Cosmetic/psychological concerns
27
Q

Define the following:
1. Phimosis
2. Paraphimosis

A
  1. When foreskin is too tight to be retracted over penis glans. Usually resolves naturally overtime.
  2. 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.
28
Q

What can cause phimosis in adults?

A
  • STIs
  • Eczema
  • Psoriasis
  • Lichen sclerosis
  • Balanitis
29
Q

Tx of phimosis?

A
  • Steroid cream - reduce inflammation
  • If severe - circumcision
30
Q

What is vesicouretric reflux?

A

Abnormal backflow of urine from bladder into ureter and kidney and predisposes to UTI.

31
Q

How does a vesicouretric reflux present?

A
  • Recurrent childhood UTIs
  • Reflux nephropathy - chronic pyelonephiritis
32
Q

Ix of vesicouretric reflux?

A

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)
33
Q

What is haemolytic uraemic syndrome?

A

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.

34
Q

What usually triggers haemolytic uraemic syndrome?

A

Shiga toxins from either E. coli 0157 or shigella.

35
Q

Sx of haemolytic uraemic syndrome?

A

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)

36
Q

Mx of haemolytic uraemic syndrome?

A

Medical emergency = hospital admission:
* IV fluids - hypovolaemia
* Blood transfusions - severe anaemia
* Haemodialysis - severe renal failure

Self-limiting + pts recover w/good support

Phase 3a - Paediatrics (14 decks)

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