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Medicine, Year 4, Paediatrics > Renal and Urology > Flashcards

Renal and Urology Flashcards

1
Q

What are three causes of UTI in children?

A

E.Coli
Proteus
Pseudomonas

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2
Q

What are symptoms of a UTI in babies?

A
  • Fever
  • Irritability
  • Lethargy
  • Poor feeding
  • Vomiting
  • Urinary frequency
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3
Q

How might you diagnose a UTI? What are positive results? What do you do with the results?

A

Urine dipstick:
Nitrites ++
Leukocytes ++

If either present, send off an MSU for microbiology

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4
Q

When might you consider Pyelonephritis as a differential for a child with ?UTI?

A

Fever >38C

Loin pain / tenderness

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5
Q

How do you manage a child under 3 months with a ?UTI?

A
  • Immediate paediatric referral
  • Immediate IV ABX
  • Full sepsis screen, blood cultures, blood, lactate and LP
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6
Q

How do you manage a child over 3 months with a ?UTI?

A
  • Oral ABX for 3 days (Trimethoprim, Nitrofuratoin, Cefalexin, Amoxicillin)
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7
Q

When are Abdominal Ultrasounds indicated regarding UTIs?

A
  • All children under the age of 6 months should have an Abdo US within 6 weeks of their first UTI
  • Children with recurrent UTI should have an Abdo US within 6 weeks
  • Children with atypical UTI should have an Abdo US during the illness
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8
Q

When is a Micturating Cystogram indicated regarding UTIs?

A

If you suspect Vesico-Ureteric Reflux (VUR)

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9
Q

UTIs are more common in which gender?

A

More common in boys until 3 months of age (due to congenital anomalies), and then more common in girls

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10
Q

Vulvovaginitis affects which group of people?

A

Pre-pubertal girls aged between 3 and 10

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11
Q

In one sentence, explain Vulvovaginitis?

A

Vulvovaginitis refers to inflammation and irritation of the vulva and vagina, common in girls aged between 3 and 10. It is caused by sensitive and thin skin and mucosa, which is more prone to colonisation with bacteria spread from faeces

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12
Q

Why does Vulvovaginitis improve after puberty?

A

The protective effects of Oesotrogen help keep skin and mucosa resistant to infection

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13
Q

What are symptoms of Vulvovaginitis?

A

Soreness, Itching, Erythema around labia, Vaginal discharge, Dysuria, Constipation

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14
Q

Why is Vulvovaginitis misdiagnosed for a UTI?

A

Have similar symptoms of Dysuria, and on urine dipstick it may also show leukocytes

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15
Q

What are the home remedies for Vulvovaginitis?

A
  • Avoiding washing with soap / chemicals
  • Avoid perfumed, antiseptic products
  • Good toilet hygiene (wipe front to back)
  • Keep the area dry
  • Emollients i.e. Sudacreme may help
  • Loose cotton clothing
  • Treat constipation / worms were applicable
  • Avoid activities which may exacerbate the problem i.e. horseriding
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16
Q

In severe cases of Vulvovaginitis, what may be prescribed?

A

An Oestrogen cream

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17
Q

What is the triad for Nephrotic Syndrome?

What are additional features?

A
  • Peripheral Oedema
  • Hypoalbuminaemia (< 25g / L)
  • Proteinuria (> 1 g / m2)

Additional features:

  • Derranged lipids (Hypercholesterolaemia, hypertriglyceridaemia, high LDLs)
  • Hypertension
  • Hypercoagulopathy
  • Haematuria
  • Predisposition to infection
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18
Q

Nephrotic Syndrome is most commonly seen in what age of patients?

A

Ages 2 - 5 years old

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19
Q

Why are patients in a hypercoagulable state in Nephrotic Syndrome?

A

Due to loss of anti-thrombin III

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20
Q

Why are patients predisposed to infections in Nephrotic Syndrome

A

Due to loss of immunoglobulins

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21
Q

What is the most common cause of Nephrotic Syndrome in children, in 80% of cases?

A

Minimal Change Disease

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22
Q

What might you see on renal biopsy + renal microscopy for Minimal Change Disease?

A

Minimal changes / No abnormality

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23
Q

What might you see in Urinalysis for Minimal Change Disease?

A

Small molecular weight proteins and hyaline casts

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24
Q

What might you see in Immunofluorescence for Minimal Change Disease?

A

Occasional IgM in mesangium

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25
Q

What might you see on Electron Microscopy for Minimal Change Disease?

A

Effacement of Podocyte foot processes

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26
Q

What is the management for Minimal Change Disease?

A
  • High dose steroids (Prednisolone)
  • Low salt diet
  • Diuretics
  • Albumin infusion (for severe hypoalbuminaemia)
  • Antibiotic prophylaxis (for severe immunocompromised patients)
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27
Q

What proportion of patients are treated successfully with Steroids in Minimal Change Disease

A
  • 80% of patients respond to steroids (steroid sensitive)
  • 80% of the above 80% will relapse again
  • 20% of patients do not respond (steroid resistant)
  • Some patients will struggle to wean off steroids (Steroid dependent)
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28
Q

From least severe to most severe, what are the three types of Hypospadias?

A

Glanular
Mid-shaft
Penoscrotal

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29
Q

From least severe to most severe, what are the three types of epispadias?

A

Glanular
Penile
Penopubic

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30
Q

What is Hypospadias associated with?

A

Chordee (downward facing penis)
Inguinal hernia
Cryptochordism

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31
Q

What is Epispadias associated with?

A

Bladder Extrophy

32
Q

What are symptoms of Hypo / Epispadias?

A

Difficulty targeting

Incontinence

33
Q

Why is Circumcision a contraindication to Hypospadias?

A

Because the foreskin can be used for Hypospadias reconstruction (can be circumcised later)

34
Q

What is the management of Hypo / Epispadias?

A
  • Reconstructive surgery in first few months of life
35
Q

When is Hypo / Epispadias commonly diagnosed?

A

During the newborn examination

36
Q

What are the medical benefits of circumcision?

A
  • Reduces the risk of penile cancer
  • Reduces the risk of UTIs
  • Reduces the risk of STIs i.e. HIV
37
Q

What are the medical indications for circumcision?

A
  • Phimosis / Paraphimosis
  • Recurrent balanitis
  • Balanitis Xerotica Obliterans
38
Q

What are the two most common nephritic syndromes in children?

A

IgA nephropathy

Post-streptoccocal glomerulonephritis

39
Q

PSGN is commonly caused by what?

A

A Group A Beta-haemolytic strep infection, commonly Strep pyogenes

40
Q

How does PSGN cause nephritis?

A

Deposition of immune complexes IgG, IgM, C3 in the glomerulus

41
Q

What are two findings on blood tests in patients with PSGN?

A 
Low C3 levels
Raised ASO (antistreptolysin O)
42
Q

What are the clinical features of Nephritic Syndrome?

A

Haematuria
Hypertension
Proteinuria (some)

43
Q

An URTI presents how long before nephritis in PSGN?

A

1-2 weeks prior

44
Q

An URTI presents how long before nephritis in IgA nephropathy?

A

1-2 days prior

45
Q

What is the management and prognosis of PSGN?

A

Mainly supportive
80% make a full recovery, however some will have progressively worsening renal function (HTN, oedema) and will need antihypertensives and diuretics

46
Q

What is IgA nephropathy also known as?

A

Berger’s disease

47
Q

What 3 conditions is IgA nephropathy associated with?

A

Coeliacs disease / Dermatitis Herpetiformis
Henoch-Schonlein Pupura
Alcoholic Cirrhosis

48
Q

What is seen on histology in patients with IgA nephropathy?

A

IgA deposits

Glomerular mesangial proliferation

49
Q

What is the prognosis of IgA nephropathy?

What is good and bad prognostic factors?

A

25% will develop end stage renal disease
Good: Frank haematuria
Bad: Hypertension, smoking, being male, proteinuria, hyperlipidaemia, ACE Genotype DD

50
Q

Haemolytic Uraemic Syndrome is a triad of what?

A

Haemolytic Anaemia
Thrombocytopaenia
Acute Kidney Injury

51
Q

What is the clinical presentation of HUS?

A

Brief gastroenteritis, often with bloody diarrhoea, then usually 5 days later:

  • Reduced urine output
  • Haematuria / dark urine
  • Abdo pain
  • Lethargy
  • Confusion
  • Irritability
  • Oedema
  • Hypertension
  • Bruising
52
Q

Most children get daytime control of urination by what age?

A

By 2 years

53
Q

Most children get night-time control of urination by what age?

A

By 3-4 years

54
Q

What is the difference between primary and secondary Enuresis?

A

Primary: Child has never achieved continence
Secondary: Child has had at-least 6 months of being dry

55
Q

What is the management for Primary Nocturnal Enuresis?

A
  • Bladder diary for 2 weeks
  • Reassurance of patients for children under 5
  • Encouragement / positive reinforcement
  • Enuresis alarms
  • Medications:
    1. Desmopressin (ADH analogue)
    2. Oxybutinin (Anticholinergic)
    3. Imipramine (TCA)
56
Q

Which form of Polycystic Kidney Disease presents in young children / infants?

A

Autosomal Recessive

57
Q

Outline the genetics of ARPKD

A

Mutation of the PKHD1 gene on chromosome 6, responsible for Fibrocystin / Polyductin Protein Complex (FPC). The FPC is responsible for renal tubules and epithelial tissue of kidneys, liver and pancreas

58
Q

What are the clinical features of ARPKD?

A
  • Cystic enlargement of the renal collecting ducts
  • Oligohydramnios
  • Pulmonary hypoplasia
  • Potter’s sequence
  • Congenital liver fibrosis
59
Q

Outline what Multicystic Dysplastic Kidney is?

A

Whereby babies have one cystic kidney while the other is normal. The affected kidney atrophies by age 5 and the unaffected kidney is usually enough, however patient is at risk of UTIs, HTN, CKD

60
Q

What is the epidemiology of Wilm’s Tumour?

A

One of the most common childhood malignancies, and presents in children under age 5 and has a median age of 3 years old

61
Q

What 3 syndromes are associated with Wilm’s Tumour?

A
  • WAGR Syndrome
  • Beckwith Weiderman Syndrome
  • Denys-Drash Syndrome
62
Q

What mutation is most commonly associated with Wilm’s Tumour?

A

WT1 on chromosome 11

63
Q

What is the Presentation of Wilm’s Tumour?

A
  • Large, palpable abdominal mass
  • Painless haematuria
  • Flank pain
  • Lethargy
  • Anorexia
  • Hypertension (due to renin secretion)
64
Q

What are the 4 features of WAGR syndrome?

A
  • Wilm’s Tumour
  • Aniridia
  • Genitourinary Malformation
  • Retardation
65
Q

What are the 4 features of Beckwith Weiderman Syndrome?

A
  • Wilm’s Tumour
  • Organomegaly
  • Macroglossia
  • Hemihypertrophy
66
Q

What are the 3 features of Denys Drash Syndrome?

A
  • Wilm’s Tumour
  • Early Onset Nephrotic Syndrome
  • Male Pseudohermaphrodism
67
Q

What is the referral pathway for children with ?Wilm’s Tumour?

A

Paediatric review within 48 hours

68
Q

What is a Posterior Urethral Valve? What is a complication of this? What about in the developing foetus?

A

A posterior urethral valve refers to tissue at the proximal end of the urethra which obstructs urine output.

The obstruction of urine can cause a back pressure on bladder, ureters, kidney causing hydronephrosis.

In the developing foetus it can cause oligohydramnios and pulmonary hypoplasia.

69
Q

What is Cryptorchidism?

A

Cryptorchidism refers to failure of the testes to descend into the scrotum by 3 months of age

70
Q

What are complications of Cryptorchidism?

A

Increased risk of testicular torsion
Increased risk of testicular cancer
Increased risk of infertility

71
Q

What is a differential diagnosis for Cryptorchidism? Outline what it is?

A

Retractile testes

Usually in prepubescent boys, where the testes retracts out of the scrotum -> inguinal canal when cold or cremasteric reflex is activated.

72
Q

What is the management for Unilateral Cryptochidism?

A

Referral from 3 months, usually to be seen by a surgeon by 6 months of age. Orchidopexy by 6-18 months of age

73
Q

What is the management for Bilateral Cryptochidism?

A

Refer to senior paediatrician within 24 hours

74
Q

Briefly outline what a Hydrocele is?

A

A hydrocele is a collection of fluid within the tunica vaginalis that surrounds the testes

75
Q

What are the two types of Hydrocele? Outline what they are caused by. Which is more common in newborns?

A

Communicating type: Connection between the tunica vaginalis and the peritoneal membrane by a processus vaginalis; allowing fluid to travel from the peritoneal cavity to the hydrocele (MORE COMMON)

Non-Communicating type: Caused by excessive fluid production in the tunica vaginalis

76
Q

What are the presenting features of a Hydrocele?

A
  • Soft, non-tender swelling of the hemi-scrotum (anterior and below the testicle)
  • Swelling is confined to the scrotum, can get “above” the mass
  • Transillumination with a pen torch
77
Q

What is the diagnosis / management of a Hydrocele?

A

Diagnosis: Clinical plus an ultrasound
Management: Surgically repaired if not resolved by 1-2 years

Medicine, Year 4, Paediatrics (16 decks)

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