RENAL & GENITOURINARY Flashcards
I cause the following in children:
Infants: Poor feeding, vomiting, irritability
Younger children: Abdominal pain, fever, dysuria
Older children: Dysuria, frequency, haematuria
Temp over 38 and loin/abdominal pain
WHAT AM I?
URINARY TRACT INFECTION
How do you identify me? (UTI)
- Mid stream urine sample to avoid contamination
- Urinanalysis
How do you manage me? (UTI)
- Infants 3 monts: Immediate referral to paediatrician
- 3 - 11 months: Hospital admission or antibiotic treatment Cefalexin (125mg x2 daily 7-10 days). (If culture results are available)
- 1–4 years: 125mg x3 daily 7-10 days
- 5 –11 years: 250mg x3 daily 7-10 days
- 12–15 years: 500 mg 2-3x daily 7-10 days
Co-Amoxiclav
- 3 –11 months: 0.25 mL/kg of 125/31 suspension 3x daily 7-10 days
- 1–5 years: 125/ 31 suspension three times a day for 7–10 days
- 6 –11 years: 5 ml of 250/ 62 suspension three times a day for 7–10 days
- 12–15 years: 500/125 mg three times a day for 7–10 days.
How do you manage recurrent UTIs in children?
1. Antibiotic prophylaxis: Trimethoprim: - 3–5 months: 12.5 mg at night - 6 months to 5 years: 25 mg at night. - 6–11 years: 50 mg at night. - 12–15 years — 100 mg at night.
Second line:
Cefalexin:
- 3 months to 15 years: 12.5 mg/kg at night
Amoxicillin for ages:
- 3 months to 11 years — 62.5 mg at night.
- 1–4 years — 125 mg at night.
- 5–15 years — 250 mg at night.
I cause the following:
- Newborns: no fever but poor feeding and vomiting
- Children <2: may have a fever (but not always), a poor appetite, vomiting and diarrhoea.
- Children >2: fever, appetite changes, stomach or lower back pain, symptoms of urgency, frequency and pain with urination.
WHAT AM I?
PYELONEPHRITIS
How am I managed? (Pyelonephritis)
- Management same as UTI oral Antibiotics
How am I managed? (Pyelonephritis)
- Management same as UTI oral Antibiotics
I cause the following:
- Sudden pain
- Unilateral flank pain
- Abdominal flank pain radiating to the labia in women and testicular pain
- Nausea, vomiting, haematuria
- Fever, Shivers, sweats
WHAT AM I?
ACUTE RENAL COLIC
How do you identify me? (Renal Colic)
- Children:
First line: Ultrasound
Second line: Low dose CT if uncertain about diagnosis - Blood testing:
- ## Serum Calcium: To identify treatable conditions like uric acid stones, and primary hyperparathyroidism.
How do you manage me? (Renal Colic)
- Stone less than 5mm - watch and wait for it to pass
- Stone greater than 5mm: medical expulsive therapy: Alpha Blockers
- Surgical treatment if stone is not likely to pass.
Shockwave lithotripsy (SWL) - shock waves to break up the stones
Percutaneous nephrolithotomy (PCNL) - nephroscope is passed percutaneously into the collecting system and the stone is fragmented and extracted
Ureteroscopy (URS) — involves the use of various energy sources (such as lasers) to break up the stone.
Open surgery if stone is too large or all other methods fail
I cause the following:
- I usually affect children ages 2-5 years of age
- Leak large amounts of protein in the urine > 1 g/m^2 per 24 hours
- Hypoalbuminaemia (< 25 g/l) - protein responsible for keeping fluids in the blood vessels
- I cause body tissue to swell
- Cause Hyperlipidaemia, a hypercoagulable state (due to loss of antithrombin III) and a predisposition to infection (due to loss of immunoglobulins)
WHAT AM I?
NEPHROTIC SYNDROME
How do you identify me? (Nephrotic syndrome)
- Urine dip stick shows albuminuria
- FBC, coagulation screen, Glucose, Autoimmune screen
How do you manage me? (Nephrotic syndrome)
- Depends on the cause. Refer to nephrologists early for further investigations.
- Fluid and salt restriction.
- Treatment of complications e.g lipid control by giving statins (Artorvastatin)
- Children diagnosed with nephrotic syndrome for the first time are normally prescribed at least a 4-week course of the steroid medicine prednisolone
- Diuretic e.g furosemide to help with fluid overload
- Sometimes angiotensin-converting enzyme (ACE) inhibitors for high blood pressure.
I cause the following:
- Peripheral oedema
- Macroscopic Haematuria coca cola colour
- Reduced urine output
- Hypertension
- Anorexia, pruritus, lethargy, nausea
WHAT AM I?
ACUTE NEPHRITIS
How do you manage me? (Acute Nephritis)
- Refer to secondary care
- Investigations are focused on assessing severity of renal injury and looking for the underlying cause
- Management depends on the underlying cause of acute nephritis.
I cause the following:
- Heavy presence of blood in the urine
- Any single episode of Visible Haematuria
WHAT AM I?
FRANK HAEMATURIA
How do you manage me (Frank Haematuria)?
To rule out UTI and Trauma urine analysis
Dipstick positive
Haematuria
Haemoglobinuria
Myoglobinuria
Refer to paediatrician
How do you manage me (Frank Haematuria)?
To rule out UTI and Trauma urine analysis
Dipstick positive
Haematuria
Haemoglobinuria
Myoglobinuria
Refer to paediatrician
I cause the following:
- Pass small amounts of urine to no urine at all
- Brown urine colour
- Leg swelling, feet, swelling in abdomen
- Fatigue and lethargy
- Nausea and vomiting
WHAT AM I?
ACUTE RENAL FAILURE
How do you manage me? (Acute renal Failure)
loop diuretics should be considered for treating fluid overload or oedema
Fluid replacement: Potassium containing solutions (Hartmann’s)
Monitoring fluid status important to monitor the patient’s volume status throughout
Management are treatment of any hyperkalaemia (danger of arrhythmias) (Calcium gluconate)
I cause the following:
- Penile Inflammation on the head
- Red, swollen, hot
- Itchy
- Red and inflamed foreskin and difficulty passing urine
WHAT AM I?
BALANITIS
How do you manage me? (Balanitis)
Advise the child or parents/carers to clean the penis daily with lukewarm water and to dry it gently.
Do not attempt to retract the foreskin to clean under it, if it is still fixed.
First line:
Oral Flucloxacillin:
1 month to 1 year of age — 62.5 mg to 125 mg, 4x daily for 7 days
2–9 years of age — 125 mg to 250 mg, 4x daily for 7 days.
Adults and children older than 10 years of age — 250 mg to 500 mg, 4x daily for 7 days.
Second line: Clarithromycin Oral: 1 month to 11 years 8 kg — 7.5mg/kg twice daily. 8–11 kg — 62.5mg twice daily. 12–19 kg — 125mg twice daily. 20–29 kg — 187.5mg twice daily. 30–40 kg — 250mg twice daily
12–17 years and adults:
250mg twice daily usually for 7–14 days, increased to 500mg twice daily
Persistent topical hydrocortisone 1% cream or ointment for up to 14 days in addition.
I cause the following:
- Acute scrotal pain
- Swelling, redness
- Enlarged testicle
- Radiation of pain to the abdominal or groin region
- Nausea and vomiting
- Cremasteric reflex may be abnormal or absent
- In neonates i may present painless scrotal swelling or mass with or without inflammation
WHAT AM I?
TESTICULAR TORSION
I cause the following:
- Acute scrotal pain
- Swelling, redness
- Enlarged testicle
- Radiation of pain to the abdominal or groin region
- Nausea and vomiting
- Cremasteric reflex may be abnormal or absent
- In neonates i may present painless scrotal swelling or mass with or without inflammation
WHAT AM I?
TESTICULAR TORSION
How do you manage me? (Testicular Torsion)?
- Immediate hospital admission
- If patient does not have scrotal swelling or pain but has a history of previous episodes of severe, self-limiting scrotal pain or swelling, arrange a urology referral
I cause the following:
- Scrotum will be swollen or enlarged
- The size of the scrotum can vary throughout the day
- Laying down or sleeping, the swelling often goes down in scrotum
- Fluid filled ballon in the scrotum
WHAT AM I?
HYDROCOELE
How do you manage me (Hydrocoele)?
- Usually self resolving after 12 months
- Arrange referral to a paediatric surgeon:
A simple, non-communicating hydrocele either is not decreasing in size, or is still present after 12 months of age. - Surgical removal: Hydrocelectomy
I cause the following:
- Opening of the urethra at a location other than the tip of the penis
- Downward curve of the penis (chordee)
- Hooded appearance of the penis because only the top half of the penis is covered by foreskin.
- Abnormal spraying during urination
WHAT AM I?
-HYPOSPADIUS
How do you manage me (Hypospadius)
Some forms of hypospadias are very minor and do not require surgery.
Involves surgery to reposition the urethral opening and, if necessary, straighten the shaft of the penis. Surgery is usually done between the ages of 6 and 12 months
I cause the following:
- Primary Involuntary discharge of urine at night by children old enough to be expected to have bladder control.
- Can have night or day time symptoms
WHAT AM I?
NOCTURAL ENEURESIS
How do you manage me (Nocturnal eneuresis)?
- Advice on lifting and waking, and advice on fluid intake, diet, toileting patterns, and positive reward systems.
- Children younger than 5 years of age, giving reassurance that many children of that age wet the bed and that this usually resolves without treatment.
- 5 years of age and older, if bedwetting is infrequent (less than twice a week), giving reassurance that bedwetting may resolve without treatment and offering the option of a wait-and-see approach. Alarm can be helpful
- Referring the child or young person to secondary care or an enuresis clinic for further investigations and assessment.
- Considering further assessment and investigation to exclude a specific medical problem for children over 2 years who, despite awareness of toileting needs and showing appropriate toileting behaviour, are struggling to not wet themselves during the day as well as the night.
