Renal + GU Flashcards
What is hypospadias
Urethral opening on ventral aspect of penis
Often seen with urinary tract abnormalities and undescended testes
Circumcision is absolutely contraindicated
Surgical repair at 1 yr (prepuce required)
Also assoc with: CAH, hermaphroditism
What is acute glomerulonephritis?
Presents with periorbital oedema, oliguria, haematuria
Oft follows strep throat
AKI -> hyperkalaemia, htn, fluid overload
Serum u + e, creatinine, bp, weight must be monitored
Urine m, c + s: Presence of hyaline + red cell casts, no infection
To confirm: throat swab, ASOT, complement ( low C 3)
Wilms’ tumour
Hypertension
Renal impairment
Malnutrition
Metastasis
Neuroblastoma
Neuro last cells in the adrenals
Catecholamine detected in urine
HSP
3-10 yrs vasculitis following viral illness
Arthralgia
Rash: urticaria - purpura
Abdo pain
Renal involvement: htn, nephrotic syndrome
Normal observations + normal platelet count
HUS
Complication of E.coli (O157H7) or shigella gastroenteritis verocytotoxin
= inflamm reaction in vasc endothelium + neutrophil activation
AKI + thrombocytopenia + microangiopathic haemolytic anaemia
Renal impairment may req dialysis or progress to CKD
Micturating cystourethrogram
To investigate suspected bladder outflow obstruction
- palpable bladder
- anuria
Posterior urethral valves
Bladder outflow obstruction
Poor urinary stream
DMSA
Dimercapto succinct acid: radio labelled compound which becomes fixed in functioning proximal renal tubular cells
Not taken up by scarred non functioning areas of the kidney
E.g. Following recurrent UTIs
PKD AR
Childhood presentation
Bilat renal masses
Pulmonary hypoplasia = resp distress
Pulmonary HTN
Congenital hepatic fibrosis
Cysts= grossly dilated nephrons, compress normal renal tissue
Affects renal, liver and cerebral vasculature (berry aneurysm)
Torsion of the hydatid of Morgagni
Small embryological remnant at upper pole of testes
Most common cause of acute scrotum in children
Benign but needs to be distinguished from testicular torsion a surgical emergency
Complications of HUS
Abdo pain Myocarditis Hepatitis Pancreatitis Retinal haemorrhages Encephalitis like features Renal damage-> htn
Testicular torsion
Twisting of spermatic cord in/ below inguinal canal
Strangulation of gonadal vessels -> testicular necrosis + atrophy
More common in adolescents
Hydrocele
Tunica vaginalis? Produces liquid
Epididymitis
Inflammation of the epididymis Swollen painful testicle Associated fever + nausea Prehn's sign positive Assoc urinary Sx
Nephrotic syndrome
Proteinuria:
Hypoalbuminaemia:
Oedema
(Also often hyperlipidaemia)
Rationale for treating cryptorchidism
Prevention of testicular cancer (always once risk tho)
Psychological benefit
To improve fertility slightly (temperature in abdomen too high)
Complications of cryptorchidism
Psychological distress Decr fertility Incr risk torsion Indirect hernias Malignancies
Common causes of UTI
E.coli
Proteus spp. (More common in boys)
Pseudomonas spp. (Oft assoc with structural abnormalities)
How would you acquire a good quality urine sample from a young child?
Adhesive bag
Clean catch (sit child on sterile pot)
Catheter insertion (in-out unless req going forward)
Suprapubic aspiration
Caricocele
Usually L sided
‘Bag of worms’
Varicosities in the pampiniform venous plexus
Assoc with defective spermatogenesis
Do USS: venous dilatation >2mm
Reassurance, supportive underwear
Radiological embolisation of L testicular vein can be performed o ligation and division of the L testicular veins
Phimosis
Inability to retract the prepuce
Should only be diagnosed after 3 yrs of age
Surgical correction if:
Prepuce remains non retractile
UTI or balantitis occurs secondary to phimosis
Paraphimosis
Retraction of tight foreskin over glans which impedes venous outflow -> oedema = more difficult to reduce the skin
Administer LA ringblock without adrenaline!!
Squeeze glans and reduce foreskin
Circumcision to prevent recurrence
How does Wilms tumour present
Unilat abdo mass
Painless haematuria
Flank pain
B sx
How is Wilms tumour managed?
Nephrectomy
Chemotherapy
If advanced + radiotherapy
Good prognosis, 80% cure rate
How would you manage undescended testis?
Review at 6-8wks age
Review at 3 months
To be seen by paeds surgeon before 6 months
