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Part 2 Paediatrics > renal medicine > Flashcards

renal medicine Flashcards

1
Q

how common is bedwetting?

A

16% of 5 year olds and 3% of 9 year olds

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2
Q

what is the definition of nocturnal enuresis?

A

intermittent discrete incontinance in discrete episodes when asleep.

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3
Q

monosymptomatic enuresis

A

nocturnal enuresis without any daytime urinary symptoms

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4
Q

non-monosymptomatic enuresis

A

nocturnal enuresis with associated daytime urinary symptoms

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5
Q

secondary enuresis

A

bedwetting that has occurred after a child has been dry for 6 months

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6
Q

severe enuresis

A

bedwetting that occurs more than 5 times a week

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7
Q

what are the LUT symptoms of non-monosymptomatic enuresis?

A 
consistently increased (greater than 8) or decreased (less than 3) 
daytime incontinance 
urgency 
hesitancy 
straining (applying abdominal pressure to initiate and maintain voiding)
a weak stream 
intermittent micturition 
holding manoeuvres 
a feeling of incomplete emptying 
post micturition dribbling 
genital or LUT pain
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8
Q

what is the DSM definition of enuresis?

A

related voiding of urine onto the bed or clothes at least twice per week for three consecutive months in a child that is greater than 5.

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9
Q

most cases of enuresis can be traced by what?

A

behaviour support and avoidance of constipation

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10
Q

what is the first line treatment for bedwetting?

A

advise on fluid management, toileting before bed, behaviour management

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11
Q

what is second line treatment for enuresis?

A

alarm

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12
Q

when would you not offer an alarm for bedwetting?

A

infrequent voiding 1-2 per week
emotional difficulty with bedwetting
parents blaming child

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13
Q

what is the last intervention for bedwetting

A

desmopressin

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14
Q

what is the most common pathogen for UTI?

A

eccoli, then proteus, klebsiella, enterococcus

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15
Q

what are the common pathogens of urethritis?

A

N. Gonorrhoea and chlamydia trachomatis

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16
Q

what are congenital anomalies of the kidney and urinary tract?

A 
renal hypodysplasia or agenesis
multi cystic dysplastic kidney 
hydronephrosis 
duplex kidney or duplicated collecting system 
pelvic ureteric junction obstruction 
megaureter 
vesicoureteral reflux 
posterior urethral valve (blocks flow out of the bladder)
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17
Q

when can renal anomalies be picked up?

A

20% can be picked ip at 18 - 20 weeks gestation.

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18
Q

what are the long term complications of the untreated CAKUT?

A

HTN, impaired renal function, and end stage renal disease requiring dialysis.

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19
Q

how is the diagnosis of UTI made in children?

A

the presence of pyuria and at least 50,000 colonies per ml of urine.

20
Q

what are the common abx for UTI?

A

trimethoprim, nitrofurantoin, amoxicillin, co-amoxiclav, doxycycline (in children over 8).

21
Q

when is hospitalisation need for a UTI?

A 
in a child younger than 6 months 
has a high fever that is not improving 
likely has a kidney infection 
has sepsis 
is dehydrated, voimiting or unable to take oral medication
22
Q

how can a UTI present in 0-2 months

A

jaundice, fever, failure to thrive, poor feeding, vomiting, irritability

23
Q

UTI in a 2 months to 2 year old child presents like

A 
poor feeding
fever
vomiting
strong smelling urine 
abdominal pain 
irritability
24
Q

what would a UTI present with in a child 2 to 6 years old?

A 
vomiting
abdominal pain 
fever 
strong smelling urine 
enuresis 
urinary symptoms (dysuria, urgency, frequency)
25
Q

what do children that are 6 plus present with in a uti

A 
fever
vomiting abdominal pain 
flank or back pain 
strong smelling urine 
urinary symptoms (dysuria, urgency, frequency) 
enuresis 
incontinence
26
Q

when should you do a MCUG?

A

if the renal US shows hydronephrosis, scarring or urinary obstruction

27
Q

if leukocyte esterase is negative and nitrites is positive ?UTI

A

start abx treatment, send urine for culture

28
Q

if leuk is pos but nitrites are neg

A

Dont start abx unless cultures is positive, and a hx suggestive ofUTI

29
Q

What in pyuria is positive on urine culture?

A

abx treatment should be started if clinically uti

30
Q

what is bacteria and pus positive in urine culture?

A

treat as UTI

31
Q

what if bacteria is positive in urine culture but not pus

A

treat as uti

32
Q

when should a urine culture be sent for a child?

A 
if you suspect a UTI from hx 
in a really unwell child
in infants under 3 month 
if pos leuk esterase or nitrite 
recurrent UTI 
in an infection that does not respond to treatment in the first 24-48 hours
33
Q

When should you do US in the context of UTI?

A

if a child has an atypical UTI they should have a US. If a child is less than 6 months get an US with 6 weeks. A child greater 6 months only gets an us if recurrent infection or atypical organism.

34
Q

what about DMSA in children under 6 months?

A

yes if atypical infection or recurrent uti this is 4-6 month after acute infection

35
Q

what about MCUG?

A

yes if atypical or recurrent UTI if under 6 months

36
Q

would you do a MCUG in a child over. 6 months?

A

no

37
Q

would you do an us in a child over 6 months?

A

yes if atypical organism (during illness unless recovering within 48 hours) if recurrent us in 6 weeks

38
Q

when would you do a DMSA in a child is over 6 months?

A

if atypical (only if under 3) or recurrent in 4 to 6 months.

39
Q

what is an atypical UTI?

A

seriously ill, poor urine flow, abdominal or bladder mass, raised creatinine, septicaemia, failure to respond to tx, infection with non ecoli organism

40
Q

what is the definition of recurrent uti

A

2 or more episodes of upper uti
1 uti upper plus 1 lower
3 lower uti

41
Q

what is hypospadias

A

congenital condition where the urethral opening is on the underside of the penis.

42
Q

what are the signs of DSD

A

sex organs that don’t look male or female
menstruation can begin at odd age
hormonal or electrolyte abnormalities
hypospadias

43
Q

what causes 46XX DSD

A

placental aromatase deficiency
hormone medications
maternal hormonal imbalance
congenital adrenal hyperplasia

44
Q

what causes 46 xy dsd

A

testosterone biosynthesis defect
5a reductase deficiency
partial or complete androgen insensitivity syndrome

45
Q

what is the common cause of obstructive uropathy?

A

PUJO

46
Q

distal causes of obstructive uropathy

A

vesicle-ureteral junction obstruction, uretherocele, and an ectopic ureter

47
Q

what is the treatment for severe hydronephrosis?

A

pyeloplasty

Part 2 Paediatrics (8 decks)

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