renal medicine Flashcards
how common is bedwetting?
16% of 5 year olds and 3% of 9 year olds
what is the definition of nocturnal enuresis?
intermittent discrete incontinance in discrete episodes when asleep.
monosymptomatic enuresis
nocturnal enuresis without any daytime urinary symptoms
non-monosymptomatic enuresis
nocturnal enuresis with associated daytime urinary symptoms
secondary enuresis
bedwetting that has occurred after a child has been dry for 6 months
severe enuresis
bedwetting that occurs more than 5 times a week
what are the LUT symptoms of non-monosymptomatic enuresis?
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
what is the DSM definition of enuresis?
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.
most cases of enuresis can be traced by what?
behaviour support and avoidance of constipation
what is the first line treatment for bedwetting?
advise on fluid management, toileting before bed, behaviour management
what is second line treatment for enuresis?
alarm
when would you not offer an alarm for bedwetting?
infrequent voiding 1-2 per week
emotional difficulty with bedwetting
parents blaming child
what is the last intervention for bedwetting
desmopressin
what is the most common pathogen for UTI?
eccoli, then proteus, klebsiella, enterococcus
what are the common pathogens of urethritis?
N. Gonorrhoea and chlamydia trachomatis
what are congenital anomalies of the kidney and urinary tract?
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)
when can renal anomalies be picked up?
20% can be picked ip at 18 - 20 weeks gestation.
what are the long term complications of the untreated CAKUT?
HTN, impaired renal function, and end stage renal disease requiring dialysis.
how is the diagnosis of UTI made in children?
the presence of pyuria and at least 50,000 colonies per ml of urine.
what are the common abx for UTI?
trimethoprim, nitrofurantoin, amoxicillin, co-amoxiclav, doxycycline (in children over 8).
when is hospitalisation need for a UTI?
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
how can a UTI present in 0-2 months
jaundice, fever, failure to thrive, poor feeding, vomiting, irritability
UTI in a 2 months to 2 year old child presents like
poor feeding fever vomiting strong smelling urine abdominal pain irritability
what would a UTI present with in a child 2 to 6 years old?
vomiting abdominal pain fever strong smelling urine enuresis urinary symptoms (dysuria, urgency, frequency)
what do children that are 6 plus present with in a uti
fever vomiting abdominal pain flank or back pain strong smelling urine urinary symptoms (dysuria, urgency, frequency) enuresis incontinence
when should you do a MCUG?
if the renal US shows hydronephrosis, scarring or urinary obstruction
if leukocyte esterase is negative and nitrites is positive ?UTI
start abx treatment, send urine for culture
if leuk is pos but nitrites are neg
Dont start abx unless cultures is positive, and a hx suggestive ofUTI
What in pyuria is positive on urine culture?
abx treatment should be started if clinically uti
what is bacteria and pus positive in urine culture?
treat as UTI
what if bacteria is positive in urine culture but not pus
treat as uti
when should a urine culture be sent for a child?
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
When should you do US in the context of UTI?
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.
what about DMSA in children under 6 months?
yes if atypical infection or recurrent uti this is 4-6 month after acute infection
what about MCUG?
yes if atypical or recurrent UTI if under 6 months
would you do a MCUG in a child over. 6 months?
no
would you do an us in a child over 6 months?
yes if atypical organism (during illness unless recovering within 48 hours) if recurrent us in 6 weeks
when would you do a DMSA in a child is over 6 months?
if atypical (only if under 3) or recurrent in 4 to 6 months.
what is an atypical UTI?
seriously ill, poor urine flow, abdominal or bladder mass, raised creatinine, septicaemia, failure to respond to tx, infection with non ecoli organism
what is the definition of recurrent uti
2 or more episodes of upper uti
1 uti upper plus 1 lower
3 lower uti
what is hypospadias
congenital condition where the urethral opening is on the underside of the penis.
what are the signs of DSD
sex organs that don’t look male or female
menstruation can begin at odd age
hormonal or electrolyte abnormalities
hypospadias
what causes 46XX DSD
placental aromatase deficiency
hormone medications
maternal hormonal imbalance
congenital adrenal hyperplasia
what causes 46 xy dsd
testosterone biosynthesis defect
5a reductase deficiency
partial or complete androgen insensitivity syndrome
what is the common cause of obstructive uropathy?
PUJO
distal causes of obstructive uropathy
vesicle-ureteral junction obstruction, uretherocele, and an ectopic ureter
what is the treatment for severe hydronephrosis?
pyeloplasty
