Renal/ Urinary Flashcards
Where are infections of the urinary tract?
Urethra, bladder, ureters and kidneys
What is acute pyelonephritis?
Infection of the kidneys
What is cystitis?
Infection of the bladder
What is the most common cause of a UTI?
E coli
What is a cause of UTIs in hospitals with catheters?
Klebsiella
What are symptoms of UTI in babies?
Very non-specific
Lethargy
Fever
Irritability
Vomiting
Poor feeding
Urinary frequency
What are the symptoms of UTI in older infants and children?
Fever
Suprapubic pain
Vomiting
Dysuria
Urinary frequency and incontinence
What is the best investigation for UTI?
Clean catch - avoids contamination
What is the management of UTI in under 3 months with a fever?
Immediate IV ceftriaxone
Full septic screen
Blood cultures
What is the treatment for over 3 months with upper UTI?
Oral cefotaxime/ Co-amoxiclav for 7-10 days
What is the treatment for over 3 months with a lower UTI?
Oral trimethoprim/ Nitrofurantoin
What is the investigation needed for recurrent UTI?
Abdominal USS within 6 weeks or during
What are some findings on urine dipstick for UTI?
Nitrites and leukocytes
At what age do children normally control daytime urination?
2 years
At what age do children normally control night time urination?
3-4 years
What is primary nocturnal enuresis?
Child has never managed to be dry at night consistently
What are some causes of primary nocturnal enuresis?
Overactive bladder
Fluid intake - fizzy drinks
Failure to wake - underdeveloped bladder signals
Psychological distress
Chronic constipation, UTI, CP
What is secondary nocturnal enuresis?
Bedwetting after keeping dry for at least 6 months
Indicates an underlying problem
What are some causes of secondary nocturnal enuresis?
UTI
Constipation
T1DM
New psychosocial problems
Maltreatment
What is stress incontinence?
Leakage of urine during high pressure physical exertion such as coughing or laughing?
What is urge incontinence?
Overactive bladder that gives little warning before emptying
What are some medications for overactive bladders?
Desmopressin - ADH analogue
Oxybutynin - anticholinergic reduces bladder contractility
What is phimosis?
Inability to retract foreskin as it is very tight
What causes phimosis?
Balantis zerotica obliterans
What is the presentation of phimosis?
Penile irritation
Ballooning with urination
Bleeding
Urinary retention
Painful erections
Recurrent infections - balanoposthitis
Paraphimosis - foreskin stuck in retracted position
UTI
What is the management for phimosis?
Topical corticosteroids to soften foreskin such as hydrocortisone
Circumcision
What are some symptoms of renal malformation?
Failure to thrive
Swollen bladder
Frequent urination and UTI
Night bedwetting
Pain when urinating
Weak urinary stream
What is renal agenesis?
One kidney missing
What is renal hypoplasia?
One or both kidneys are abnormally small
What is horseshoe kidney?
Kidneys are joined to form a single arched kidney
What is horseshoe kidney associated with?
Trisomy 18 and turner syndrome
What are some complications of horseshoe kidney?
Kidney stones
Wilms tumour
Renal cancer
PKD
Hydrocephaly
Spina bifida
What are the symptoms of horseshoe kidney?
UTI
Restlessness
Flank pain
Chills
Poor weight gain
Decreased urination
Abdominal mass
What is polycystic kidney disease?
Kidneys are filled with fluid filled cysts which can be recessive or dominant
What do poorly perfused kidneys activate?
RAAS causing hypertension and fluid retention
What are the investigations for polycystic kidney disease?
Renal biopsy showing salt and pepper appearance
What is a complication of PKD?
Berry aneurysm causing SAH
What is hypospadias?
Urethral meatus is displaced to the underside of the penis towards the scrotum
What are some consequences of hypospadias?
difficulty urinating when standing
cosmetic appearance differs
Sexual function is not affected
What is the management of hypospadias?
Mild cases may not require treatment
Surgery after 3-4 months
No circumcision
What is vesicoureteric reflux?
Retrograde flow of urine from the bladder into the upper urinary tract predisposing patients to upper UTIs due to a developmental anomaly of the vesicoureteric junctions
What are the investigations for vesicoureteric reflux?
Micrurating cystourethrogram
Indirect cystogram
What is the treatment for vesicoureteric reflux?
Prophylactic antibiotics
STING
Endoscopic injections
Open surgery
What is HUS?
Thrombosis in small blood vessels throughout the body triggered by Shiga toxins from E.coli 0157 or Shigella.
What is the presentation of HUS?
Microangiopathic haemolytic anaemia
AKI
Thrombocytopenia
Fever
Abdominal pain
Lethargy
Pallor
Oliguria
Haematuria
What are the investigations for HUS?
Schistocytes
Raised creatinine
Raised LDH
Low haptoglobin
What is the management for HUS?
IV fluids
Blood transfusions
Hamodialysis
What is nephritic syndrome?
Inflammation of the glomeruli causing reduction in kidney function, haematuria and proteinuria
What are the two most common causes of nephritic syndrome?
Post-strep and IgA nephropathy
What is post-strep glomerulonephritis?
Occurs 1-3 weeks after strep infection
Immune complexes get stuck in glomeruli
Leads to acute deterioration and AKI
What is IgA nephropathy?
IgA deposits in the nephrons causing nephritis
What is HSP?
IgA deposits in both liver and skin
What is the difference between IgA nephropathy and Post strep?
IgA is 1-2 days post URTI and post strep is 1-3 weeks later
IgA shows IgA deposits and post strep is IgG
IgA has normal C3 and post strep is low
What is the presentation of nephritic syndrome?
Oedema
Visible haematuria
Fatigue
Pallor
SOB
Cough
What is the diagnosis of nephritic syndrome?
Urinalysis - haematuria, proteinuria, RBC casts
Bloods - raised creatinine and urea
Renal biopsy - crescent glomeruli, IgA depositions
What is nephrotic syndrome?
A group of proteinuria, oedema and hypoalbuminaemia
What is the criteria for proteinuria in nephrotic syndrome?
Over 3.5g in 24 hours causing frothy urine
What does hypoalbuminaemia cause in nephrotic syndrome?
Oedema
Fatigue
Dyspnoea
What is minimal change disease?
Affects glomeruli where T cells release cytokines that damage podocyte foot processes = effacement
How do you treat minimal change disease?
Corticosteroids such as prednisolone
What is focal segmental glomerulosclerosis?
- Chronic pathological process caused by injury to podocytes in the renal glomeruli
- Cells in glomeruli filter are damaged so proteins leak into urine, build up and cause damage
- Segments of the nephron are replaced with scar tissue
What is the presentation of focal segmental glomerulosclerosis?
Generalised oedema
Frothy urine
Pallor
Deranged lipids
High blood pressure
Hypercoaguability
What is the treatment for focal segmental glomerulosclerosis?
High steroids - prednisolone
Low salt diet
diuretics
What are some pre-renal causes of AKI?
Hypovolaemia - DKA, gastroenteritis
Nephrotic syndrome
Peripheral vasodilation - sepsis
Drugs - ACEi
What are some renal causes of AKI?
Acute tubular necrosis
Glomerulonephritis
Bilateral pyelonephritis
HUS
What are some post renal causes of AKI?
Obstruction
Neurogenic bladder
Tumours
Calculi
What are some symptoms of AKI?
Haemorrhage
Fever
Rash
Bloody diarrhoea
Severe vomiting
Abdominal pain
No or high urine output
Eye inflammation
What is the treatment for AKI?
IV fluids
Diuretics
Correct electrolytes
Limit protein to 0.5-1g/kg/day
What are some causes of CKD?
Congenital - renal dysplasia, prolonged urinary tract obstruction
Hereditary - PKD
Alport syndrome
HUS
SLE
Wilms tumour
What are some symptoms of CKD?
Failure to thrive
Polyuria and polydipsia
Lethargy
Bone pain
Vomiting
Headache
Malaise
Pale skin
Irritability
Stunted growth
What is the treatment of CKD?
diuretics
minimum protein and no vitamin A
Avoid high potassium
Control HTN
Dialysis
Kidney transplant
What are the two types of dialysis?
Peritoneal and haemodialysis
Name 3 features of an atypical UTI
Poor urine flow
Sepsis
Non E coli organism
Raised creatinine
Failure to respond to antibiotic within 48 hours
Name 3 things for UTI prevention
Regular voiding
High fluid intake to produce high urine output
Ensuring complete bladder emptying
Prophylactic antibiotics
What is the triad of symptoms of HUS?
Acute renal failure
Microangiopathic anaemia
Thrombocytopenia
