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Paediatrics > Renal/urinary > Flashcards

Renal/urinary Flashcards

1
Q

What is glomerulonephritis?

A

Acute and chronic

Damage inflicted by the formation of immune complexes, most commonly post streptococcal infection –> haematuria, brown urine, oedema (peri-orbital and ankles)

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2
Q

Why is important to check the BP when investigating haematuria?

A

HTN indicates kidney pathology - child needs to be admitted

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3
Q

What is the most common cause of haematuria in children?

A

UTI

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4
Q

What is the most common type of tumour that will cause haematuria in children?

A

Wilm’s tumour - should be palpable mass in the loin

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5
Q

Investigations for a child with haematuria?

A

Urine - MSU dip and culture
Bloods
- FBC, ESR, CRP, clotting screen
- plasma urea, creatinine, eGFR, U+Es, albumin, phosphate

If suggestive of renal pathology - screen for hepatitis, renal biospy, throat swab (+ ASO titre for streptococcal)

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6
Q

What is haemolytic uraemic syndrome (HUS)?

A

A triad of AKI, microangiopathic haemolytic anaemia and thrombocytopaenia

Typically affects children 3mo-3yrs after a GI infection (e.coli or shighella)

Toxins damage the renal endothelium –> intravascular thrombogenesis
No consumption of clotting factors but consumption of platelets

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7
Q

Symptoms and signs of HUS?

A

Diarrhoea and colitis from GI infection

Oliguria, pallor, jaundice, encephalopathy

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8
Q

Investigations of HUS?

A

Bloods:

  • High LDH (tissue damage)
  • High WCC
  • Coombes -ve
  • Decreased PCV (% of RBC in blood)
  • Fragmented RBCs
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9
Q

What is nephrotic syndrome?

A

Oedema + hypoalbuminaemia + proteinuria

Due to increased permeability of the glomerular capillary wall –> increased loss of protein in urine

Cause = minimal change glomeurlonephritis (80%)

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10
Q

Presentation of nephrotic syndrome?

A
  1. peri-orbital oedema –> becomes more generalised (pitting oedema of legs/ankles and oedema of scrotum, vulva)
  2. Ascites and pulmonary effusion (SOB/respiratory distress)
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11
Q

Investigations in nephrotic syndrome?

A

MSU dip and culture - increased protein, may have microscopic haematuria

Bloods - FBC, U+Es, ESR
Decreased levels of albumin, increased levels of cholesterol

Renal biospy if not typical minimal change disease (85% of cases) or if haven’t responded to steroid treatment

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12
Q

Management of nephrotic syndrome?

A

2-4 weeks prednisolone and then wean down to low-dose for 4-6 weeks
If persistent recurrence treat with cyclophosphamide

Refer to specialist if symptoms do not improve with steroid treatment

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13
Q

Presentation of glomerulonephritis?

A

haematuria, oedema, HTN, oliguira +/- proteinuria

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14
Q

Aetiology of glomerulonephritis?

A

Autoimmune - SLE, IgA nephropathy, membranoproliferative

Post infection (~1-2 weeks after URTI)
Bacterial - strep, stap A, salmonella
Viral - CMV, EBV, Varicella
Fungal - aspergillus, candida

Toxins/drugs e.g. gentamicin

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15
Q

Symptoms/signs of glomerulonephritis?

A

Often asymptomatic
Nephrotic syndrome - oedema, Proteinuria, hypoalbuminaemia
Nephritic syndrome - nephrotic + haematuria

Lethargy, malaise, anorexia
Pruritis
Oliguria
Pulmonary oedema

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16
Q

Management of glomerulonephritis?

A

Infection –> penecillin 10 days
Autoimmune –> high dose oral steroids and immunosuppressants

Symptomatic - diuretics for HTN and oedema

17
Q

Complications of glomerulonephritis?

A

AKI –> CKD
HTN and fluid overload

Infection - due to loss of immunoglobulins
Hyperlipidaemia
Hyper-coagulable state - due to loss of antithrombin II

Hyperkalemia
Acidosis
Seizures

18
Q

What is hypospadias?

A

Urethral meatus opens proximal to it’s correct position (at top of glans) - 1 in 200 boys
Graded according to position - glns = first degree, shaft = second degree, scrotal/perineal = third degree

Results in a triad of:
ventral urethral meatus
A hooded dorsal foreskin
Chordee (ventral curvature of penile shast - most prominent on erection)

19
Q

management of hypospadias?

A

Corrective surgery before the age of two

Aim is to fashion a normal looking penis

20
Q

What is vulvovagintis?

A

Inflammation of the vulva most common in 3-10yr olds due to lower levels of oestrogen

Inflammation –> red, itchy, sore –> green/yellow discharge

Encourage good hygiene - not normally treated with Abx

21
Q

What is the definition of nocturnal enuresis?

A

Involuntary passage of urine at night
Must be >5yrs
Must wet the bed >2 times a week
Absence of any abnormalities or pathology

22
Q

Causes of wetting?

A

Waking with the urge to urinate
Detrusor control - check day time frequency
levels of ADH

Psychological - abuse/neglect, behavioural
Illness - IDDM, UTI, constipation
Functional abnormalities - detrusor overactivity, bladder neck weakness, neuropathic bladder

23
Q

Investigations into bed wetting?

A

urine dipstick
Social Hx
+/- Ultrasound

24
Q

management of nocturnal enuresis?

A

Address precipitating factors - stop punishments, adjust night time routine, consider abuse/bullying, stop inadvertent reinforcement (let them sleep in parents bed), refer to school nuse

Alarms - use in children where other measures don’t work - 70% dry in 2 months - 2 types matt or pad

Medication - can be first line in children >7yrs = desmopressin given at bed-time
Second line = Imipramine

25
Q

What medication can be used for day-time wetting caused by detrusor overactivity?

A

Oxybutynin

26
Q

Epidemiology and aetiology of UTIs in neonates?

A

M>F - usually due to a structural abnormality e.g. VUR

27
Q

Risk factors for UTI?

A

Vesico-ureteric reflux - 1/3 have recurrence within 1 year (a cause of end-stage renal failure later in life) - mild forms usually resolve spontaneously

Incomplete voiding
Structural abnormalities - up to 50% of patients

28
Q

Usual cause of UTI?

A

Gram -ve: E. coli (90%)

Others:
Pseudomonas - hints at structural abnormality
Proteus - hints at kidney stones
Staph saprophyticus = common in adolescent girls

29
Q

Common symptoms in an infant with a UTI?

A

Fever - can be septic
Irritability
Lethargy
Vomiting

30
Q

Common presentation for cystitis in children >3yrs?

A

polyuria, dysuria, (–> enuresis)
Suprapubic pain
Fever

31
Q

Common presentation of pyelonephritis?

A 
Loin pain (can radiate to back)
Fever, vomiting, lethargy

Infants - Irritability, poor feeding

32
Q

Investigations into UTI in children <3yrs?

A

Urine microscopy - look for WCC >10^5/L

33
Q

Investigations into UTI for children >3 years?

A

Urine dip - leucocytes, nitrites, RBC, protein

34
Q

When is further imaging can be done and when is required?

A 
Ultrasound - good for structural abnormalities
DMSA - scan that shows renal scarring
Micturating Urethrogram (MCUG) - look for VUR

Required when child is <6months, seriously ill, atypical/recurrent infections, failure to respond to Rx in 48hrs, deranged U+E

35
Q

Management for pyelonephritis?

A

Consider admission
Abx for 10 days e.g. co-amoxiclav
Increase fluid intake and encourage micturition

36
Q

Treatment for lower UTI in children >3 years?

A

3 day course of trimethoprim - 4mg/kg BD

37
Q

Features of atypical UTI?

A 
Seriously ill
Poor urine flow
Abdominal or bladder mass
Raised creatinine
Septicaemia
Failure to respond to Abx within 48hrs
Infection with non-E.coli organisms

Paediatrics (14 decks)

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