Renal/ Urinary Flashcards
Causes of primary enuresis
Lack of attention to bladder Detrusor instability Bladder neck weakness Neuropathic bladder UTI Constipation Ectopic ureter
Management of enuresis
Star charts, bladder training, pelvic floor exercises Enuresis alarm Anticholinergic drugs (Oxybutinin) Desmopressin for short term (synthetic analogue of ADH)
Causes of secondary enuresis
Emotional upset UTI Diabetes Renal concentrating disorder = sickle cell anaemia, renal failure
Common causes of UTI
E coli Klebsiella Proteus - common in boys + predisposes to phosphate stone formation Pseudomonas Strep faecalis
S+S UTI
Non-specific in infants = fever, vomiting, lethargy, jaundice, sepsis
Management of UTI by age
<3 months = admit, IV abx (cefotaxime) Infants >3 months or children with upper UTI = co-amoxiclav for 7-10 dyas Older children with lower UTI = oral trimethoprim 3 days
What are the signs of glomerular haematuria?
Brown urine Presence of deformed red cells + casts Accompanied by proteinuria
Glomerular causes of haematuria
Glomerulonephritis (usually with proteinuria) IgA nephropathy Familial nephiritis (e.g. Alport syndrome) Thin basement membrane disease)
Non-glomerular causes of haematuria
Infection Trauma to genitalia, urinary tract or kidneys. Stones Tumours Sickle cell disease Bleeding disorders Renal vein thrombosis Hypercalciuria
What is recurrent haematuria syndrome?
Occurs at time of systemic infection Due to nephritis
What are the features of haemolytic uraemic syndrome?
Acute renal failure Microangiopathic haemolytic anaemia Thrombocytopenia
Pathology + causes of HUS
Typically secondary to GI infection with E coli producing verocytotoxin Coagulation cascade activated but normal clotting
S+S HUS
Prodrome of bloody diarrhoea Abdo pain Fever Vomiting
Management of HUS
Peritoneal dialysis Plasma exchange if needed
Pathology of nephrotic syndrome
Heavy proteinuria = low albumin + oedema Peak onset 2-5 y/o
S+S of nephrotic syndrome
Periorbital oedema Scrotal/ leg/ ankle oedema Ascites SOB
Blood results for nephrotic syndrome
Low albumin Raised cholesterol
Management of nephrotic syndrome
Prenisolone
What features suggest nephrotic syndrome is steroid sensitive?
1-10 y/o No macroscopic haematuria Normal BP Normal complement levels Normal renal function Precipitated by resp infection
Causes of steroid resistant nephrotic syndrome?
Glomerulonephritis Membranous nephropathy
Pathology of glomerulonephritis
Renal inflammation causing: Haematuria Oliguria HTN Raised creatinine
Causes of glomerulonephritis
2-3 weeks after B haemolytic strep throat
S+S of glomerulonephritis
Sudden onset illness 2-3 weeks after pharyngitis Coco-cola coloured urine (excess RBC, WBC + proteinuria) Facial oedema Abdo pain Raised BP
Causes of acute nephritis
post infection Vasculitis (HSP, SLE etc) IgA nephropathy
Pathology of acute nephritis
Increased glomerular cellularity restricts blood flow so there is reduced filtration Leads to reduced urine output + fluid overload HTN Oedema Haematuria + proteinuria
HSP pathology
Skin rash Arthralgia Periarticular oedema Abdo pain Glomerulonephritis Due to raised IgA
S+S HSP
Symmetrical rash (buttocks, arms, legs and ankles) = urticarial, rapidly becoming maculopapular and pupuric. Joint pain (esp knees and ankles) Periarticular oedema Abdominal pain Haematemesis Malaena Intussusception
What is IgA nephropathy?
Episodes of macroscopic haematuria Commonly associated with URTIs
What is familial nephritis?
Commonest: Alport syndrome X linked recessive disorder = progresses to renal failure Associated with nerve deafness + ocular defects
What are the characteristics of SLE?
Presence of multiple autoantibodies C3 + C4 complements are low Haematuria + proteinuria
What is hypospadias?
Urethral opening proximal to normal meatus on ventral surface Correctional surgery needed before 2 y/o
What is a hydrocele and how is it managed?
Managed conservatively
Illuminates with transillumination
Disappears by 1
