Renal/Urinary

Question 1

Primary vs Secondary enuresis

Answer 1

Primary = child has never achieved continence at night

Secondary = enuresis after being dry for >6 months

Question 2

Risk factors for enuresis

Answer 2

Genetic predisposition - autosomal dominant, high penetrance

Upper airway obstruction (apnoea)

Constipation, ADHD, psychological disorders

Question 3

Management of Enuresis in a child under 7?

Answer 3

Reassurance + Education
Promote good toileting behaviour
Consider rewards (star charts)

Question 4

Management of enuresis in a child 7+

Answer 4

Infrequent (<2/week) - watch and wait, education, behaviour

Frequent - 1st line - Enuresis alarm
+ Desmopressin short term + star charts

Desmopressin long term if above ineffective

Question 5

Presentation of UTI in neonates vs infants?

Answer 5

Neonates - irritable, poor feeding, vomiting, mottled

Infants - fever, D+V, smelly urine, new-onset incontinence, abdo/back/flank pain

Question 6

Criteria for UTI on dipstick?

Answer 6

Pyuria - WBC >50 x10^6/L

Pure growth of 1 species >10^5 organisms/ml

Question 7

Immediate management of a UTI?

Answer 7

Encourage fluid intake
Oral Trimethoprim
Hygiene advice
Avoid delaying micturation

Question 8

What follow up scans are offered and what do they look for?

Answer 8

USS - structural abnormalities of kidneys, discrepancy in size

MCUG - Vesicoureteric reflux

DMSA - renal scarring

Question 9

Indications for follow-up scanning

Answer 9

Age <6 months = typical - USS, atypical - USS, DMSA, MCUG

Age 6mth - 3yrs = typical - none, atypical - USS, DMSA

Age >3yrs = typical - none, atypical - USS, (DMSA if recurrent)

Question 10

Causes of haematuria in children?

Answer 10

UTI, acute nephritis, HSP
IgA nephropathy
HUS - post E.coli O157 infection

Question 11

What is Haemolytic Uraemic Syndrome? (HUS)

Answer 11

Triad of:

1) Microangiopathic haemolytic anaemia
2) Thrombocytopenia
3) Acute Kidney Injury

Question 12

What is microangiopathic haemolytic anaemia, and what does it produce?

Answer 12

Shiga toxin –> thrombin/fibrin deposition in glomerulus

• –> RBCs damaged/fragmented as they pass through
• –> presence of schistocytes on peripheral blood smear

Question 13

Presentation of HUS?

Answer 13

Bloody diarrhoea, <5yrs, N+V, abdo pain

often afebrile at presentation

Question 14

Mx of HUS?

Answer 14

IV fluid rehydration
Avoid Abx, antidiarrhoeics, opioids, NSAIDs
Anti-HTN therapy if BP too high
Early peritoneal dialysis

Question 15

4 features of nephrotic syndrome (NS)

Answer 15

1) Massive proteinuria
2) Hypoalbuminaemia
3) Oedema
4) Hyperlipidaemia

Question 16

Presentation of Nephrotic syndrome?

Answer 16

Widespread oedema - peri-orbital, pulmonary, ascites
SoB - due to PO
Hyper-coagulability due to loss of thrombin
Foamy urine = Proteinuria

Question 17

4 features of Nephritic syndrome (AGN - acute glomerulonephritis)

Answer 17

1) Haematuria
2) Oliguria
3) Azotemia
4) Hypertension

Question 18

Causes of Nephrotic syndrome?

Answer 18

Minimal Change Disease (MCD - 90%)
Focal segmental glomerulosclerosis
Infection, drugs, SLE, malignancy

Question 19

Mx of nephrotic syndrome?

Answer 19

Sodium and fluid restriction + diuretic to relieve oedema

Oral Prednisolone - 4 weeks

Question 20

Diseases within the spectrum of glomerulonephritis?

Answer 20

MCD
Diffuse - Focal - Segmental
Immune mediated - IgA nephropathies

Question 21

Presentation of glomerulonephritis?

Answer 21

Often 2-3 weeks post infection (often Strep)
Coca-Cola urine - proteinuria + haematuria + WBC
Facial oedema, abdo pain, ^BP, oliguria, AKI

Question 22

Presentation and management of hypospadias?

Answer 22

On VENTRAL surface
Adjacent to glans
More severe is midway along the shaft

Corrective surgery before 2yrs of age