Renal/Urinary Flashcards
At what age are children usually dry by day?
2 years
At what age are children usually dry by night?
3 years
What proportion of children are dry by day and night by age 4?
75%
How is enuresis managed in under 5s?
Reassurance and lifestyle modification to help avoid enuresis. NO PUNISHMENT OR EMBARRASSMENT FOR WET NIGHTS - counterproductive.
Star chart reward system for dry nights.
How is enuresis managed in over 5s?
Reassurance and lifestyle modification to help avoid enuresis. NO PUNISHMENT OR EMBARRASSMENT FOR WET NIGHTS - counterproductive.
Enuresis alarm is first line in combination with star chart reward system.
Desmopressin may be added if no success, can also be offered for short overnight stays elsewhere e.g. sleepover, school trip.
Consult specialist before beginning oxybutynin.
What is the most common (90%) causative organism in UTI in children?
E. coli
Which organism is more common in boys with UTI and predisposes to phosphate stone formation?
Proteus
UTI due to which organism may suggest structural abnoramlity in the urinary tract?
Pseudomonas
What features make a UTI atypical?
Serious illness. Poor urine flow. Abdominal or bladder mass. Raised creatinine. Sepsis. Failure to respond to treatment with suitable antibiotics within 48 hours. Infection with non-E. coli organisms.
What is classed as recurrent UTIs?
2+ episodes of upper UTI OR 1 of UTI plus 1+ episode(s) of lower UTI OR 3+ episodes of lower UTI
What results on urine dipstick should prompt you to regard the problem as UTI and to start antibiotics and send a urine sample for MC+S?
Positive nitrites and positive leukocytes
Positive nitrites and negative leukocytes
How should you proceed if the urine dipstick results show negative nitrites but positive leukocytes?
Only start antibiotics if clinical suspicion of UTI. Send sample for MC+S
What investigations should a child under 6 months with a typical UTI get?
USS
What investigations should a child under 6 months with an atypical UTI get?
USS, MCUG, DMSA
What investigations should a child aged 6 months - 3 years with an atypical UTI get?
USS and DMSA
What investigations should a child over 3 years with an atypical UTI get?
USS (and DMSA if recurrent)
What can MCUG identify?
Urethral abnormalities and vesico-ureteric reflux
What can DMSA identify?
Identifies areas of renal scarring and differential renal function
How is UTI managed in children under 3 months and those over 3 months?
Under 3 months: Admit. iv cefotaxime until temp has settled, then switch to oral Abx
Over 3 months with UUTI: IV/PO Abx for 7-10 days
Over 3 months with LUTI: PO Abx for 3 days
What forms the triad in Haemolytic Uraemic Syndrome?
Acute renal failure
Microangiopathic haemolytic anaemia
Thrombocytopenia
Which age group does HUS tend to affect?
Infants and toddlers.
What causes HUS?
Typical HUS is secondary to GI infection with E. coli O157 through contact with farm animals or uncooked beef.
How may HUS present?
Diarrhoea turning bloody after 1-3 days. Abdominal pain. N+V. Absence of fever. The E. coli toxin localises to the renal endothelial cells where it causes intravascular thrombogenesis, damaging RBCs (anaemia) hence the acute renal failure.
What are the features of nephrotic syndrome?
Heavy proteinuria causing hypoalbuminaemia, accompanied by oedema and hyperlipidaemia
