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Renal + Urinary Flashcards

1
Q

Pyelonephritis can lead to ______ in the kidney tissue and therefore a ______ in kidney function

A

scarring

reduction

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2
Q

Always consider ____ in a child with temperature, unless there is a clear alternative source of infection

A

UTI

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3
Q

Which symptoms do babies with UTI present with?

A 
Fever
Lethargy
Irritability
Vomiting
Poor feeding
Urinary frequency
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4
Q

Signs and symptoms in older infants and children of UTI

A 
Fever
Abdo pain (suprapubic pain)
Vomiting
Dysuria (painful urination)
Urinary frequency
Incontinence
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5
Q

What is the fine, thin hair that grows on babies in utero called?

A

Ianugo

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6
Q

Diagnosis of acute pyelonephritis is made when:

Temp __________

____ pain/tenderness

A

38c

Loin

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7
Q

Main investigation for UTI

A

Clean catch sample for urine dipstick

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8
Q

What would show on a urine dipstick for a UTI?

A

Nitrites
Leukocytes
Blood

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9
Q

Children under 3 months old with fever should be given what drug immediately?

A

IV ceftriaxone

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10
Q

Children under 3 months old with fever should have which investigations?

A 
Septic screen (blood cultures, bloods and lactate)
LP
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11
Q

List antibiotic choices that can be used in children with UTI

A

Trimethoprim
Nitrofurantoin
Cefalexin
Amoxicillin

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12
Q

What 3 investigations can be used to investigate recurrent UTIs?

A

USS abdo
DMSA
MCUG

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13
Q

When is USS used in children under 6 months with UTI?

A

Within 6 weeks

Or during illness if recurrent UTIs or atypical bacteria

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14
Q

How does DMSA scan work?

A

Uptake of DMSA material by kidneys.

Patches with no uptake = scarred tissue due to previous infection

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15
Q

List the gold standard investigation for VUR

A

MCUG

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16
Q

How can VUR be treated?

A

Avoid constipation
Avoid excessively full bladder
Prophylactic antibiotics
Surgical input from paeds urology

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17
Q

How does MCUG investigation work?

A

Catherise child, inject contrast into bladder.

Series of X-rays taken and see whether contrast is refluxing into ureters

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18
Q

List the most common microorganism of UTI. List 2 other bugs?

A

E.coli
Klebsiella
Proteus

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19
Q

Define nocturnal enuresis

A

Bed wetting at night

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20
Q

Define diurnal enuresis

A

Wetting self during day

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21
Q

What is the most common cause of primary nocturnal enuresis?

A

Normal variation on normal development

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22
Q

What is primary vs secondary nocturnal enuresis?

A

Primary - never managed to control wetting self yet

Secondary - previously managed to control wetting for 6 months but now not

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23
Q

Other causes of primary nocturnal enuresis apart from normal development

A

Overactive bladder
Fluid intake
Failure to wake up
Psych distress

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24
Q

How do you establish the cause of primary nocturnal enuresis?

A

Toileting 2 week diary

History and examination to exclude psych or physical causes

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25
Give management options for primary nocturnal enuresis
``` Conservative Reassurance to parents Reduced fluid in evenings Pass urine before bed Easy toilet access Encouragement Treat underlying causes Enuresis alarm ``` Medical Pharmacological treatment
26
Causes of secondary nocturnal enuresis
``` UTI Constipation T1DM New psych problems Maltreatment (safeguarding) ```
27
2 main types of incontinence and what they mean
Urge - overactive bladder that gives little warning before emptying Stress - leaking urine during exertion (coughing/laughing etc)
28
What drugs can be given to stop enuresis?
Desmopressin (ADH analogue) Oxybutinin (anticholenergic - reduces bladder contractility) Imipramine - (TCA - relax bladder and lightens sleep)
29
Causes of prerenal failure
``` - Hypovolaemia due to: Gastroenteritis Burns Sepsis Haemorrhage Nephrotic syndrome ``` - Circulatory failure
30
Causes of renal failure
``` Vascular: HUS Vasculitis Embolus Renal vein thrombosis ``` ``` Tubular: Acute tubular necrosis Ischaemic Toxic Obstructive ``` Glomerular: Glomerulonephirtis Interstitial: Interstitial nephritis Pyelonephritis
31
Cause of post-renal failure
Obstruction: - congenital (valve abnormality) - acquired (blocked urinary catheter)
32
What is the last line of AKI management?
Dialysis
33
Management topics for CKD
1. Diet 2. Prevent renal osteodystrophy 3. Salt/water balance/acidosis 4. Anaemia 5. Hormonal abnormalities
34
What is the last line of CKD management?
Dialysis or kidney transplant
35
Presentation of CKD
``` Anorexia Lethargy Polydipsia/polyuria Faltering growth/growth failure Renal rickets HTN Proteinuria Anaemia ```
36
How is HUS managed?
``` Supportive management Urgent referral if dialysis needed Anti-HTN if needed Fluid balance Blood tranfusion if needed ```
37
What is hypospadias?
Urethral meatus displaced posteriorly on penis
38
When is hypospadias diagnosed?
Newborn examination
39
When is surgery on hypospadias performed?
Surgery done 3-4 months of age Mild cases DON'T need treatment
40
Complications of hypospadias?
Difficulty directing urination Cosmetic and psych concerns Sexual dysfunction
41
What is phimosis?
Non-retractile foreskin when trying to pull down foreskin to expose glans. Glans is "muzzled"
42
What is chordee?
Head of penis is extremely curved
43
Most common condition giving rise to "true" phimosis?
BXO Balanitis Xerotica Obliterans
44
List clinical features of Wilm's Tumour
Mass in abdomen ``` Abdo pain Haematuria Lethargy Fever HTN Weight loss ```
45
Where does Wilm's tumour occur? and at what age?
Kidneys Children under 5 years old
46
Investigation to explore Wilm's Tumour
USS abdomen CT/MRI to stage tumour Renal biopsy for definitive diagnosis
47
Management of Wilm's Tumour
Surgical excision of tumour and nephrectomy (of affected kidney) Adjuvant treatment after surgery: chemo or radiotherapy
48
What is renal agenesis?
Congenital absence of both kidneys
49
Amniotic fluid is mainly derived from which fluid?
Fetal urine
50
What is Potter's syndrome?
Both kidneys absent so oligohydramnios occurs. Less cushioning of the baby due to less aminotic fluid. Baby compressed and does not develop properly -> Potter's syndrome (fatal) Most have end-stage renal failure by adulthood
51
How is multicystic dysplastic kidney different from PKD?
One kidney is made up of many cysts, other is normal.
52
How is multicystic dysplastic kidney diagnosed?
Antenatal USS
53
What are complications of having a single kidney?
UTI HTN CKD
54
Give the two types of PKD. Which presents more commonly in children?
ARPKD ADPKD ARPKD is more common in children
55
Which gene/chromosome results in ARPKD?
PKHD1 gene on chromosome 6 Codes for FPC complex
56
Give pathological features of PKD on the developing fetus
``` Cystic enlargement of renal collecting ducts Oligohydramnios Pulmonary hypoplasia Potter syndrome Congenital liver fibrosis ```
57
List complications of PKD
``` Liver fibrosis --> failure Portal HTN --> oesophageal varices Progressive renal failure HTN Chronic lung disease ```
58
Briefly, what is the pathology in nephrotic syndrome?
Basement membrane in the glomerulus becomes highly permeable to protein. Protein leaks from blood into urine.
59
Which ages is nephrotic syndrome most common in?
2-5 years old
60
Frothy urine Generalised oedema Pallor All features in what?
Nephrotic syndrome
61
What is the classic triad of nephrotic syndrome?
Hypoalbuminaemia Proteinuria (3+ protein on dipstick) Oedema
62
Give 3 other features (apart from classic HPO triad) in nephrotic syndrome
Hyperlipidaemia, cholesterol HTN Hyper-coagulability
63
What is the most common cause of nephrotic syndrome in children?
Minimal change disease
64
Causes of nephrotic syndrome?
Primary: no underlying cause Secondary to: Intrinsic kidney disease (focal segmental glomeruloscelorosis) or membranopoliferative glomerulonephritis ``` Secondary to: Systemic illness: HSP Diabetes Infection (HIV/hepatitis/malaria) ```
65
Give the standard investigations for minimal change disease. What will they show?
Renal biopsy with microsocopy (shows no abnormality) Urinalysis (shows small molecular weight proteins and hyaline casts)
66
How is minimal change disease treated?
Corticosteroids - prednisolone
67
How is nephrotic syndrome managed conservatively?
Low salt diet
68
How is nephrotic syndrome managed pharmacologically?
``` High dose steroids (prednisolone) Diurietics (for oedema) Albumin infusions (severe hypoalbuminaemia) Antibiotic prophylaxis (severe cases) ```
69
How can steroid resistant nephrotic syndrome be treated?
ACE inhibitors | Immunosuppresants (cyclosporin, tacrolimus, rituximab)
70
How is fluid shifted in nephrotic syndrome and why?
Hypovolaemia (low fluid intravasc), oedema (high fluid extravasc) and low BP All due to loss of oncotic pressure in blood vessels as proteins leak into urine!
71
Give some complications of nephrotic syndrome
``` Oedema Low BP Thrombosis Infection (immunoglobulins leak into urine) Acute or chronic renal failure Relapse ```
72
Give the classic triad for nephritis
Reduction in kidney function Haematuria Proteinuria
73
2 most common nephritis causes in children?
Post-streptococcal glomerulonephritis (Group B strep) IgA nephropathy (Berger's disease)
74
Tonsillitis ---> nephritis What is the causative pathogen
Strep pyogenes (Group B strep)
75
How does Group B strep cause nephritis? Give the pathophysiology
Immune complexes made of strep antigens, antibodies and complement get stuck in glomeruli and cause inflammation Leads to acute loss of kidney function --> AKI
76
How is post-strep glomerulonephritis diagnosed?
Recent tonsillitis Positive throat swab Anti-streptolysis antiobody titres (ASO) on blood test
77
How is post-strep glomerulonephritis treated? How about if kidney function worsens?
Supportive treatment If kidney function worsens: Anti-HTN meds Diuretics (if HTN/oedema)
78
What is IgA nephropathy also known as?
Berger's disease
79
What other condition is IgA nephropathy related to?
HSP (this is an IgA vasculitis)
80
Which antibody can cause inflammation in kidneys by leaving deposits and "glomerular mesangial proliferation"?
IgA (in IgA nephropathy - a type of nephritis)
81
What ages does IgA nephropathy usually present in?
Teenagers/young adults
82
How to treat a child with IgA nephropathy?
Supportive treatment of renal failure Immunosuppressants (steroids/cyclophosphamide) to slow disease progression
83
How is IgA nephropathy diagnosis confirmed?
Renal biopsy with histology. Shows IgA deposits and glomerular mesangial proliferation.

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