Renal/Urological Problems Flashcards
What are the 3 key features of typical nephrotic syndrome?
Oedema
Proteinuria
Hypoalbuminaemia
How is typical nephrotic syndrome managed in children?
High dose steroids
- no need for a renal biopsy
What is the most common cause of nephrotic syndrome in children?
Minimal change disease
Which atypical features would prompt discussion with nephrologist + renal biopsy in children with nephrotic syndrome?
Age < 1 or > 12 years Hypertension Impaired renal function Frank haematuria Steroid resistant nephrotic syndrome
What are the complications of nephrotic syndrome in children?
Dehydration
Infection (prophylactic antibiotics)
Chicken pox –> VZV checked on presentation as very dangerous if child on steroids/immunosuppressants
Thrombosis –> pro-thrombotic state
What are the risk factors for UTI in children?
Age < 1 year Previous UTI Voiding dysfunction Vesicoureteric-reflux (VUR) - especially if pyelonephritis Sexual abuse Spinal abnormalities Constipation --> urinary obstruction Immunosuppression
What are the symptoms of UTI in children?
Age < 5: - fever, lethargy, irritability - vomiting + diarrhoea - neonatal jaundice - poor feeding + failure to thrive Age > 5: - increased frequency - painful urination - bed wetting
Temperature > 38 +/- loin pain in pyelonephritis
What are the options for collecting a urine sample in young children?
Pads in nappy
‘Clean catch’ when nappy is removed
Suprapubic aspiration or catheter if severely ill or urgent
What is the first line imaging to check for abnormal anatomy or obstruction in a child with UTI?
USS
What is the gold standard investigation for VUR?
Micturating cystourethrogram (MCUG)
What is the gold standard investigation for renal scarring?
DMSA Scintigraphy
What are the imaging recommendation for a first time UTI in child age < 6 months?
USS within 6 weeks
Follow up MCUG if USS abnormal
What are the imaging recommendation for a first time UTI in child age > 6 months?
No imaging needed
What are the atypical UTI features?
Poor urine flow Abdominal or bladder mass Raised creatinine Sepsis Failure to respond to treatment within 48 hours Non- E.coli organism
What is the definition of recurrent UTIs?
Two or more upper UTIs (pyelonephritis)
Or 3 episode of lower UTI
What are the imaging recommendations for a child with atypical or recurrent UTI?
Acute USS
Follow up DMSA for all
Follow up MCUG if < 6 months old
When should UTI be treated in children?
If microscopy or dipstick is +ve for infection
OR negative but strong clinical suspicion
What are the possible complications of UTI in children?
Renal scarring
Hypertension
Renal insufficiency + failure
Stones
What is cryptorchidism?
Failure of testicular descent into the scrotum
What are the risk factors for cryptorchidism?
Prematurity
Low birth weight
Other abnormalities of genitalia e.g. hypospadias
First degree relative with cryptorchidism
What are the different types of cryptorchidism?
True undescended testis:
- absent from scrotum but lies along line of true descent
Ectopic testis:
- impalpable in normal pathway of descent
Ascending testis:
- previously identified in scrotum but undergoes a secondary ascent
What is the role of imaging in cryptorchidism?
None - low sensitivity for locating testis
When should a child be urgently referred to senior paediatrician with cryptorchidism?
- disorder of sexual development suspected
- associated ambiguous genitalia or hypospadias
- or bilateral undescended testis
–> may be presentation of congenital adrenal hyperplasia (CAH)
How is cryptorchidism managed?
At birth: - review at 6-8 weeks At 6-8 weeks: - if fully descended, no further action - if unilateral, re-examine at 3 months At 3 months: - if testis is retractile, advise annual follow up - if undescended, refer to paediatric surgery/urology for definitive intervention
What is the definitive intervention for cryptorchidism?
If palpable –> open orchidoplexy
If impalpable –> EUA + laparoscopy to identify if testis is absent or intra-abdominal
What are the complications of undescended testis?
Impaired fertility, esp if bilateral
Testicular cancer
Torsion
What is hypospadias?
Congenital defect causing the urethral meatus to be located at an abnormal site - usually on the underside of the penis rather than at the tip
What are the three key features of hypospadias?
Ventral opening of urethral meatus
Ventral curvature of the penis or “Chordee”
Dorsal hooded foreskin
What is the management for hypospadias?
Urethroplasty
note circumcision should not be performed as foreskin used in reconstruction
What is Balanitis xerotica obliterans (BXO)?
Keratinisation of the tip of the foreskin –> scarring + the prepuce remains non-retractile
What is the peak age for BXO?
9-11
What are the features of BXO?
Irritation, dysuria, haematuria + local infection
Prepuce appears white, fibrotic + scarred
What is the management of BXO?
Circumcision
–> send foreskin for histopathology to confirm diagnosis
