Renal/Urological Problems Flashcards

1
Q

What are the 3 key features of typical nephrotic syndrome?

A

Oedema
Proteinuria
Hypoalbuminaemia

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2
Q

How is typical nephrotic syndrome managed in children?

A

High dose steroids

- no need for a renal biopsy

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3
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal change disease

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4
Q

Which atypical features would prompt discussion with nephrologist + renal biopsy in children with nephrotic syndrome?

A
Age < 1 or > 12 years
Hypertension
Impaired renal function
Frank haematuria
Steroid resistant nephrotic syndrome
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5
Q

What are the complications of nephrotic syndrome in children?

A

Dehydration
Infection (prophylactic antibiotics)
Chicken pox –> VZV checked on presentation as very dangerous if child on steroids/immunosuppressants
Thrombosis –> pro-thrombotic state

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6
Q

What are the risk factors for UTI in children?

A
Age < 1 year
Previous UTI
Voiding dysfunction
Vesicoureteric-reflux (VUR) - especially if pyelonephritis
Sexual abuse
Spinal abnormalities 
Constipation --> urinary obstruction
Immunosuppression
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7
Q

What are the symptoms of UTI in children?

A
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

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8
Q

What are the options for collecting a urine sample in young children?

A

Pads in nappy
‘Clean catch’ when nappy is removed
Suprapubic aspiration or catheter if severely ill or urgent

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9
Q

What is the first line imaging to check for abnormal anatomy or obstruction in a child with UTI?

A

USS

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10
Q

What is the gold standard investigation for VUR?

A

Micturating cystourethrogram (MCUG)

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11
Q

What is the gold standard investigation for renal scarring?

A

DMSA Scintigraphy

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12
Q

What are the imaging recommendation for a first time UTI in child age < 6 months?

A

USS within 6 weeks

Follow up MCUG if USS abnormal

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13
Q

What are the imaging recommendation for a first time UTI in child age > 6 months?

A

No imaging needed

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14
Q

What are the atypical UTI features?

A
Poor urine flow
Abdominal or bladder mass
Raised creatinine
Sepsis
Failure to respond to treatment within 48 hours
Non- E.coli organism
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15
Q

What is the definition of recurrent UTIs?

A

Two or more upper UTIs (pyelonephritis)

Or 3 episode of lower UTI

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16
Q

What are the imaging recommendations for a child with atypical or recurrent UTI?

A

Acute USS
Follow up DMSA for all
Follow up MCUG if < 6 months old

17
Q

When should UTI be treated in children?

A

If microscopy or dipstick is +ve for infection

OR negative but strong clinical suspicion

18
Q

What are the possible complications of UTI in children?

A

Renal scarring
Hypertension
Renal insufficiency + failure
Stones

19
Q

What is cryptorchidism?

A

Failure of testicular descent into the scrotum

20
Q

What are the risk factors for cryptorchidism?

A

Prematurity
Low birth weight
Other abnormalities of genitalia e.g. hypospadias
First degree relative with cryptorchidism

21
Q

What are the different types of cryptorchidism?

A

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

22
Q

What is the role of imaging in cryptorchidism?

A

None - low sensitivity for locating testis

23
Q

When should a child be urgently referred to senior paediatrician with cryptorchidism?

A
  • disorder of sexual development suspected
  • associated ambiguous genitalia or hypospadias
  • or bilateral undescended testis

–> may be presentation of congenital adrenal hyperplasia (CAH)

24
Q

How is cryptorchidism managed?

A
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
25
What is the definitive intervention for cryptorchidism?
If palpable --> open orchidoplexy If impalpable --> EUA + laparoscopy to identify if testis is absent or intra-abdominal
26
What are the complications of undescended testis?
Impaired fertility, esp if bilateral Testicular cancer Torsion
27
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
28
What are the three key features of hypospadias?
Ventral opening of urethral meatus Ventral curvature of the penis or "Chordee" Dorsal hooded foreskin
29
What is the management for hypospadias?
Urethroplasty | note circumcision should not be performed as foreskin used in reconstruction
30
What is Balanitis xerotica obliterans (BXO)?
Keratinisation of the tip of the foreskin --> scarring + the prepuce remains non-retractile
31
What is the peak age for BXO?
9-11
32
What are the features of BXO?
Irritation, dysuria, haematuria + local infection | Prepuce appears white, fibrotic + scarred
33
What is the management of BXO?
Circumcision | --> send foreskin for histopathology to confirm diagnosis