Renal/ urology Flashcards
Give 3 causative organisms of UTIs in children
- E coli
- Proteus mirabilis
- Pseudomonas
Give 4 predisposing factors for UTIs in children
- infrequent voiding
- hurried micturition
- not wiping front to back in girls
- vesicoureteric reflux
How does a UTI present in infants
- poor feeding
- vomiting
- irritability
- fever
How does a UTI present in older children
- abdominal pain
- dysuria
- frequency
- haematuria
- smelly/ cloudy urine
- fever
How is a UTI investigated in children
- urine sample: clean catch if possible
- urine collection pads if above not possible
- MSU in older children is suitable
- USS of urinary tract and kidneys
How are UTIs managed in children
- infants <3 months should be referred immediately to a paediatrician
- lower UTI and >3m: oral antibiotics for 3 days - trimethoprim/nitrofurantoin/ amoxicillin/ cefalexin
- Upper UTI - consider admission + oral cefalexin/ co-amoxiclav for 7-10 days
When should an ultrasound of the urinary tract be arranged for children with a UTI
- During acute infection in all children with atypical infection.
- Within 6 weeks for children <6 months with a first-time UTI that responds to treatment.
- For babies and children with non-E. coli UTIs responding well to antibiotics, a non-urgent ultrasound can be requested within 6 weeks.
What indicates an atypical UTI in children
- Seriously ill/Sepsis
- Poor urine flow
- Abdominal/ bladder mass
- Raised creatinine
- Failure to respond to Abx within 48 hours
- Infection with non E coli organism
For children under 3 years with atypical UTI, what scan should be performed to check for renal parenchymal defects and when should this be done?
a dimercaptosuccinic acid (DMSA) scan should be carried out within 4–6 months following the acute infection
How is a recurrent UTI defined in children
- ≥2 episodes of UTI with acute pyelonephritis/upper UTI, or
- 1 episode of UTI with acute pyelonephritis/upper UTI plus ≥1 episode of UTI with cystitis/lower UTI, or
- ≥3 episodes of UTI with cystitis/lower UTI
What is vesicoureteric reflux
developmental abnormality where there is abnormal backflow of urine from the bladder into the ureter and kidney
Explain the pathophysiology of vesicoureteric reflux
- ureters are displaced laterally, entering the bladder in a more perpendicular fashion rather than at an angle
- vesicoureteric junction can’t function properly
How is vesicoureteric reflux investigated
- micturating cystourethrogram (MCUG)
- dimercaptosuccinic acid scan (DSMA) scan to look for renal scarring
How is vesicoureteric reflux managed
- low dose prophylactic antibiotics
- regular monitoring to assess progress
- conservative: avoid constipation, voiding schedules, ensure adequate fluid intake
- surgical input if there’s high grade influx
What is nocturnal enuresis
night time incontinence in a child aged 5 years or older
When do most children achieve day and night time continence
by age 3 or 4
What is primary nocturnal enuresis
when a child has never been consistently dry at night
What is the most common cause of primary nocturnal enuresis in children under 5 years?
a variation of normal development, often with a family history of delayed dry nights.
How is primary nocturnal enuresis typically managed if it’s due to normal development?
Reassurance is important, and there is no need for further investigations or management in these cases.
Other than normal variation, what are some causes of primary nocturnal enuresis?
- Overactive bladder (small volume urination reduces bladder capacity)
- Fluid intake before bedtime, especially fizzy drinks, juice, and caffeine
- Failure to wake due to deep sleep or underdeveloped bladder signals
- Psychological distress (low self-esteem, stress from home/school)
What are some secondary causes of primary nocturnal enuresis?
- Chronic constipation
- Urinary tract infection
- Learning disability
- Cerebral palsy
What is secondary nocturnal enuresis
where a child begins wetting the bed when they have previously been dry for at least 6 months
What are some causes of secondary nocturnal enuresis
- Urinary tract infection
- Constipation
- Type 1 diabetes
- New psychosocial problems (e.g. stress in family or school life)
- Maltreatment
How is nocturnal enuresis managed
- identify causes/ triggers
- reward system (star charts) - for agreed behaviour
- if above not helpful: enuresis alarm - sounds at first sign of bed wetting
- desmopressin for short term control (e.g. sleepovers)
What is the classic triad of features in nephrotic syndrome?
- Low serum albumin (<25g/l)
- High urine protein content (>3+ on urine dipstick)
- Oedema
When is the peak incidence of nephrotic syndrome in children
between ages 2 and 5
Give 3 primary causes of nephrotic syndrome
- Minimal change disease
- focal segmental glomerulosclerosis (FSGS)
- membranous nephropathy.
What is the most common cause of nephrotic syndrome in children?
minimal change disease
Give 4 secondary causes of nephrotic syndrome
Systemic diseases:
* systemic lupus erythematosus (SLE
* Diabetes mellitus
* Infections (e.g., HIV, hepatitis B and C)
* Drugs - NSAIDs
How is minimal change disease diagnosed
- renal biopsy:
- light microscopy -> normal glomeruli
- electron microscopy -> fusion of podocytes and effacement of foot processes
- urinalysis - small molecular weight proteins and hyaline casts
How is nephrotic syndrome managed
- high dose steroids - prednisolone
- furosemide to treat oedema
- reduced salt diet
- steroid-resistant: cyclosporine/ tacrolimus/ rituximab
- prophylactic LMWH
Complications of nephrotic syndrome
- increased risk of VTE related to loss of antithrombin III and plasminogen in the urine
- hypovolaemia
- hypocalcaemia
- hyperlipidaemia
- chronic kidney disease
- infections
What are the main features of nephritis?
- Reduced kidney function
- Haematuria (invisible or visible blood in the urine)
- Proteinuria (but less than in nephrotic syndrome)
What are the two most common causes of nephritis in children?
- Post-streptococcal glomerulonephritis
- IgA nephropathy (Berger’s disease)
What typically precedes post-streptococcal glomerulonephritis
PSGN occurs 1–3 weeks after a β-haemolytic streptococcus infection, such as tonsillitis caused by Streptococcus pyogenes
What condition is IgA nephropathy associated with?
related to Henoch-Schonlein Purpura, which is an IgA vasculitis
How is nephritic syndrome managed
- supportive treatment of renal failure
- steroids
- diuretics and anti-hypertensives for complications
What is hypospadias?
condition affecting males where the urethral meatus is abnormally displaced to the ventral (underside) side of the penis, towards the scrotum
When is hypospadias typically diagnosed?
usually diagnosed on the examination of the newborn, as it is a congenital condition.
How is hypospadias managed
- Referral to a paediatric specialist urologist
- Parents should be warned not to circumcise the infant until a urologist indicates it is safe
- Surgery is usually performed around 12 months of age.
- The goal of surgery is to correct the position of the meatus and straighten the penis.
What is the classic triad of Haemolytic Uraemic Syndrome (HUS)?
- Microangiopathic haemolytic anaemia
- Acute kidney injury (AKI)
- Thrombocytopenia (low platelets)
What causes haemolytic uraemic syndrome
most cases are secondary to gastroenteritis
* Shiga toxins from either E. coli O157 or Shigella (mc)
* HIV
* Pneumococcal infection
How does haemolytic uraemic syndrome present
may begin with diarrhoea if preceding gastroenteritis
* Fever
* Abdominal pain
* Lethargy and pallor
* Reduced urine output (oliguria)
* confusion
* bloody diarrhoea and haematuria
* vomiting
What are the key investigations for Haemolytic Uraemic Syndrome (HUS)?
- FBC: Anaemia (Hb <8 g/dL) and thrombocytopenia.
- Fragmented blood film: Shows schistocytes and helmet cells.
- U&E : Indicates AKI
- Stool culture: detect Shiga toxin-producing E. coli infection
How is haemolytic uraemic anaemia managed
- medical emergency and requires hospital admission
- supportive - fluids, blood transfusion and dialysis
- plasma exchange is reserved for severe cases of HUS not associated with diarrhoea
- eculizumab
- there is no role for antibiotics, despite the preceding diarrhoeal illness in many patients
