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3a Child Health > Renal/ urology > Flashcards

Renal/ urology Flashcards

1
Q

Give 3 causative organisms of UTIs in children

A
  • E coli
  • Proteus mirabilis
  • Pseudomonas
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2
Q

Give 4 predisposing factors for UTIs in children

A
  • infrequent voiding
  • hurried micturition
  • not wiping front to back in girls
  • vesicoureteric reflux
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3
Q

How does a UTI present in infants

A
  • poor feeding
  • vomiting
  • irritability
  • fever
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4
Q

How does a UTI present in older children

A
  • abdominal pain
  • dysuria
  • frequency
  • haematuria
  • smelly/ cloudy urine
  • fever
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5
Q

How is a UTI investigated in children

A
  • 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
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6
Q

How are UTIs managed in children

A
  • 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
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7
Q

When should an ultrasound of the urinary tract be arranged for children with a UTI

A
  • 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.
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8
Q

What indicates an atypical UTI in children

A
  • 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
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9
Q

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

a dimercaptosuccinic acid (DMSA) scan should be carried out within 4–6 months following the acute infection

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10
Q

How is a recurrent UTI defined in children

A
  • ≥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
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11
Q

What is vesicoureteric reflux

A

developmental abnormality where there is abnormal backflow of urine from the bladder into the ureter and kidney

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12
Q

Explain the pathophysiology of vesicoureteric reflux

A
  • ureters are displaced laterally, entering the bladder in a more perpendicular fashion rather than at an angle
  • vesicoureteric junction can’t function properly
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13
Q

How is vesicoureteric reflux investigated

A
  • micturating cystourethrogram (MCUG)
  • dimercaptosuccinic acid scan (DSMA) scan to look for renal scarring
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14
Q

How is vesicoureteric reflux managed

A
  • 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
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15
Q

What is nocturnal enuresis

A

night time incontinence in a child aged 5 years or older

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16
Q

When do most children achieve day and night time continence

A

by age 3 or 4

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17
Q

What is primary nocturnal enuresis

A

when a child has never been consistently dry at night

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18
Q

What is the most common cause of primary nocturnal enuresis in children under 5 years?

A

a variation of normal development, often with a family history of delayed dry nights.

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19
Q

How is primary nocturnal enuresis typically managed if it’s due to normal development?

A

Reassurance is important, and there is no need for further investigations or management in these cases.

20
Q

Other than normal variation, what are some causes of primary nocturnal enuresis?

A
  • 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)
21
Q

What are some secondary causes of primary nocturnal enuresis?

A
  • Chronic constipation
  • Urinary tract infection
  • Learning disability
  • Cerebral palsy
22
Q

What is secondary nocturnal enuresis

A

where a child begins wetting the bed when they have previously been dry for at least 6 months

23
Q

What are some causes of secondary nocturnal enuresis

A
  • Urinary tract infection
  • Constipation
  • Type 1 diabetes
  • New psychosocial problems (e.g. stress in family or school life)
  • Maltreatment
24
Q

How is nocturnal enuresis managed

A
  • 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)
25
Q

What is the classic triad of features in nephrotic syndrome?

A
  • Low serum albumin (<25g/l)
  • High urine protein content (>3+ on urine dipstick)
  • Oedema
26
Q

When is the peak incidence of nephrotic syndrome in children

A

between ages 2 and 5

27
Q

Give 3 primary causes of nephrotic syndrome

A
  • Minimal change disease
  • focal segmental glomerulosclerosis (FSGS)
  • membranous nephropathy.
28
Q

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

A

minimal change disease

29
Q

Give 4 secondary causes of nephrotic syndrome

A

Systemic diseases:
* systemic lupus erythematosus (SLE
* Diabetes mellitus
* Infections (e.g., HIV, hepatitis B and C)
* Drugs - NSAIDs

30
Q

How is minimal change disease diagnosed

A
  • renal biopsy:
    • light microscopy -> normal glomeruli
    • electron microscopy -> fusion of podocytes and effacement of foot processes
  • urinalysis - small molecular weight proteins and hyaline casts
31
Q

How is nephrotic syndrome managed

A
  • high dose steroids - prednisolone
  • furosemide to treat oedema
  • reduced salt diet
  • steroid-resistant: cyclosporine/ tacrolimus/ rituximab
  • prophylactic LMWH
32
Q

Complications of nephrotic syndrome

A
  • increased risk of VTE related to loss of antithrombin III and plasminogen in the urine
  • hypovolaemia
  • hypocalcaemia
  • hyperlipidaemia
  • chronic kidney disease
  • infections
33
Q

What are the main features of nephritis?

A
  • Reduced kidney function
  • Haematuria (invisible or visible blood in the urine)
  • Proteinuria (but less than in nephrotic syndrome)
34
Q

What are the two most common causes of nephritis in children?

A
  • Post-streptococcal glomerulonephritis
  • IgA nephropathy (Berger’s disease)
35
Q

What typically precedes post-streptococcal glomerulonephritis

A

PSGN occurs 1–3 weeks after a β-haemolytic streptococcus infection, such as tonsillitis caused by Streptococcus pyogenes

36
Q

What condition is IgA nephropathy associated with?

A

related to Henoch-Schonlein Purpura, which is an IgA vasculitis

37
Q

How is nephritic syndrome managed

A
  • supportive treatment of renal failure
  • steroids
  • diuretics and anti-hypertensives for complications
38
Q

What is hypospadias?

A

condition affecting males where the urethral meatus is abnormally displaced to the ventral (underside) side of the penis, towards the scrotum

39
Q

When is hypospadias typically diagnosed?

A

usually diagnosed on the examination of the newborn, as it is a congenital condition.

40
Q

How is hypospadias managed

A
  • 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.
41
Q

What is the classic triad of Haemolytic Uraemic Syndrome (HUS)?

A
  • Microangiopathic haemolytic anaemia
  • Acute kidney injury (AKI)
  • Thrombocytopenia (low platelets)
42
Q

What causes haemolytic uraemic syndrome

A

most cases are secondary to gastroenteritis
* Shiga toxins from either E. coli O157 or Shigella (mc)
* HIV
* Pneumococcal infection

43
Q

How does haemolytic uraemic syndrome present

A

may begin with diarrhoea if preceding gastroenteritis
* Fever
* Abdominal pain
* Lethargy and pallor
* Reduced urine output (oliguria)
* confusion
* bloody diarrhoea and haematuria
* vomiting

44
Q

What are the key investigations for Haemolytic Uraemic Syndrome (HUS)?

A
  • 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
45
Q

How is haemolytic uraemic anaemia managed

A
  • 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

3a Child Health (19 decks)

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