Renal & Urology Flashcards
What is vulvovaginitis and what can cause an exacerbation?
What - inflammation and irritation of vulva/vagina in girls 3-10 years.
Exacerbated by wet nappies, use of soaps, tight clothing, poor toilet hygiene, constipation, threadworms, pressure on area, heavily chlorinated pools.
Less common after puberty as oestrogen keeps skin and vaginal mucosa healthy.
Presentation and management of vulvovaginitis?
Presentation - soreness, itching, erythema, vaginal discharge, dysuria, constipation.
Urine dipstick may show leukocytes.
Management - supportive care with avoiding soaps, keep area dry, emollients, lose cotton clothing. If severe then may use oestrogen cream.
Urinalysis in minimal change disease?
Small molecular weight proteins and hyaline casts.
Management and complications of nephrotic syndrome in children?
Rx - high dose steroids given for 4 weeks then weaned. If resistant to steroids then can use ACEi and immunosuppresants.
Complications - hypovolaemia, thrombosis, infection (kidneys leak immunoglobulins), renal failure and relapse.
Causes, presentation and management of Haemolytic uremic syndrome?
Causes - E.coli 0157 or shigella.
Presentation - triad of AKI, microangiopathic haemolytic anaemia and thrombocytopenia. May also have fever, abdo pain, lethargy, palloe, haematuria, bruising.
Rx - Hospital admission and supportive management: give IV fluids, blood transfusions and haemodilaysis if severe renal failure. Self limiting
Features of primary nocturnal enuresis?
Bed wetting.
Most common cause - variation on normal development. Other causes = overactive bladder, fluid intake, failure to wake, psychological distress or secondary causes.
What is enuresis?
Involuntary discharge of urine by day/night in a child age 5 years or older.
What is secondary nocturnal enuresis and its causes?
Child begins wetting bed when been previously dry for past 6 months.
Causes: UTI, constipation, T1DM, new psychosocial problems, maltreatment, always think about abuse.
What is diurnal enuresis?
Daytime incontinence (when they are dry at night). Either urge incontinence or stress incontinence.
Management of nocturnal enuresis?
1st line - enuresis alarm (sensor pads that senses wetness).
Desmopressin can be given if short term control is needed (sleepovers) or enuresis alarm ineffective.
Also look for underlying cause, give general advice and use reward systems in day.
Features of Wilm’s tumour?
Presentation - mass in abdomen in child under age 5. Abdominal pain, haematuria, lethargy, fever, HTN, weight loss.
Ix - Ultrasound initially. Then CT/MRI to stage.
Rx - surgical excision with adjuvant chemo/radiotherapy. Prognosis is good unless metastatic
Features of posterior urethral valve?
Mild case - difficulty urinarting, weak urinary system, chronic retention, palpable bladder, impaired kidney function. Severe - bilateral hydronephrosis and oligohydramnios.
Ix - Abdo ultrasound, micturating cystourethrogram, cystoscopy.
Rx - Ablation/removal of urethral tissue during cystoscopy.
Features of undescended testes - causes and management?
Undescended if testes haven’t reached scrotum by birth.
Risk factors - family history, ow birth weight, SFG, prematurity, maternal smoking during pregnancy.
Rx - Most will descend by 3-6 months.
Unilateral undescended testes then by 3 months then consider refer to paed urology for orchidopexy.
Bilateral undescended testes - review by senior paeds within 24hr.
Complications of undescended testes?
Infertility,
Torsion,
Testicular cancer,
Psychological
What are retractile testies?
When testes move into the inguinal canal when cold or with cremaster reflex.
Normal variant in pre-pubertal boys.
