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Sarah Paeds > Renal/Urology/Genitalia > Flashcards

Renal/Urology/Genitalia Flashcards

1
Q

What is Potter’s syndrome?

A

Renal agenesis = oligohydramnios = intrauterine compression

  • Facies
  • Limb deformities
  • Lung hypoplasia
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2
Q

Why is UTI in children important (2)?

A
  • Structural abnormalities in 50%

- Pyelonephritis = scarring = CKD

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3
Q

What is dysuria alone usually due to in boys and girls?

A

Boys - balanitis

Girls - cystitis, vulvitis

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4
Q

Signs of an atypical UTI

A 
Refractory to abx treatment 
Abdo/pelvic mass 
Seriously ill/septicaemia 
Poor urine flow 
Raised Cr 
Non- E.coli organism
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5
Q

Predisposing factors for UTI

A

Structural abnormality
Incomplete voiding/emptying
Constipation
Vesicoureteric reflux

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6
Q

Is nocturnal enuresis more common in boys or girls?

A

Boys (2:1)

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7
Q

When is nocturnal enuresis worth investigating?

A

After 6 years

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8
Q

Organic causes of nocturnal enuresis

A
  • UTI
  • Constipation
  • DM
  • CKD
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9
Q

Contributing factors to nocturnal enuresis

A

Organic causes (e.g. UTI, constipation, DM)

Genetics

Emotional stress

Lack of parental approval

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10
Q

Management steps of nocturnal enuresis

A

Explanation (common, most self resolve, not conscious)

Ensure easy access to toilet, bladder emptying before bed

Start chart

Alarms

Desmopressin (ADH)

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11
Q

When are most children dry by day and night?

A

5 years

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12
Q

When are most children dry by day?

A

4 years

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13
Q

When is desmopressin appropriate in enuresis?

A

Short ter control e.g. for school trip or sleepover

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14
Q

Causes of primary daytime enuresis

A
  • Inattention to sensation
  • Detrusor overactivity
  • Neuropathic bladder
  • UTI
  • Ectopic ureter (constant dribbling)
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15
Q

Treatment for overactive detrusor

A

Anticholinergics e.g. oxybutynin

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16
Q

Mx for primary daytime enuresis >5 years

A 
Referral to specialists 
USS
Urine dip (MC&S)
USS
Spine XR
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17
Q

Causes of secondary enuresis

A

Emotional upset
UTI
DM

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18
Q

Clinical features of nephrotic syndrome

A

Periorbital oedema
Scrotal, vulval, leg and ankle oedema
Abdo distension - ascites
Resp distress (pulm effusion/abdo distension)

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19
Q

Nephrotic syndrome triad

A

Proteinuria
Oedema
Hypoalbuminaemia

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20
Q

Commonest childhood cause of nephrotic syndrome

A

Minimal change disease

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21
Q

Causes of nephrotic syndrome in children

A

Glomerular - minimal change disease, glomerulonephritis
Orthostatic proteinuria
HTN
SECONDARY - SLE, HSP

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22
Q

Investigations nephrotic syndrome

A 
Urine dip (+ MC&S)
FBC + ESR 
U&E 
Complement (SLE)
Antistreptolysin O/ DNAse B Abs (HSP)
Urinary sodium 
Malaria (if travel)
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23
Q

Management nephrotc syndrome

A

Regular urine monitoring

4 weeks PO prednisolone
Wean over next four weeks, or alternate days
(Proteinuria should resolve by 11 days)

Fluid/salt restriction

If it hasn’t resolved after course of pred - consider renal biopsy

  • Albumin
  • Furosemide
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24
Q

Complications of nephrotic syndrome

A

Hypovolaemia (abdo pain/faint) - treated with albumin
Thrombosis
Infection (capsulated e.g. pneumococcus)
Hypercholesterolaemia

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25
Q

Commonest cause of haematuria in children

A

UTI

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26
Q

Two broad categories of haematuria causes

A

Non-glomerular - UTI, trauma, stones, tumour, hypercalciuria, SCD

Glomerular - acute nephritis, post-streptococcocal, HSP, IgA nephropathy, familial (Alport’s)

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27
Q

Hearing loss and nephritis

A

Alport’s

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28
Q

Investigations for haematuria

A

Urine dip (MC&S)
Bloods (FBC, U&E, albumin, ESR)
Special bloods (anti-streptolysin O titre, anti-DNA)
Renal biopsy

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29
Q

Causes of acute nephritis

A

Post-streptococcal
HSP
IgA nephropathy

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30
Q

Acute nephritis (nephritic syndrome) features

A

Oedema
HTN
Haematuria/proteinuria
Reduced urine output

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31
Q

Post strep nephritis

A

Following throat or skin infection
Raised ASO/Anti-DNAse B titres
Low C3 (resolves over 3-4 weeks)

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32
Q

Features of HSP

A 
Fever 
Characteristic skin rash 
Arthralgia 
Glomerulonephritis 
Periarticular oedema 
Abdominal pain (colicky)
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33
Q

Features of HSP rash

A

Trunk sparing. Buttocks, legs, extensor surfaces, ankles

Urticarial –> maculopapular –> purpuric

Palpable

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34
Q

When does HSP typically occur

A

Winter months

After URTI

(3-10 years)

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35
Q

Demographics of patients at highest risk of HSP

A

Boys > girls (2:1)

3-10 years

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36
Q

What is HSP?

A

IgA mediated vasculitis

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37
Q

Management of HSP (by feature)

A

Arthralgia - ibuprofen/paracetamol

Severe oedema or abdominal pain - oral prednisolone

Proteinuria/deteriorating renal fx - IV corticosteroids

Follow up to check BP and renal fx

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38
Q

Commonest familial nephritis

A

Alport’s

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39
Q

Commonest vasculitis to involve the kidney

A

HSP

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40
Q

When is dialysis appropriate?

A 
Severe hyperkalaemia 
Metabolic acidosis 
Severe hypo/hypernatraemia 
Pulmonary oedema
HTN
41
Q

Commonest cause of AKI in children

A

Pre-renal

42
Q

Mx pre-renal AKI

A

Fluid replacement
Circulatory support

Dopamine/adrenaline is very low blood pressure

Furosemide if volume overloaded

43
Q

Causes of prerenal AKI

A

Hypovolaemia (gastroenteritis, sepsis, burns, haemorrhage, nephrotic syndrome)
Circulatory failure

44
Q

Causes of Renal AKI

A

Vascular - HSP, HUS
Tubular - ATN, ischaemia, toxins
Interstitial - pyelonephritis
Glomerular - glomerulonephritis

45
Q

Mx of renal AKI

A
  • Treat the underlying cause ***
  • Monitor H2O, U&Es
  • High calorie, normal protein diet. Reduce catabolism, uraemia nd hyperkalaemia
  • Furosemide if vol overload
  • IVI if co-existent pre-renal AKI
46
Q

Causes of post-renal AKI

A

Obstruction

47
Q

Mx of post-renal AKI

A

Urgent r/f to urology for ax of site of obstruction
Nephrostomy
Bladder catheterisation

48
Q

HUS triad

A

Uraemia
Haemolytic anaemia
Thrombocytopenia

49
Q

Primary cause HUS

A

Gastroenteritis (E.coli H157)

50
Q

What type of renal failure is HUS?

A

Acute renal (vascular)

51
Q

Presentation of HUS

A

History of bloody diarrhoea (gastroenteritis)

Malaise/lethargy

Bruising

Haematuria

52
Q

Mx HUS

A

Refer to haematology/nephrology

Supportive:

  • Monitor fluid balance and BP
  • IV isotonic crystalloids
  • Blood transfusion if anaemic
  • 50% will require dialysis
53
Q

What % of patients with HUS will require dialysis in the acute phase?

A

50%

54
Q

What treatments should be avoided in HUS?

A

Abx, opioids, NSAIDs, anti-diarrhoeals

55
Q

Features of atypical HUS

A

No diarrhoeal prodrome
Frequent relapses

–> higher risk of HTN and progressive CKD

56
Q

Mx for irreversible renal failure caused by HUS

A

Transplant

57
Q

Why is long term follow up necessary after resolution of acute HUS?

A

Persistent proteinuria
HTN
Progressive CKD

58
Q

How is AKI defined?

A

Oliguria (<0.5ml/kg/day)

59
Q

How is CKD defined?

A

eGFR <15 ml/min

60
Q

Commonest cause of CKD

A

Structural abnormalities and malformations

61
Q

Presentation of CKD

A

Abnormal AN USS

Anorexia/lethargy 
FTT 
Polydipsia, polyuria 
Real rickets 
HTN 
Proteinuria 
Anaemia
62
Q

Mx CKD (think different symptoms)

A

Anorexia/lethargy/FTT - nutrition. Consider NGT/gastrotomy with calorie supplements.

Polydipsia, polyuria

Renal rickets - phosphate restriction, calcium carbonate, activated D3

HTN - ACEi/ARB, CCB, dialysis, transplant

Anaemia - EPO stimulating agent

Hormonal abnormalities - Recombinant GH

Salt imbalances, met acidosos - sodium bicarb, salt supplements, water

63
Q

What is renal rickets?

A

Renal osteodystrophy
- Kidney cannot hydroxylate D2 –> D3
- Impaired absorption of Ca/excretion of PO4
= Osteitis fibrosa, osteomalacia leading to secondary hyperparathyroidism

64
Q

What type of inguinal hernia is more common in children? Why?

A

Indirect - patent processus vaginalis

65
Q

Which group of children are most at risk of inguinal hernias?

A

Prems

Boys

66
Q

Presentation of inguinal hernia

A

Intermitten groin swelling (on crying/straining)
Irreducible, firm, tender lump in groin/scrotum
Irritability, vomiting

67
Q

Mx of reducible hernia

A

Reduce under opioid analgesia

Surgery 24-48h to allow oedema to go down

68
Q

Mx of irreducible hernia

A

Emergency surgery (might be incarcerated)

69
Q

Common cause of hydrocoele

A

Patent processus vaginalis

70
Q

Where does the fluid come from/go to in a hydrocoele?

A

Peritoneal fluid into tunica vaginalis

71
Q

Presentation of hydrocoele

A 
Asymptomatic swelling in scrotum (commonly bilateral)
Bluish 
Non-tender 
Transilluminates 
Sometimes present after viral/GI illness
72
Q

Treatment of hydrocoele <2 years

A

Observe - most resolve spontaneously over 18-24 months

73
Q

Treatment of hydrocoele 2-11 years

A

Surgery with open repair.

Laparoscopic exploration

74
Q

Treatment of hydrocoele 11+ years

A

Dependent on cause:
- Idiopathic – observe. Surgery if particularly large/uncomfortable

  • After varicocelectomy - conservative management
  • Parasitic - surgery
75
Q

When must surgery occur in suspected testicular torsion?

A

Immediately

Before 6 hours

76
Q

Testicular torsion surgery

A

Orchidectomy

Orchidopexy (if undescended)

Contralateral and affected testicle fixed to the posterior wall

77
Q

When is testicular torsion most common?

A

Adolescents

78
Q

Risk factors for testicular torsion

A

Previous self-limiting episodes

Undescended testes

79
Q

Presentation epididymoorchitis

A

Insidious onset unilateral scrotal/groin pain

+/- urinary symptoms
+/- STI symptoms
+/- mumps symptoms

80
Q

Treatment epididiymoorchitis

A

Symptomatic relief - bed rest, analgesia, scrotal elevation

Abx if bacteral cause (UTI/STI)

Supportive if viral cause (mumps)

IV abx and fluids if systemically unwell with high-grade fever

81
Q

Three types of cryptorchidism

A

Retractile - can manipulate testis into the scortum, but retracts back

Palpable - palpated in groin, but not in scrotum

Impalpable - in inguinal canal/intraabdominal/absent (10%)

82
Q

What percentage of impalpable testes are completely absent?

A

10%

83
Q

Why are undescended testes more common in pre-term infants?

A

Testes’ descent through the inguinal canal largely occurs during the third trimester

84
Q

Investigations for undescended testes

A

USS
Hormonal (check testosterone response to hCG - check to see if there is any testicular tissue)
Laparoscopic exploration

85
Q

Management of undescended testes in neonate

A

R/v at 6-8 weeks.
If still not descended, re-exmaine at 3 months.
If retractile –> reassurance +annual review
If still not descended –> orchidopexy

86
Q

When should infant with undescended testes be referred to paediatrician?

A

Within first 24 hours if

  • possibility of disorder of sexual development
  • bilateral

If has not resolved (or at least become retractile) by 3 months

87
Q

When should orchidopexy be performed?

A

3 months - 1 year

88
Q

Why is orchidopexy performed?

A

Cosmetic
Reduced risk trauma/torsion
Reduced risk malignancy
Fertility

89
Q

Incidence of hypospasias

A

1/200 male births

90
Q

Pathophysiology hypospadias

A

Urethral tubularisation occurs proximally to distally under the influence of fetal testosterone.
Failure to complete this migration = hypospadia

91
Q

Three types of hypospadia

A

Ventral urethral meatus (on underside)
Hooded dorsal foreskin
Chordee (ventral curvature)

92
Q

What should be investigated in particularly proximal hypospadias?

A

For other GU anomalies

93
Q

Management of hypospadia

A

Surgery is NOT mandatory

May be performend for function or cosmesis after 3 months (ideally before 2 years)

94
Q

What must not happen in infants with hypospadias

A

Circumcision - foreskin can be used for reconstruction

95
Q

What is the aim of hypospadia surgery

A

Stand and pee in straight line

Straight erection

96
Q

Medical indications for circumcision

A

Phimosis (inability to retract foreskin - whitish scarring caused by localised skin disease BXO)

Recurrent balanoposthitis (redness and inflammation of foreskin, purulent discharge)

Recurrent UTI

97
Q

Paraphimosis

A

Foreskin trapped in retracted position, proximal to swollen glans

98
Q

Management of paraphimosis

A

Topic analgesia - ice packs, compression, osmotic agents

Puncture technique - exudation of oedmatous fluids

Surgical reduction and circumcision

Sarah Paeds (20 decks)

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