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PAEDIATRICS > RENAL/UROLOGY PAEDS > Flashcards

RENAL/UROLOGY PAEDS Flashcards

1
Q

UTI PAEDS presentation

A

Babies: Fever, lethargy, irritability, vomiting, poor feeding, urinary frequency
Older infants/children: fever, abdo pain, vomiting, dysuria, frequency, incontinence

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2
Q

Urine dipstick: Presence of nitrites

A

Gram negative bacteria (e.g. E.Coli)

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3
Q

Urine dipstick: Presence of Leukocytes

A

Significant levels of leukocytes in urine suggest inflammation or infection
Don’t treat for UTI if only leukocytes present - unless clinically indicated

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4
Q

UTI: Antibiotics

A

All children under 3 months with a fever: start on IV abx (e.g. ceftriaxone), full septic screen, blood cultures, bloods, lactate. Consider LP

Children over 3 months: Oral abx if they are otherwise well (if signs of sepsis —> admission + IV abx)

  • Trimethoprim
  • Nitrofurantoin
  • Cefalexin
  • Amoxicillin
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5
Q

Investigations for recurrent UTIs

A

USS
DMSA (dimercaptosuccinic acid) scan - 4-6 months after illness to assess for damage from recurrent or atypical UTIs
MCUG (micturating cystourethrogram)

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6
Q

Vesicoureteral reflux (VUR)

A

Urine flows from the bladder back into ureters
Predisposes patient to developing UTIs and subsequent renal scarring
Diagnosed using MICTURATING CYSTOURETHROGRAM

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7
Q

Vulvo vaginitis: Precipitants

A 
Wet nappies 
CLeaning/soaps use in area
Tight clothing that traps moisture in the area 
Poor toilet hygiene 
Constipation 
Threadworms 
Pressure on area (e.g. horse riding) 
Heavily chlorinated pools
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8
Q

Why is vulvovaginitis better after puberty?

A

OEstrogen helps keep skin and vaginal mucosa healthy and resistant to infection
Commonly affects girls aged 3-10 yrs

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9
Q

Vulvovaginitis presentation

A 
Soreness
Itching 
Erythema around labia 
Vaginal discharge 
Dysuria 
Constipation
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10
Q

Vulvovaginitis MANAGEMENT

A

No medical treatment often required. Simple measures to improve symptoms.
E.g. avoid washing with soap/chemicals, good toilet hygiene, emollients e.g. sudacrem, loose cotton clothing, treat any constipation, avoid activities that exacerbate problem

Oestrogen cream in very severe cases

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11
Q

NEPHROTIC SYNDROME features (triad + 3 others)

A
  1. Low serum albumin
  2. High urine protein conc.
  3. Oedema
  4. Deranged lipid profile
  5. High BP
  6. Hyper-coagulability
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12
Q

Nephrotic syndrome: what is it?

A

When the BM in the glomerulus becomes highly permeable to protein.
Frothy urine
Generalised oedema
Pallor

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13
Q

Nephrotic syndrome: cause (primary)

A

Most common cause in children: MINIMAL CHANGE DISEASE

- accounting for 90% of cases in children U10

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14
Q

Nephrotic syndrome: causes (secondary)

A

Secondary to intrinsic kidney disease

  • focal segmental glomerulosclerosis
  • membranoproliferative glomerulonephritis

Secondary to underlying systemic illness

  • Henoch-schonlein purpura (HSP)
  • Diabetes
  • infection (HIV, Hepatitis, malaria)
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15
Q

Minimal change disease: management

A

Corticosteroids (prednisolone)

Most children make full recovery, it may reoccur

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16
Q

Nephrotic syndrome: Management

A

High dose steroids - given for 4w then slowly weaned off for 8w
Low salt diet
Diuretics (for oedema)
Albumin infusions may be required if severe hypoalbuminaemia
Antibiotic prophylaxis (in severe cases)

If steroid resistant - ACEi, immunosuppressants (e.g. tacrolimus, cyclosporine, rituximab)

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17
Q

Nephrotic syndrome: complications

A

Hypovolaemia: fluid goes from intravascular space —> interstitial space (oedema and low BP)
Thrombosis: proteins that normally prevent blood clotting are lost in the kidneys, liver responds to low-albumin by producing pro-thrombotic proteins
Infection: kidneys leak immunoglobulins, exacerbated by treatment with immunosuppressants e.g. steroids
Acute or chronic renal failure
Relapse

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18
Q

Common causes of nephritis in children

A 
Post-streptococcal glomerulonephritis 
IgA Nephropathy (Berger’s disease)
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19
Q

Post-streptococcal glomerulonephritis: Cause

A

Occurs 1-3 weeks after beta haemolytic streptococcus infection (e.g. tonsillitis caused by strep pyogenes)
Immune complexes made of streptococcal antigens, antibodies, complement proteins get stuck in glomeruli of the kidneys causing inflammation
Inflammation —> reduction in kidney function —> AKI

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20
Q

Post-streptococcal glomerulonephritis: management

A

Supportive, 80% make full recovery

Some patients develop a progressive worsening of their renal function

May need treatment with: antihypertensive medication and diuretics if they develop complications

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21
Q

IgA nephropathy: Causes

A

Condition related to henoch-schonlein purpura (IgA vasculitis)
IgA deposits in the nephrons of kidney causes inflammation

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22
Q

IgA nephropathy: renal biopsy/histology

A

IgA deposits and glomerular mesangial proliferation

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23
Q

IgA nephropathy: Management

A

Supportive

Immunosuppressant meds to slow progression of disease (e.g. steroids and cyclophosphamide)

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24
Q

Haemolytic uraemia syndrome: what is it?

A

Thrombosis within small blood vessels throughout the body

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25
Q

Haemolytic uraemia syndrome: cause

A

Usually caused by bacterial toxin = SHIGA TOXIN

Produced by the E. Coli 0157 bacteria or shigella

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26
Q

Haemolytic uraemia syndrome: TRIAD

A
  1. Haemolytic anaemia
  2. AKI
  3. Thrombocytopenia
27
Q

Haemolytic uraemia syndrome: Risk factors

A

Use of antibiotics and anti-motility medications (e.g. loperamide) to treat gastroenteritis caused by the causative pathogens increases the risk of developing HUS

28
Q

Haemolytic uraemia syndrome: Presentation

A

E. Coli 0157 usually causes gastroenteritis + bloody diarrhoea
Sx of HUS typically start 5 days after the onset of diarrhoea
- reduced urine output, haematuria or dark brown urine, abdo pain, lethargy and irritability, confusion, oedema, HTN, bruising

29
Q

Haemolytic uraemia syndrome: Management

A 
MEDICAL EMERGENCY (10% mortality) 
Self limiting, supportive management 
Renal and paed specialist 
Renal dialysis may be needed 
Antihypertensives 
Careful maintenance of fluids 
Blood transfusions if required
30
Q

When should NOCTURAL ENURESIS stop

A

3-4 years

31
Q

When should DIURNAL ENURESIS stop

A

Should be able to control daytime urination by 2 years

32
Q

Primary noctural enuresis: causes

A

(Means never managed to be completely dry at night)
Most common = variation in normal development (particularly if child younger than 5) - parents just need reassurance

Other causes:
- Overactive bladder, fluid intake prior to bedtimes, psychological distress, chronic constipation, UTI, learning disability, cerebral palsy

33
Q

Primary noctural enuresis: Establishing cause

A

2 week bladder diary (diary of toileting, fluid intake, bed wetting) - identify patterns
Thorough history
Exclude underlying physical / psychological causes

34
Q

Primary noctural enuresis: Management

A
  • Reassure parents of pt under 5
  • lifestyle changes
  • encouragement + positive reinforcement
  • treat underlying/exacerbating factors (e.g. constipation)
  • Enuresis alarms
  • Pharmacological treatment
35
Q

Secondary noctural enuresis: definition

A

When child starts bed wetting after they have previously been dry for at least 6 months

36
Q

Secondary noctural enuresis: causes

A

More indicative of an underlying illness

  • UTI
  • Constipation
  • T1 DM
  • New psychological problems
  • Maltreatment (consider safeguarding)
37
Q

Diurnal enuresis: types of incontinence

A

Urge incontinence

Stress incontinence

38
Q

Enuresis alarm

A

Device that makes a noise at the first sign of bet wetting, waking the child up and stopping them from urinating
Needs to be used consistently for a prolonged period (at least 3 months)

39
Q

Enuresis: Pharmacological treatment

A

DESMOPRESSIN: reduces volume of urine produced by the kidneys (similar to anti-diuretic hormone). Taken at bedtime to reduce noctural enuresis.

OXYBUTININ: Anticholinergic, reduces contractility of the bladder. Helpful with overactive bladder causing urge incontinence.

IMIPRAMINE: tricyclic antidepressant,

40
Q

Type of POLYCYSTIC KIDNEY DISEASE that presents in children

A

There are 2 types of PKD:
1. Autosomal recessive polycystic kidney disease (ARPKD) —> presents in neonates and usually picked up on antenatal ultrasounds

  1. Autosomal dominant PKD - presents later in life usually adults
41
Q

PKD: Features

A

Cystic enlargement of the renal collecting ducts
Oligohydramnios (lack of amniotic fluid - caused by reduced urine production by foetus) —> pulmonary hypoplasia (resp. Failure short after birth) and potters syndrome (dysmorphic features)
Congenial liver fibrosis

42
Q

ARPKD: Ongoing problems throughout life

A 
Liver failure due to liver fibrosis 
Portal hypertension —> oesophageal varices 
Progressive renal failure 
Hypertension due to renal failure 
Chronic lung disease
43
Q

Multicystic dysplastic kidney (MCDK): definition

A

Where one of babies kidneys made up of lots of cysts, but other kidney is normal
In rare cases it can be bilateral —> death in infancy
Single good kidney to prone to problems (e.g. UTIs, hypertension, CKD later in life)
No treatment required

44
Q

WILMS TUMOUR: definition

A

Tumour affecting the kidneys in children

45
Q

WILMS TUMOUR: Presentation

A 
Consider in a pt. Under 5 yrs presenting with a mass in the abdomen.
Signs/Sx: 
- Abdo pain 
- haematuria 
- lethargy 
- fever
- hypertension 
- weight loss
46
Q

WILMS TUMOUR: Diagnosis

A

Ultrasound of abdo
CT/MRI to stage tumour
Biopsy - histology and definitive diagnosis

47
Q

WILMS TUMOUR: Management

A

SURGERY: Surgical excision of tumour and nephrectomy of affected kidney

ADJUVANT TREATMENT: chemo/radio therapy

48
Q

Posterior urethral valve: definition

A

Where there is tissue at the proximal end of the urethra (closest to the bladder) that causes obstruction to urine outflow
Occurs in newborn boys

49
Q

Posterior urethral valve: consequences

A

Obstruction of urine outflow —> hydronephrosis from backward flow pressure

Severe cases can cause obstruction in developing foetus —> bilateral hydronephrosis and oligohydramnios (low amniotic fluid volume)
—> pulmonary hypoplasia + resp. Failure short after birth

50
Q

Posterior urethral valve: Presentation

A

Can vary in severity

  • difficulty urinating
  • weak urinary stream
  • chronic urinary retention
  • palpable bladder
  • recurrent UTIs
  • impaired kidney function
51
Q

Posterior urethral valve: Investigations

A 
Abdo USS
Micturating cystourethrogram (MCUG) - shows location of extra urethral tissue and reflux of urine back into the bladder 
Cystoscopy: to get a view of the tissue/ used to ablate the tissue
52
Q

Posterior urethral valve: Management

A

Mild: observed and monitored
A temporary urinary catheter could be inserted to bypass the valve whilst awaiting definitive management
Definitive management: ablation or removal of the extra urethral tissue, usually during cystoscopy

53
Q

Undescended testis: risk factors

A 
FH do undescended testis 
Low birth weight 
Small for gestational age 
Prematurity 
Maternal smoking during pregnancy
54
Q

Undescended testis: Management

A

Watch and wait in newborns - most cases testis will descend in first 3-6 months
ORCHIDOPEXY (surgical correction of undescended testis) - should be carried out between 6-12 months

55
Q

Undescended testis: consequences

A

If undescended in older children or after puberty, higher risk of:
Testicular torsion
Infertility
Testicular cancer

56
Q

Retractile testicles: explanation

A

Normal variant - where the testes move out the scrotum into inguinal canal when it is cold or the cremasteric reflex is activated

Occasionally may fully retract and require surgical correction

57
Q

Hypospadias: definition

A

Urethral meatus in males abnormally placed posterior on the penis
Usually foreskin is abnormally placed to match the position of the meatus
Congential condition

58
Q

Hypospadias: Complications

A

Difficulty directing urine
Cosmetic and psychological concerns
Sexual dysfunction

59
Q

Hypospadias: Management

A

Mild cases may not require any treatment
Surgery usually performed at 3-4 months of age
Surgery aims to correct the position of the meatus and straighten the penis

60
Q

Hydrocele: definition

A

Collection of fluid within tunica vaginal is surrounding testes

SIMPLE HYDROCELE: common in new board males, usually resolves
COMMUNICATING HYDROCELE: tunica vaginal is around testis connected with peritoneal cavity via PROCESSUS VAGINALIS. - allowing fluid to travel from the peritoneal cavity into the Hydrocele

61
Q

Hydrocele: examination

A

Soft, smooth, non-tender swelling around one testes
In front of and below testicle
TRANSILLUMINATE

62
Q

Differential diagnoses for a scrotal/inguinal swelling in a neonate

A 
Hydrocele 
Partially descended testes 
Inguinal hernia 
Testicular torsion 
Haematoma 
Tumours (rare)
63
Q

Hydrocele: Management

A

Simple ones: usually resolve within 2 years without having lasting negative affects
Communicating: surgery to ligate the processus vaginalis

PAEDIATRICS (18 decks)

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