Urinary Flashcards
How is a urine sample in children collected?
Ideally clean catch but can use urine collection pads
What is the management of UTI’s in
a) <3 months
b) LUTI
c) UUTI
a) urgently admit
b) 3 days of trimethoprim or nitrofurantoin
c) Most need admitting but can do 7-10 days of oral co-amoxiclav or ceftriaxone
What should be done if a child is experiencing recurrent UTIs?
Imaging of the genitourinary system often with USS
May need antibiotic prophylaxis
Describe the process leading to renal failure in VUR
Ureters enter the bladder at a more perpendicular angle leading to an inadequate PUJ. Urine can reflux back up the system leading to progressive dilation.
Frequent UTIs due to this abnormal flow leads to renal scarring and eventually failure
How would you investigate VUR in
a) <2 y/o
b) >2 y/o
c) suspected renal scarring
<2 y/o = micturating cystourethogram (need to catheterise)
> 2 y/o = indirect cystogram
scarring = DSMA
How is VUR managed?
Prophylactic antibiotics until 2 y/o
If not self-resolved by 2 then surgical
What happens in testicular torsion?
The spermatic cord twists on its mesentery within the tunica vaginalis leading to necrosis
What are the signs and symptoms of testicular torsion?
Severe, unilateral scrotal pain
Radiates to groin and abdomen
Vomiting
Testis is retracted up
Negative Phren’s
Absent cremateric reflex
If you were to investigate testicular torsion, what would you do?
Doppler USS
What is the management of testicular torsion?
bilateral orchidoplexy
May need orchidectomy if necrosed and non-viable
When is bed wetting considered abnormal?
> 5 in girls
>6 in boys
What would you want to rule out/ investigated in a child wetting the bed?
UTI Diabetes Constipation Renal failure Abuse
What is the stepwise management of enuresis?
- reassurance, no caffeine, rewards for using toilet before bed
- Enuresis alarm for 1 month
- Desmopressin for 1 month
- Specialists for anti-cholinergics and tricyclics
At what age should you refer a child with undescended testis?
3 months so that they are investigated etc and ready to have surgery by 1
What are the complications of undescended testis?
Infertility
Testicular cancer
Psychological impact
Torsion
How are undescended testis managed
a) if it’s palpable
b) if it’s not palpable
c) it’s bilateral
a) orchidopexy
b) laparotomy to find the testis and then orchidopexy
c) Refer to genetics
What are some differentials for childhood haematuria?
V: sickle cell, coagulation disorder I: UTI T: prolonged exercise, stones A: HSP, glomerulonephritis M: I: PCKD N: Wilm's tumour
Fabricated induced illness, child abuse
What is Henoch-Schonlein Purpura?
IgA mediated autoimmune hypersensitivity vasculitis
What are the signs and symptoms of HSP?
Abdominal pain and bloody diarrhoea
Rash: purpuric on back of legs and ulnar arm
Joint: painful, swollen ankles and knees
Renal: haematuria and proteinuria
What are some complications of HSP?
Renal failure Intussusception Arthritis Testicular pain Pancreatitis
Which nephrotic syndrome is most commonly seen in children? What are some secondary causes of nephrotic syndrome?
Minimal change disease
SLE, HPS, Alport, NSAIDs, leukaemia and lymphoma
How does nephrotic syndrome present?
Periorbital swelling
Frothy urine
Fatigue, weakness, anorexia
What is the management of nephrotic syndrome?
- Steroids
2. Ciclosporin
What are some complications of nephrotic syndrome?
Thrombotic events
Hyperlipidaemia
Infections
Compare IgA nephritis and post-streptococcal glomerulonephritis
IgA:
- 1-2 days post-URTI
- macroscopic haematuria
Post-strep:
- 1-2 weeks post-URTI
- low complement
- oedema, haematuria, proteinuria, HTN
What organism typically causes haemolytic uraemic syndrome?
E.coli
What are the signs, symptoms and blood results seen in HUS?
History of bloody diarrhoea, appear pale, reduced urine output
- Haemolytic anaemia
- Thrombocytopenia
- AKI
What are the signs and symptoms of Wilms tumour?
Palpable abdominal mass
Painless haematuria
Flank pain
Anorexia and fever
