UROGEN Flashcards
UTI
Aetiology
Symptoms
Aetiology E. Coli Enterobacter Kelbsiella Proteus --> stones Pseudomonas --> indicates underlying abnormality
RF
- Dehydration
- Underlying renal disease
- Poor hygiene
Symptoms Infant Poor feeding/ FTT/ jaundice/ diarrhoea Lower Dysurea/ freq/ urgency/ nocturia/ subrapubic pain/ temp
Upper Fever Rigors Abd pain/ diarrhoea N+V
Definition of UTI
WCC >10^5
UTI investigations
Bloods
FBC, U+E, LFT, ESP/CRP
CULTURES
Urine dip
Nitrites
Leucocytes
1) USS - structural abnormality
2) MCUG - check for VUR
3) DMSA - 3 months later - check for scarring
UTI management
Fluids
Analgesics
Antiemetics
<3 months - refer to paeds renal
> 3 months
Upper - cephalosporin + co-amox - 7-10 days
Lower - nitro, trimeth, amox etc as per local - 3 days
Method of urine collection
Clean catch - best
Urine collection pads
Catheter
Supra-pubic aspiration
When to do a urine sample (in general)
UTI symptoms
Fever unknown origin
Infection elsewhere not responding to Rx
UTI complications
Scarring –>
CKD
HTN
UTI prophylaxis
Good hygiene
Regular voiding Lactobacillus acidophilus
Prophylactic abx - trimethoprim
What counts as a complicated UTI
Non E Coli organism
Septicaemia
Poor urine flow
Raised Creatinine
Not responding to abx in 48hrs
Who to follow up in UTI
Recurrent
Underlying structural abnormality
Reflux
Definition of nocturnal enuresis
bed wetting >5 y/o in the absence of structural abnormality
Nocturnal enuresis aetiology
Organic
- Undiagnosed structural abnormality
- Polyuria - DM/DI
- Faecal retention
Non- organic
Stress
Sexual abuse
Watch out for the non-organics
Nocturnal enuresis management
Educate and ensure
Rule out organic causes eg DM/ structural abnormality
Star chart - reward for good behaviour
<7 - enuresis alarm
>7 - desmopressin
PSG
Presentation
URTI (strep pyogenes)
Pharyngitis etc
–> 7-14 days later –>
Haematuria
Proteinuria
Oedema
HTN/ headaches
Signs of cardiovascular overload
PSG pathophysiology
antigen-antibody complex formation in kidneys –> nephritis
LOW COMPLEMENT
PSG investigations
Bloods - FBC - anaemia - U+E - raised creatinine Hypokalaemia AKI Acidosis Low C3 ASO titre ^ AntiDNAse B titre
Urine
Haematuria
Proteinuria
Biopsy - starry sky appearance
PSG management
PENICILLIN 10 days
Supportive
Nitroprusside if encephalopathy
Rx HTN etc
HUS
Aetiology
Presentation
HUS
E. Coli O157:H7
Presentation
Dysentery –> days later
Haematuria
Proteinuria
TRIAD
- AKI
- Thrombocytopaenia
- Microangropathic haemolytic anaemia
HUS
Investigations and management
Investigations Bloods FBC - thrombocytopaenia U+E - raised urea and creatinine - STOOL SAMPLE
Management
Supportive - fluids
Pred if severe but minimal evidence for this
HSP - Aetiology
Strep pyogenes
wow yet again
HSP presentation
URTI
then
1) Haematuria / proteinuria
2) GI - abdo pain
3) Rash - purpuric - buttocks and extensors of legs and feet
4) MSK - limp - arthropathy/ periarticular oedema
HSP pathophysiology
IgA mediated vasculitis
HSP investigations
Bloods
IgA ^
Raised ESP
ASO titre - check for cause
Urinalysis
HSP management
Supportive
pred if severe
Nephrotic syndrome
Aetiology
Minimal change 80% (NSAIDS + PSGN HSP Unknown Focal segmental glomerulonephropathy
Nephrotic syndrome
Presentation
TRIAD Proteinuria hypoalbuminaemia Oedema - Periorbital - Scrotal - Leg - Breathless (pleural eff)
Increased infections
Hypercoagulable state
Hyperlipidaemia
Nephrotic syndrome
AKI
Hypercholersterolaemia
Hypercoaguable
Recurrent infections
Nephrotic investigations
LIVER (LIVCR) Lipids ^ Infection ^ VTE^ Calcium Renal injury
Urine - proteinuria (rarely harm except in non sensitive)
Bloods
- Hypercholerterolaemia
- Complement
- ASO titre
- U+E - usually normal
- Clotting ^
- Hypocalcaemia
- Hyponatraemia
CXR - oedema
Renal USS
Nephrotic complications
Hypercholersterolaemia Hyponatraemia Hypocalcaemia Thrombosis Infection AKI
Nephrotic syndrome management
Steroid sensitive
Prednisolone
60mg/m for 4 weeks
40mg alternate days for 4 weeks
Cyclophosphamide if relapse + diuretics etc
Pen V
Non sensitive
Cyclophosphamide
Salt restriction, ACEi, diuretics
