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Paeds > UROGEN > Flashcards

UROGEN Flashcards

1
Q

UTI
Aetiology
Symptoms

A 
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
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2
Q

Definition of UTI

A

WCC >10^5

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3
Q

UTI investigations

A

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

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4
Q

UTI management

A

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

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5
Q

Method of urine collection

A

Clean catch - best
Urine collection pads
Catheter
Supra-pubic aspiration

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6
Q

When to do a urine sample (in general)

A

UTI symptoms
Fever unknown origin
Infection elsewhere not responding to Rx

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7
Q

UTI complications

A

Scarring –>
CKD
HTN

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8
Q

UTI prophylaxis

A

Good hygiene
Regular voiding Lactobacillus acidophilus

Prophylactic abx - trimethoprim

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9
Q

What counts as a complicated UTI

A

Non E Coli organism

Septicaemia
Poor urine flow

Raised Creatinine

Not responding to abx in 48hrs

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10
Q

Who to follow up in UTI

A

Recurrent
Underlying structural abnormality
Reflux

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11
Q

Definition of nocturnal enuresis

A

bed wetting >5 y/o in the absence of structural abnormality

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12
Q

Nocturnal enuresis aetiology

A

Organic

  • Undiagnosed structural abnormality
  • Polyuria - DM/DI
  • Faecal retention

Non- organic
Stress
Sexual abuse
Watch out for the non-organics

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13
Q

Nocturnal enuresis management

A

Educate and ensure
Rule out organic causes eg DM/ structural abnormality

Star chart - reward for good behaviour

<7 - enuresis alarm
>7 - desmopressin

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14
Q

PSG

Presentation

A

URTI (strep pyogenes)
Pharyngitis etc

–> 7-14 days later –>

Haematuria
Proteinuria

Oedema
HTN/ headaches
Signs of cardiovascular overload

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15
Q

PSG pathophysiology

A

antigen-antibody complex formation in kidneys –> nephritis

LOW COMPLEMENT

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16
Q

PSG investigations

A 
Bloods 
- FBC - anaemia 
- U+E - raised creatinine 
Hypokalaemia 
AKI 
Acidosis 
Low C3 
ASO titre ^
AntiDNAse B titre

Urine
Haematuria
Proteinuria

Biopsy - starry sky appearance

17
Q

PSG management

A

PENICILLIN 10 days

Supportive
Nitroprusside if encephalopathy
Rx HTN etc

18
Q

HUS
Aetiology
Presentation

A

HUS

E. Coli O157:H7

Presentation

Dysentery –> days later

Haematuria
Proteinuria

TRIAD

  • AKI
  • Thrombocytopaenia
  • Microangropathic haemolytic anaemia
19
Q

HUS

Investigations and management

A 
Investigations 
Bloods 
FBC - thrombocytopaenia 
U+E - raised urea and creatinine - 
STOOL SAMPLE

Management
Supportive - fluids
Pred if severe but minimal evidence for this

20
Q

HSP - Aetiology

A

Strep pyogenes

wow yet again

21
Q

HSP presentation

A

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

22
Q

HSP pathophysiology

A

IgA mediated vasculitis

23
Q

HSP investigations

A

Bloods
IgA ^
Raised ESP
ASO titre - check for cause

Urinalysis

24
Q

HSP management

A

Supportive

pred if severe

25
Q

Nephrotic syndrome

Aetiology

A 
Minimal change 80% (NSAIDS + 
PSGN 
HSP 
Unknown 
Focal segmental glomerulonephropathy
26
Q

Nephrotic syndrome

Presentation

A 
TRIAD 
Proteinuria 
hypoalbuminaemia 
Oedema 
- Periorbital 
- Scrotal
- Leg 
- Breathless (pleural eff)

Increased infections
Hypercoagulable state
Hyperlipidaemia

27
Q

Nephrotic syndrome

A

AKI
Hypercholersterolaemia
Hypercoaguable
Recurrent infections

28
Q

Nephrotic investigations

A 
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

29
Q

Nephrotic complications

A 
Hypercholersterolaemia 
Hyponatraemia 
Hypocalcaemia 
Thrombosis 
Infection 
AKI
30
Q

Nephrotic syndrome management

A

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

Paeds (14 decks)

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