Urology/Renal (Alice) (3%) Flashcards
failure of testes to descent (one or both)
cryptochordism
complications of unrepaired cryptochordism (2)
infertility
malignancy
dx for cryptochordism
US
tx for cryptochordism
orchiopexy by age 1
as soon as possible after 4 mos
t/f: bacterial UTIs are a common cause of pediatric morbidity
t!
mc bacterial pathogen in pediatric UTIs
e.coli
most significant rf for pediatric UTI
urinary tract abnl -> stasis, obstruction, reflux
sx of UTI in newborns (lots!)
fever
hypothermia
jaundice
poor feeding
irritability
vomiting
ftt
sepsis
most kids w. UTI will have what UA finding
pyuria (WBC > 5)
gs dx for UTIs
urine culture
UA specimen older kids vs infants/young kids
older: midstream, clean catch
infants/young kids: bladder cath vs suprapubic collection
what peds should get RBUS (renal bladder US) (4)
-all infants/kids 2-24 mos following first febrile UTI
-any ped w. recurrent febrile UTI
-any ped w. UTI and hx of renal or urologic dz/poor growth/HTN
-peds who do not respond as expected to abx following UTI
tx for pediatric UTIs: low risk of renal involvement vs high risk
low risk: keflex
high risk: cefixime vs cefdinir vs ceftibuten
abx NOT recommended for empiric tx for UTIs in peds due to resistance to e.coli
amoxicillin vs ampicillin
definition of enuresis
involuntary loss of urine in a child > 5 yo
successful bladder control is usually achieved by what age
24-36 mos
clinically significant enuresis (4)
-more than twice/week for >3 consecutive mos
-affects day-to-day life
->/= 5 yo
-not caused by substance
classifications of enuresis
primary: never had period of dryness
secondary: dry for several mos before regular wetting occurs
primary nocturnal enuresis is thought to be due to (2)
delayed maturational control
vs
inadequate levels of ADH during sleep
work up for enuresis
if > 5 yo:
-UA w. culture
-assess fluids/stooling/voiding habits
management of enuresis (2)
-behavioral mods (ex nighttime audio alarm)
-desmopressin acetate (DDAVP)
with tx, parents can expect enuresis to improve by _ %
15%
kids who remain enuretic past _ yo are at higher risk of never having sx resolve
10
5 yo w. coke colored urine w. (+) protein and elevated BP - PMH includes impetigo 3 weeks ago
glomerulonephritis
urine microscopy findings of glomerulonephritis
dysmorphic erythrocytes
RBC casts
glomerulonephritis is inflammation in the
glomerular basement membrane
hallmark finding of glomerulonephritis
hematuria
glomerulonephritis is classified in to
acute
chronic
types of acute glomerulonephritis (2)
-postinfectious: GAS
-rapidly progressive: goodpasture vs vasculitis
lab findings of postinfctious GN
(+) ASO titers
low serum complement (C3/C4)
tx for post infectious GN
supportive
+/- abx
hallmark finding of rapidly progressive GN
crescent formation on bx
due to fibrin and plasma deposition
hallmarks of goodpasture’s
(+) anti GBM abs
linear IgG deposits -> dx
tx for goodpasture’s (3)
high dose steroids
plasmapheresis
cyclophosphamide
hallmarks of vasculitis (3)
lack of immune deposits
(+) ANCA abs
microscopic polyangitis
types of chronic glomerulonephritis (3)
IgA nephropathy (berger)
alport’s membranoproliferative
hallmarks of IgA nephropathy
-post URI or GI
-renal bx: mesangial deposits of IgA in glomeruli
complication of IgA nephropathy
renal failure in 25%
dx for IgA nephropathy
renal bx
isolated, persistent, painless hematuria
alport’s
2 complications of alport’s
renal failure
hearing loss
what is anterior lenticonus
conical shape of anterior lens -> alport’s
dx for alport’s
C3/C4 levels
2 causes of membranoproliferative GN
SLE
viral hepatitis
dx for chronic GN
proteinuria + HTN, azotemia, oliguria, hematuria
hallmark finding of chronic GN
RBC casts
UA findings of chronic GN (3)
proteinuria < 3.5 g/day
hematuria
RBC casts
bx findings of chronic GN
hypercellular, immune complex deposition
tx for chronic chronic GN (5)
abx if strep
steroids: IgA
salt restriction
BP control
immunosuppression: RPGN
indication for dialysis w. chronic GN
symptomatic azotemia
penis abnl’s to know (5)
hydrocele
hypospadias
paraphimosis
phimosis
testicular torsion
1 day old infant male w. scrotal mass on PE that illuminates
hydrocele
collection of fluid around the testicle or along the spermatic cord that leads to a nontender fluid-filled cystic mass
hydrocele
t/f: hydrocele usually resolves w.o tx during first year of life
t!
dx for hydrocele
scrotal US -> transillumination
if you suspect a scrotal mass but it does not illuminate, consider
tumor
varicocele
if hydrocele does not resolve w.in 12 mos, what do you do (2)
needle aspiration
surgery
healthy newborn with urethral meatus proximal to the tip of the glans on the ventral aspect of the penile shaft
hypospadias
hypospadias is mc when the urethra opens onto the
bottom (underside) of the penile shaft
what defines the type of hypospadias
position of the urethral meatus
3 different types of hypospadias
most -> least severe
glandular: head of penis
midshaft: middle of penis
penile/scrotal: penis and scrotum join
dx for hypospadias is mc made during exam, but _ can help confirm
excretory urogram
tx for hypospadias
surgery prior to 1-2 yo
what is contraindicated in hypospadias
circumcision
foreskin may be used to reconstruct urethra
foreskin of penis can’t be pulled back over the head
phimosis
entrapment of foreskin in retracted position behind the glans
paraphimosis
why is paraphimosis a medical emergency
causes a tourniquet effect
management of paraphimosis (3)
-circumferential compression to glans
-dorsal slit
-circumcision once resolved
management of phimosis (3)
-usually resolves by 5 yo
-betamethasone
-circumcision if persistent
15 yo w. severe lower abd pain that radiates to left thigh, vomiting, hx of cryptochordism - normal vitals, benign abd exam, transillumination is negative
testicular torsion
hallmark findings of testicular torsion
-diffusely tender elevated left testis
-loss of cremasteric reflex
-lifting testicle does NOT relieve pain
twisting of testicle around the cord supplying blood to scrotum
cryptocordism
what is this showing
asymmetric high riding testicle -> bell clapper deformity
what is prehn sign, what does positive make you think of
relief of pain w. elevation of tender testis -> epididymitis
typical presentation of testicular torsion (3)
-severe pain/swelling associated w. n/v
-absent cremaster reflex
-blue dot sign
what is the blue dot sign
tender nodule 2-3 mm in diametr on upper pole of testicle
dx for testicular torsion
US
radionuclide study -> gs
what is this showing
lack of blood flow -> testicular torsion
testicular torsion is a medical emergency and must be repaired w.in
4-6 hr
complication of delayed repair of testicular torsion
infertility
condition in which urine flows retrograde from bladder into ureters/kidneys
vesicoureteral reflux (VUR)
typical presentation of VUR (2)
-young female
-recurrent infxns, esp cystitis or pyelonephritis
dx/monitoring for VUR
dx w. VCUG
monitor w. serial US/VCUG
management of VUR
mild-mod: self resolves
severe: surgery
new dx: +/- abx
