Urology/Renal (Alice) (3%) Flashcards by Seth Northway

failure of testes to descent (one or both)

cryptochordism

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complications of unrepaired cryptochordism (2)

infertility
malignancy

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dx for cryptochordism

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tx for cryptochordism

orchiopexy by age 1
as soon as possible after 4 mos

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t/f: bacterial UTIs are a common cause of pediatric morbidity

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mc bacterial pathogen in pediatric UTIs

e.coli

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most significant rf for pediatric UTI

urinary tract abnl -> stasis, obstruction, reflux

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sx of UTI in newborns (lots!)

fever
hypothermia
jaundice
poor feeding
irritability
vomiting
ftt
sepsis

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most kids w. UTI will have what UA finding

pyuria (WBC > 5)

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gs dx for UTIs

urine culture

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UA specimen older kids vs infants/young kids

older: midstream, clean catch
infants/young kids: bladder cath vs suprapubic collection

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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

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tx for pediatric UTIs: low risk of renal involvement vs high risk

low risk: keflex
high risk: cefixime vs cefdinir vs ceftibuten

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abx NOT recommended for empiric tx for UTIs in peds due to resistance to e.coli

amoxicillin vs ampicillin

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definition of enuresis

involuntary loss of urine in a child > 5 yo

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successful bladder control is usually achieved by what age

24-36 mos

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clinically significant enuresis (4)

-more than twice/week for >3 consecutive mos
-affects day-to-day life
->/= 5 yo
-not caused by substance

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classifications of enuresis

primary: never had period of dryness
secondary: dry for several mos before regular wetting occurs

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primary nocturnal enuresis is thought to be due to (2)

delayed maturational control
vs
inadequate levels of ADH during sleep

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work up for enuresis

if > 5 yo:
-UA w. culture
-assess fluids/stooling/voiding habits

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management of enuresis (2)

-behavioral mods (ex nighttime audio alarm)
-desmopressin acetate (DDAVP)

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with tx, parents can expect enuresis to improve by _ %

15%

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kids who remain enuretic past _ yo are at higher risk of never having sx resolve

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5 yo w. coke colored urine w. (+) protein and elevated BP - PMH includes impetigo 3 weeks ago

glomerulonephritis

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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

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