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Terms in this set (64)
What is the most common cause of UTIs in children?
What are three other common causes of UTIs in children?
Factors that predispose kids to UTIs?
-Urinary tract obstruction
-Vesicoutereral reflex (VUR)
-Poor perianal hygiene
What are some symptoms that young children may present with for a UTI?
What are some symptoms that older children may present with for a UTI?
-Fever, chills, malaise
-New onset seizures
What would you have to do for a child who is unable to void on command?
Catheterize in order to get a urinanalysis and culture
What are the three most useful components of the urinanalysis?
If the patient is aged 2 months to 2 years and they are ill appearing and unable to retain oral intake, how should they be managed?
IV antibiotics and hospitalization
What are some reasons you would want imaging on a kid with a UTI?
-Girls under 3 with first UTI
-Boys under 1 with first UTI
-Children under 5 with fever and UTI
-Kids not responding promptly to treatment
What are two ways that a child can have a vesicoureteral reflux?
-Congenital (inadequate tunneling of ureters into bladder)
-Acquired (i.e. increased bladder pressure)
Describe a Grade 3 vesicoureteral reflux (VUR)and how you would treat.
Grades 1-5 so Grade 3 is when dilation begins to occur in the ureter as the urine continues to reflux back. You don't need surgery generally at this point but do want to treat with prophylaxis antibiotics
What are the treatment options for a Grade 4 or 5 vesicoureteral reflux?
-Open surgery to reimplant (intravesical-cut into bladder or extravesical-no opening of bladder)
-Deflux implant under ureteral opening
Which treatment (surgery or Deflux) is better for treating a vesicoureteral reflux?
What is the problem with a posterior urethral valves (PUV)?
There is an obstruction to flow of urine from the bladder.
What is the characteristic description of the urethra in PUV and the effect on the bladder?
Urethra gets a "key hole" appearance
Bladder wall becomes thickened
True or False: PUV only occurs in males and accounts for 20% of end -stage renal disease in children.
What is the most common site of urinary tract obstruction in children?
Uretero-pelvic junction (UPJ)
True or False: An obstruction at the uretero-pelvic junction is often bilateral (75%).
FALSE! It is unilateral 75% of the time.
What could you see on renal ultrasound with a partial uretero-pelvic junction obstruction?
How would you treat a uretero-pelvic junction obstruction?
Autosomal dominant PKD is often associated with what?
Autosomal recessive PKD is often associated with what?
ADPKD- intracranial aneurysms
ARPKD- hepatic fibrosis
When is it likely to get multicystic dysplastic kidney?
Usually present at birth
What is a VCUG?
When would might you use a VCUG?
To diagnose multicystic dysplastic kidney and vesicoureteral reflux (VUR).
What is the inheritance of juvenile onset medullary cystic (nephronophthisis)?
Horseshoe kidneys do not ________________(ascend/descend) and get caught on what artery?
Do not ASCEND because they get caught on the inferior mesenteric artery.
Horseshoe kidneys are often seen in what syndrome?
Turner's syndrome (7% of cases)
______________ tumor are 4x more frequent in children with horseshoe kidneys than the general population.
True or False: It is very unusual to find protein in a child's urine so it is often an indication of an underlying disease.
FALSE! About 5-15% of children will have a random dipstick with protein.
What are 4 characteristics of nephrotic syndrome?
What would swelling of the periorbital region in the am and swelling of the testicle in the pm make you think?
Nephrotic syndrome (edema due to loss of proteins)
What are the 3 nephritic/nephrotic diseases with low complement?
(hint: when you PMS you give low compliments)
In childhood nephrotic disease which races and gender are more prone?
Hispanics and African Americans
Males more than females 2:1
What age is the peak incidence of minimal change disease?
2-6 years old
How might you treat minimal change disease?
Loop diuretic (furosemide) and prednisone (steroids!)
How do children with membranous glomerulopathy usually present?
What are some other diseases that membranous glomerulopathy is associated with?
Hep B, Hep C, SLE, drugs
What is the characteristic appearance of membranous glomerulopathy on EM?
Spike and dome- due to subepithelium deposits and thick basement membrane
What is the other name for IgA nephropathy?
Where are the deposits found?
Deposits in the mesangium
A post-streptococcal glomerulonephritis presents ___________ after an infection.
An IgA nephropathy presents ___________ after an infection.
(fill in with days or weeks)
PSGN is WEEKS after an infection
IgA is DAYS after an infection
What is the inheritance of Alport syndrome?
X-linked dominant (so more common and severe in boys)
Sensory hearing loss and ocular disturbances
If you had a dipstick show positive for blood but then found no RBCs on microscopy what do you suspect?
If the dipstick was negative for blood but the urine appears red, what do you suspect?
In a Type I (distal) the problem is diminished __________ __________________. So the urine pH is (higher/lower).
Higher urine pH
In Type II (proximal) the problem is diminished __________ ___________________.
In Type IV RTA there is hyper________________ which is opposite the other two RTAs.
What is the most common form of vasculitis in children?
Henoch-Schonlein purpura (HSP)
Males twice as often as females
HSP is related to what nephritic syndrome?
IgA nephropathy since it it is IgA mediated involving small vessels.
What are the signs of HSP?
-Rash on lower extremities
-Bowel edema and hemorrhage
How might you treat HSP?
What is the most common urogenital anomaly?
What are two associations with cryptochidism?
-Low birth weight
What is more common in undescended testes?
Testicular neoplasm (seminoma most common)
True or False: A retractile cryptorchid is most associated with malignancy while an intraabdominal testes is not likely to be infertile or cancerous.
FALSE! Switch them.
In hypospadias which side of the penis is the urethral opening?
On the ventral/inferior side (more likely to have ventral curving "chordee")
What is the developmental error that occurs leading to hypospadias?
Failure of the urethral folds to close
What side of the penis the urethral opening in an epispadias?
On the dorsal/superior side (with dorsal "chordee")
What is other serious manifestation is associated with epispadias?
What accounts for 40% of acute scrotal pain and swelling at all ages?
True or False: While testicular torsion is very painful it is not considered an emergency since no real damage is done.
FALSE! A medical emergency!
What is a finding with the cremasteric reflex in testicular torsion?
Cremasteric reflex will be ABSENT
What test will help diagnose testicular torsion?
How much time do you have to fix the torsion with a 90% chance of saving the testis?
If fixed within 6 hours then 90% chance of survival...testis survival that is
Bilateral renal agenesis will lead to what syndrome with what manifestations?
Oligohydramnios -> pulmonary hypoplasia
Potter's syndrome is caused by the malformation of the ____________ bud.
Ureteric (aka metanephrogenic diverticulum)
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