ASSESSMENT. anatomical assessment but not function. noninvasive. mobile. operator. does not detect all renal scars. nephrocalcinosis.

Transcription

1 MCUG GFR is urinary ASSESSMENT Radiological Investigations ultrasound provides advantages anatomical assessment but not function noninvasive mobile disadvantages operator dependent good for does not detect all renal scars urinary tract dilation stones nephrocalcinosis DMSA scan detects functional detects e g scars or nonfunctioning renal tissue very sensitive need to wait until 1 months after UTI to avoid false scars contrast introduced via catheter for vesicoureteric reflux good for urethral obstruction anatomy disadvantages invasive high radiation dose infection risk MAG } renogram dynamic scan isotope labelled substance MAG } excreted from the blood into urine measures drainage lfurosemide ten given ) requires cooperation s 4 good for VUR Xray identifies renal stones poor for nephrocalcinosisi Renal function is t in newborns { especially preterm infants GFR at 8 weeks lot term GFR rapidly rises E reaches adult levels at creatinine may not be outside normal until renal function at 501 EGTR monitor renal function serially inulin more accurate clearance substrates through glomerulus urea 4 in renal failure before creatinine seen in t protein diet catabolic States or 91 bleeding

2 soil fever 4 have Faecal abdo Important adhesive URINARY TRACT INFECTION girls 1 { 11 boys have at least one symptomatic UTI before 1 30% recurrence in year structural abnormality because pyelo nephritis may kidney Presentation Infants disease form a scar predisposing to HTN G chronic usually due to cystitis girls in Children vulviiisin or balanitis boys dysurig vomiting lethargy irritability poor feeding jaundice seizures frequency urgency Sampling pain clean catch fever anorexia haematuria seizures enuresis plattic bag urinary catheter supra pubic aspiration midstream sample! sexual abuse Infecting Organisms [ Coli Klebsiella 3 Proteus More common in boys 4 Pseudomonas 5 Strep may indicate structural is abnormality Risk Factors Vesicoureteric Reflux structural abnormality developmental abnormality incomplete bladder emptying VUR vesicoureteric junctions 30 familial to bladder pathology recurrent Investigations Only atypical or ytls Atypical seriously ill severe VUR temporarily with ytl be associated may with intra renal reflux Tends to resolve with age urine flow tagged poor mass creatine atypical organisms failure to respond to Ab s within 48 hours

3 antibiotic oral < amoxiclav First proven UTI Antibiotic therapy Us kidney G urinary tract < 1 1 s 3 year p year pp p 3 Us AN DMSA DMS NO further e MCUG { normal investigations gig NICE 007 Management Infants <3 months with suspicion or seriously ill admitted Iv antibiotics ( co ) Infants s3 months oral Ab s ltrimethoprim ) G acute pyelo nephritis / upper UTI Children with cystitis 1 lower UTI Ab s ltrimethoprimlnitrurantoin ) Prevention Y fluid intake regular voiding treatment or prevention constipation good perineal hygeine biotic pro prophylaxis to 3 congenital UTI upper severe reflux abnormality trimethoprim nitrurantoin

4 Resistant schinlein steroid GBMD schinlein NEPHROTIC Heavy protein urig results in low L NEPHRITIC Glomerular filtration leads to plasma albumin 4 oedema haematuria G protein uria Causes 1 infection Causes yecent c 3 complement to unknown Post infectious ( strep ) da 0 Henoch it SLE Presentation purpura Henoch purpura infections Wegener SLE granulomatosis allergens IGA nephropathy ( Berger s ) periorbital oedema scrotal ascitesi vulvql ankle oedema breathing problems due to pleural effusions 4 ascites infection peritonitis loss 1g septic arthritis in urine sepsis Investigations Proteinuria FBC C 3{C4 Malaria ESR urine MGC anti DNASE UGE Hep BGC albumin Management oral corticosteroids UGE s t sensitive minimal change disease renal biopsy Complications hypovolaemia thrombosis anti disease ( Good pastures ) Membrano proliferative nephritis Presentation t urine output volume overload HTN seizures oedema initially periorbital haematuria protein Investigations Coagulation urig Haematuria Urine MGC Protein 4 C a excretion Us albumin creatinine FBC Management screen Fluid { electrolyte correction infection diuretics Steroid hypercholesterolemia Nephrotics Focal segmental renal biopsy immunosuppressive plasma exchange therapy sclerosis Membrano proliferative nephritis 3 embranous nephropathy Complications Rarely rapid progressive nephritis if left untreated chronic kidney disease

5 G As It UNDESCENDED TESTES Descent the Testes genital lig gubernacyium Tested 7wK Between the 3rd month { its pregnancy end the testes become transferred from the lumbar area into the future scrotum This transfer is due to " %YubeinYet!0h t growth symphysis 3mnth The guberngculum testes also plays q decisive role arises in the course the 7th week from the lower gubernaculum after the mesonephros has atrophied scrotal At the same time an the evqgination 9ubemtaeyflegmF@processesqnormn 4mhth on 7thGlwKthegubernacuutamgYnanisijP@sahuoItiniItYeYenthaeotiniteayat swelling AM peritoneum arises the vaginal process Canal it takes the muscle fibers process the oblique internal muscle G transverse 8mnth muscle with it vaginal PGD LED downwards which the testes slide the through inguinal the vaginal process lengthens Between the name Transversal is fqscig Parietal peritoneum Extra peritoneal fasciq Muscle layers 1 Trans versus abdominal Fixes stnxteemrnaaiibiiiaau qubernaculum Process Us vaginal is c \ # *** * HE

6 Imaging t By Occurs are Most undescended testes become arrested along their normal pathway descent premature infants in 51 newborns 3 months lil age more common in still undetcended The diagnosis should be made at the routine examination the newborn is not helpfui Management orchidoplexy laparoscopic within 1st cosmetic year risk torsion G trauma fertility malignancy

7 most consider metabolic ACUTE RENAL FAILURE AKI has acute renal failure at the Most severe end the where there is a sudden potentially reversible roliguria usually Acute kidney injury present spectrum d in renal function Prerenal Renal Postrenal common cause sq tg water retention obstruction in children blood * in urine hypovolaemia µ circulatory Failure vascular protein G casts haemolytic uraemia syndrome congenital acquired nephrostomy catheterisation * was ATN Fluid replacement circulatory interstitial nephritis correct fluids electrolytes Ei support e es surgery ftppffg restriction fluid Hus Is a triad intake 4 challenge acute renal failure emergency management microangiopathic acidosis haemolytic anaemia hyperkalaemia 3 hyperphosphataemia thrombocytopenia Typically 0 to 91 biopsy infection Dialysis Indicated when failure Conservative management hyperkalaemig severe pulmonary hypolhypernatraemia oedema severe metabolic acidosis multisystem failure Generally a good prognosis for renal recovery unless complicated by a lifethreatening condition