Peds E3 -Uro & Nephro

What is the MC urethral anomaly?

Hypospadias

What is Hypospadias?

urinary meatus may be anywhere along the urethral groove (ventral aspect)

What procedure should be avoided until the hypospadias repair is complete?

circumcision

What is the tx for Hypospadias?

surgery where the preputial skin is used for grafting

What is Epispadias?

failure of midline penile fusion → dorsal location of urinary meatus

What condition is associated with Epispadias?

bladder extrophy

What is bladder exstrophy?

open, inside-out bladder (inner surface exposed) on the surface of the lower abd wall and an open exposed dorsal urethra

What is the MC congenital abnormality of the GU tract?

cryptorchidism

What is cryptorchidism?

uni or bilateral undescended testes

How does cryptorchidism present?

empty and hypoplastic or poorly rugated scrotum or hemiscrotum

What is the tx for cryptorchidism?

surgical orchidopexy by 1 yo

What is priapism?

harmful and painful erect penis that does not return to its resting state in 4 hours — MEDICAL EMERGENCY

What is a RF for priapism?

Sickle cell anemia

What is the 1st line tx for priapism?

intracavernosal injection of phenylephrine

What is a hydrocele?

accumulation of fluid between the layers of the tunic vaginalis

What is a communicating hydrocele?

failure of the processus vaginalis to close durng development resulting in hydrocele, may be associated with an inguinal hernia

How does a hydrocele present?

uni or bilateral swelling or mass of the scrotum that will usually self-resolve by 12 months

What is the GOLD standard PE test for hydrocele?

transillumination of the scrotum

What cases of hydrocele require surgery?

persistent beyond 1-2 years or communicating hydrocele

What is a varicocele?

abn dilation of the pampiniform plexus in the scrotum d/t incompetent valves in the spermatic vein

Which side of the body is a varicocele more common?

left

What is a varicocele described as?

“bag of worms”

What is the tx for varicocele?

refer to peds urology → ligation of the spermatic vein, varicocelectomy

What is paraphimosis?

retracted foreskin that cannot be returned to normal position (emergency condition)

What is phimosis?

inability to retract the foreskin

Phimosis can be the result of repeated episodes of what?

balanitis

What is balanitis?

inflammation of the glans penis d/t poor hygiene

What is the tx for paraphimosis?

consult surgery: manual reduction under anesthesia vs dorsal slit reduction vs emergency circumcision

What is the tx for phimosis?

circumcision

What is circumcision?

surgical removal of the foreskin

What disease can cause orchitis?

mumps

What is orchitis?

testicles tender & swollen -unilateral MC

How soon after mumps infxn do pts typically present w/ orchitis?

typically occurs 5-10 days after parotitis

What is the tx for orchitis?

supportive, pain control

What is testicular torsion?

acute testicular pain & swelling (urologic emergency)

What is testicular torsion associated with?

bell & clapper deformity

What is absent in testicular torsion?

cremasteric reflex

What is the blue dot sign seen in?

torsion of the appendix testis

What is the blue dot sign?

gangrenous appendix of testes seen through the scrotum

What is the diagnostic test of choice for testicular torsion?

scrotal US w/ doppler

What is the tx for testicular torsion?

STAT uro consult, manual detorsion

Definitive: surgical orchiopexy

What is the tx for torsion of the appendix testis?

no surgery needed, supportive care

What causes epididymitis in pre-pubertal males?

viral infections & mycoplasma

What causes epididymitis in post-pubertal & sexually active males?

Chlamydia, N. gonorrhea, E. coli

What is the Abx tx for non-STD epididymitis?

Bactrim or Keflex

What is the Abx tx for STD epididymitis?

Ceftriaxone + Doxy/Azithro

What is the MCC of atypical genitalia d/t CAH?

46, xx karyotype

What are the 2 types of bladder dysfunction?

1) Enuresis or nighttime incontinence

2) Daytime urinary incontinence

What is an overactive bladder?

abn bladder contraction during the filling phase

What is an underactive bladder?

occurs from prolonged holding of urine between voids which weakens the detrusor muscle

What is dysfunction voiding?

inability to relax the urethral sphincter or pelvic floor muscles during micturition, inc risk for recurrent UTIs

What is the pharmacologic tx for bladder dysfunction/incontinence?

Anticholinergics: Oxybutynin

What is primary nocturnal enuresis?

never obtained control; always bed-wetting

What is secondary nocturnal enuresis?

at least 6 months of nighttime dryness was present before the onset of sx

What are common causes of nocturnal enuresis?

diabetes insipidus, hormal imbalance (dec in ADH)

What is the pharmocologic tx for nocturnal enuresis?

Desmopressin

What is urethritis?

irritation or inflammation of the urethra

What is cystitis?

bladder infection

What is Pyelonephritis?

ascending UTI involving the kidneys

What is the MCC of UTIs in kids?

E. coli

AAP recommends a renal US for all infants/children 2-24 following what?

their 1st febrile UTI

What is vesicoureteral reflux?

retrograde passage of urine from the bladder into the upper urinary tract

What causes primary vesicoureteral reflux?

d/t incompetent closure of the ureterovesical junction (UVJ) bc of a short ureter

What causes secondary vesicoureteral reflux?

d/t abn high voiding pressure in the bladder which results in failure of the closure of the UVJ when the bladder contracts

What is the diagnostic test of choice for vesicoureteral reflux?

voiding cystourethrogram (VCUG)

What is an Ureteropelvic junction obstruction?

intrinsic narrowing of ureteropelvic musculature or extrinsic compression of ureteropelvic area → dilated renal pelvis/normal ulcer

What is the intial study for an ectopic ureter?

Renal US, diuretic renal scan

What is the confirmatory diagnostic test for an ectopic ureter?

voiding cystourethrogram (VCUG)

What is a posterior urethral valve?

pair of obstructing leaflets in the prostatic region of the urethra?

What is the MC etiology of a urinary obstruction in the newborn?

posterior urethral valve

What is the confirmatory diagnostic test for a posterior urethral valve?

Cystoscopy

What is the preferred surgical tx for posterior urethral valve?

Cystoscopy w/ ablation

What is Prune belly syndrome?

congenital disorder characterized by the TRIAD of abd muscle deficiency, urinary tract abnormalities, and bilateral cryptorchidism in males

What is the TRIAD of Prune belly syndrome?

abd muscle deficiency, urinary tract abnormalities, bilateral cryptorchidism

What is the MCC of proteinuria in children?

transient proteinuria

What is a common symptom of polycystic kidney disease?

HTN

What is polycystic kidney disease?

autosomal recessive disease that primarily affects the kidneys and hepatobiliary system

What sx are associated with glomerulonephritis?

hematuria, proteinuria, edema, HTN

What are forms of primary glomerulonephritis?

*primary = isolated to the kidney

Minimal change disease, IgA nephropathy (Berger’s disease) -MC, Goodpasture’s

What are the sx of Berger’s disease (IgA nephropathy)?

gross hematuria associated with a URI

What is the confirmatory test for IgA nephropathy?

kidney biopsy

What is the tx for IgA nephropathy?

ACE-I/ARBs + corticosteroids

What is the MCC of post-infectious / post-strep glomerulonephritis?

GABHS

What sx are associated with post-infectious glomerulonephritis?

abrupt onset of gross hematuria, generalized edema, HTN, pulm edema, seizures

What is nephrotic syndrome?

injury or disease that inc permeability to the glomerular filtration barrier

What are the clinical features of Nephrotic syndrome?

proteinuria, hypoalbuminemia, edema, HLD

What do labs show in Nephrotic syndrome?

UA: proteinuria > 50 mg/kg/day

Serum albumin < 3 g/dL

What is the MCC of nephrotic syndrome in kid?

minimal change disease

What is the tx for minimal change disease?

Prednisolone

What is the MC type of kidney stone?

Calcium oxalate

What is Nephrolithiasis?

crystalline mass w/in the urinary tract

What is the best diagnostic test for nephrolithiasis?

Helical CT scan

What is the MC renal malignancy in childhood?

Wilm’s tumor

Who is most likely to develop a Wilm’s tumor?

children < 5 yo, AA

What is the best initial test for a Wilm’s tumor?

abd US

What is the preferred tx for a Wilms tumor?

laparoscopy radial nephrectomy

What is the MC type of AKI in peds?

prerenal

What is the MCC of prerenal AKI?

dehydration

What is the MCC of renal (intrinsic) AKI?

acute tubular necrosis (ATN)

What is a hallmark finding of AKI?

oliguria