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S/Sx: F, crying w/urination, frequency, hematuria, GI Sxs, poor growth (young children)
UTI
MCC of UTI
E. coli
Possibility of UTI should be considered in any child < __ yrs of age w/unexplained fever
2
T/F: children who are unable to void on command MUST have specimen obtained from catheterization for UA + culture
TRUE
3 most useful components of UA:
leukocyte esterase test, nitrite test & urine microscopy
Tx: UTI pt who appears toxic, dehydrated, unable to retain oral intake
IV abx
Tx: UTI non-toxic pt
Abx parentally on outpatient basis or abx PO
IF VCUG is + the pt has ____
Vesicoureteral reflux (VUR)
Tx: VUR
Abx PO. < 2 mo - cephalexin or amox. > 2 mo TM-SMX, Nitrofurantoin
Occurrence of involuntary voiding at night in child 5 yo or older
Primary nocturnal enuresis
Occurs after a dry period of 3-4 mths. Warrants careful evaluation
Secondary enuresis
Primary nocturnal enuresis is MC in ___ and has significant ____ component
boys; genetic
_____ enuresis is more common in girls
Daytime
Tx: enuresis (meds)
Desmopressin acetate, tofranil (imipramine)
Signs: Massive proteinuria, hypoalbuminemia, edema, hyperlipidemia, protein loss exceeds 40mg/hr/m2
Nephrotic syndrome
S/Sx: mild puffiness around eyes (esp in AM). Edema --> ascites, pleural effusion, & scrotal or labial edema
Nephrotic syndrome
Tx: nephrotic syndrome
Corticosteroids: prednisone. Severe edema --> albumin w/or w/o diuretics & fluid and salt restriction
>5 RBC in 3 freshly voids urine collected over a few wks
Microscopic hematuria
S/Sx: hematuria, edema, HTN, w/w/o oliguria, asymptomatic, RBC casts
Acute glomerulonephritis (AGN)
Gross hematuria 2 wks after acute infxn
PSGN
MC variety of primary GN
IgA nephropathy
Familial form of nepheritis w/ neurosensory hearing loss & slow progression to renal failure
Alport syndrome
Thin glomerular basement membrane, persistent hematuria
Familial persistent hematuria
Tx: GN
salt & water restriction, diuretics, Tx\\\'ing HTN, ARF, dialysis, steroids,
S/Sx: purpuric rash (lower extremities & buttocks), arthritis, abd pain, nephritis
Henoch-Schonlein purpura
MC form of vasculitis in children
Henoch-Schonlein Purpura
May progress rapidly to acute renal failure
HSP
Tx: HSP
CS: prednisone, methylprednisolone. Cytotoxic agents, plasmapheresis
MC urogenital anomaly
Undescended testes
Cryptorchidism: not at inc risk for malignancy or infertility
Retractile
Tx: cryptorchidism
surgical correction (orchidopexy). b/f age 2 to dec risk malignancy & infertility
Urethral opening is ectopically located on dorsum of penis proximal to tip of the glans penis
Hypospadius
Male foreskin cannot be fully retracted from head of penis
Phimosis
S/Sx: swelling of scrotum is prominent & severe tenderness. Cremasteric reflex absent
Torsion of the testis
Torsion is a medical ____!
emergency
Torsion: ASAP ___ of the scrotum (Dx\\\'stic)
Doppler
x of y cards