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T or F. A few RBCs can be normal.
What is the most common cause of hematuria?
Identify some causes of gross hematuria. Microscopic hematuria.
Gross: trauma, infection, SCD, renal calculi, abnormalities of lower urinary tract
Microscopic: Infection, inflammation, hypercalciuria, perineal trauma, exercise, SLE, postinfectious glomerulonephritis
UA with alkaline pH, +nitrates, & leukocytes suggest what urinary disease?
Urine with hematuria, pyuria, and NO bacteria, what should you suspect?
STD or viral infection
If protein in the urine, what should you rule out?
What are 7 situations to refer hematuria?
- 1. Urologic trauma
- 2. Recurrent UTIs
- 3. Suspected glomerulonephritis
- 4. Thrombocytopenia
- 5. suspected renal calculi
- 6. Fx Hx of malignancy
- 7. Persistant hematuria w/ HTN, proteinuria
T or F. Proteinuria has high false positives due to exercise, fever, dehydration, alkaline urine.
True ( but can be a sign of kidney disease from DM or HTN)
For Proteinuria, what are some
you might see.
- Signs: typcially asymptomatic, some edema (periorbital, feet, hands, abdomen)
- PE: HTN, edema, failure to thrive (nephrotic syndrome)
- HX: strenuous physical activity, Viral symptoms
- Diag: Single UA
What level of proteinuria is considered significant?
+1 or higher (30mg/dl)
Discuss isolated proteinuria.
- -10-20yo, more likely male
- -orthostatic/postural proteinuria but normal when supine
- -persistent, asymptomatic--> common & transient
- -usually grow out of
Discuss Transient or Functional Proteinuria.
Discuss Glomerular proteinuria & tubulointerstitial proteinuria.
- Transient -Exercised induced or fever- resolves after fever state
- -Other: seizure, HF, infection, cold
- exposure--> resolves in 1-2 weeks
- -Glomerular--> less common and HIGH levels
- -Tubo--> less common, high levels
If dipstick shows trace 1+ proteinuria & spec gravity > 1.015, what is your management?
Monthly urine rechecks for 4-6mo, if protein persists--> refer
If dipstick shows >1+, what should your proteinuria management be?
- -2-3 random urines suggest persistent
- --> get UA upon rising, if (-) or trace, then probably orthostatic BUT if (+)--> get 12-24hr urine protein excretion checked
What are 4 classic findings of nephritis? What is the most common form in childhood?
- 1. HTN
- 2. Edema (often periorbital)
- 3. Proteinuria
- 4. Hematuria
**PSGN (strep w/in 2 weeks), peak age 7yo
What is the management if nephritis?
- -PSGN txt is supportive, 90% resolve within 6-24mo
- -hospitalization depends on symptoms
What is more common in kids, a lower or upper tract UTI?
What is the most common organism seen in kids w/ UTI?
(other: klebsiella, proteus, enterococcus)
What is suggested for kids and their first UTI (in boys & 2nd in girls)?
-Refer for U/S to rule out abnormality, should start prophylatic antibx until VCUG completed
What is the pharm recommendations for UTI in kids?
1. <24 mo--> cefuroxime 20-30mg/kg/day in 2 doses (7-14 days if febrile)
2. >24mo--> Bactrim 6-12mg/kg/day in 2 doses x 10days
3. >6yo Pyridium for dysuria
**can also use augmentin & cephalosporin
What are RED flags for UTI? (6)
- 1. Reoccurence (VUR)
- 2. High fever
- 3. Toxic appearing
- 4. Anuria
- 5. Dehydration
- 6. Age
What are some symptoms significant for Pyelo?
- -High fever (may be only symptom)
- -Dehydration common
- -poor feeding/vomiting
- -flank pain
- **Most serious infection of children <24mo (b/c of scarring)
T or F. The treatment of choice for pyelo in kids is macrobid?
False! Cefixime 10-14 days outpatient
What is the most common GU d/o in males?
- Cryptorchidism (undescended testis)
- **If you can pull down, better prognosis
T or F. If testes remain undescended by 3mo, will probably not descent spontaneously.
What are the risks of testes remaining undescended?
- -Decrease semen production/infertility
- -Increased risk of testicular cancer
- -Increased risk of testicular torsion
Communicating hydroceles are more common in adults or babies?
- Babies (noncommunicating is most common in general and my often resolves on it's own)
- **Communicating requires surgical intervention
When should you refer patients with a varicocele?
- -Right sided
- -Large & increasing, not relieved sitting or laying down
- -Testicular atrophy
- ->2ml difference in testicular volume per U/S
- -Deteriorating semen volumes
Which type of hernia has portions of the bowel protruding out into the inguinal canal and emerges at the EXTernal ring?
- (Indirect pass through internal abdominal ring, tranversing spermatic cord
T or F. Preemie infants have increases risk of incarcerated hernias.
What is a symptom especially associated w/ an incarcerated hernia?
What are 5 parts of a PE for Inguinal hernia?
- 1. General appearance (distress?)
- 2. Swelling in inguinal or scrotal area? Bilat?
- 3. Testicular exam (descended?)
- 4. Hernia check (feel for bulge behind scrotal sac)
- 5. Abdominal exam for distention
Differenciate Phimosis and paraphimosis.
- Phimosis: foreskin too tight and can't be retracted
- -->management is gentle stretching while cleaning, most retract by 5 yo
- Paraphymosis: unable to retract foreskin, edema of the glans, bluish discoloration, pain, DONUT sign
- -->management is ice to affected area to reduce swelling so foreskin can be reduced, surgical release may be indicated
- ***rule out sexual abuse**
What are 5 symptoms of testicular torsion?
- 1. Sudden onset of testicular pain, radiating to groin
- 2. Lower abd pain like appendicitis
- 3. N/V
- 4. Appears ill
- 5. Anxious & unwilling to move
What is a good test to perform to differenciate b/w testicular torsion and epididimytis?
cremaster reflex--> (neg) if torsion
What is the typical presentation of epididymitis?
-gradual onset, unilateral testicular pain, dysuria, and urethral discharge
What is the Prehn's sign?
Elevation relieves pain in epididymitis but increases pain in torsion
When should patients w/ epididymitis be referred?
- -If no hx of sexual intercourse
- -single side testicle
- -response to treatment is not prompt
What is the most common cause of gynecomastia?
puberty (low testosterone/high estrogen), often in neonatal period
What are the 4 types of gynecomastia?
- Type 1: benign, self-limiting, occurs in Tanner II/III, usually unilateral and lasts 2 years
- Type 2: painful gynecomastia w/out pathology
- Type 3: obesity-related gyn.
- Type 4: hypertrophied pectoral muscles
- -Low E2-->atrophic vag epithelium
- -Nonspecific vaginitis most commonly seen in young girls
- -Not STD
- -25% of vaginal infections are due to vulvovaginal candidiasis
- -CARDINAL SYMP: nonmalodorous, white discharge, vulvar erythemia, edema, excoriation of vulva
- -Precipitated by antibx use
What are 3 hallmarks of vulvovaginitis and possible txt?
- 1. Vaginal itching
- 2. Discharge
- 3. Vulvar itching
- TXT: depends on cause so verifiy hygiene versus candida
When do labial adhesion typically resolve?
- -no txt needed unless voiding obstructed, Hx UTI, or discomfort
- -Estrogen cream and gentle traction can be used