Pediatric Nephrology and Urology
Domain focus
Pediatric Nephrology and Urology tests nephrotic syndrome, urinary tract infection, vesicoureteric reflux, acute kidney injury, chronic kidney disease, enuresis and genital anomalies.
Core rules
- Nephrotic syndrome: heavy proteinuria, hypoalbuminaemia and oedema. Most children have steroid-sensitive minimal change disease; biopsy is not routine for a first typical episode.
- First-line treatment is oral prednisolone; monitor blood pressure, urine protein and infection risk.
- UTI needs an adequate urine sample before antibiotics; treat febrile UTI promptly. Infants with febrile UTI need imaging according to local protocol.
- Acute kidney injury: assess volume status, urine output, electrolytes and creatinine; stop nephrotoxins.
- Enuresis is common after age 5; manage constipation and use alarms or desmopressin selectively.
- Do not circumcise a boy with hypospadias before specialist assessment.
Worked example
A 4-year-old has periorbital oedema, urine protein 3+, serum albumin 15 g/L and no haematuria. This is typical nephrotic syndrome. Start prednisolone, restrict salt, monitor weight and blood pressure, and educate about infection. Do not start diuretics before steroids unless there is severe oedema or respiratory compromise.
Traps
Biopsying every first nephrotic episode; missing hypertension; treating proteinuria with diuretics alone; sending urine after antibiotics; ignoring constipation in enuresis.