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Iran Specialty Board - Pediatrics study materials
Iran Specialty Board - Pediatrics study resources

Iran Specialty Board - Pediatrics: Pediatric Nephrology and Urology

Iran Specialty Board - Pediatrics · Work through your exam, one topic at a time.

All guide sections

Pediatric Nephrology and Urology

This domain tests the nephrotic versus nephritic distinction, the febrile urinary tract infection pathway, and common urological problems of infancy.

Nephrotic syndrome

  • Age 2-6 years with periorbital oedema, proteinuria (urine protein-to-creatinine ratio above 2 or 40 mg/m2/hour), albumin below 2.5 g/dL.
  • Minimal change disease underlies 80-90% of cases; a first typical episode is treated with prednisolone 60 mg/m2/day for 4-6 weeks without biopsy.
  • Complications: spontaneous bacterial peritonitis (pneumococcus), thrombosis, hypovolaemia. Vaccinate against pneumococcus and give penicillin prophylaxis during relapse.

Nephritic syndrome

  • Post-streptococcal glomerulonephritis 1-2 weeks after infection with haematuria, hypertension, low C3 and normal C4; C3 normalises within 8 weeks.
  • IgA nephropathy: haematuria coinciding with upper respiratory infection, normal complement.
  • Haemolytic uraemic syndrome: E. coli O157:H7, microangiopathic anaemia, thrombocytopenia, acute kidney injury; avoid antibiotics and antimotility drugs.

Urinary tract infection

  • Infants under 3 months with febrile UTI need admission and intravenous antibiotics; older children may receive oral therapy after urine culture.
  • Renal ultrasound in all children after a first febrile UTI; voiding cystourethrography when the ultrasound is abnormal or the course is atypical.

Urology

  • Cryptorchidism: orchidopexy by 12-18 months.
  • Testicular torsion: acute scrotal pain, absent cremasteric reflex, surgical exploration immediately.
  • Primary nocturnal enuresis after age 5: behavioural therapy, enuresis alarm or desmopressin.

Worked example

A 4-year-old has periorbital oedema, urine protein-to-creatinine ratio of 5, albumin 1.8 g/dL, normal blood pressure and normal complement. Reasoning: this is typical steroid-sensitive nephrotic syndrome. Start prednisolone and do not biopsy.

Traps

Biopsying a first typical nephrotic episode; giving aggressive diuretics in hypovolaemia; and omitting a blood pressure measurement in glomerulonephritis.