Explanation:

Vesicoureteral reflux (VUR) is the backup of urine from the organ that stores urine (bladder) into the tube carries from the kidney to the bladder (ureter) during urination. VUR may result in urine reflux into the renal pelvis, causing distention (hydronephrosis) and kidney damage. In children, this condition is usually caused by an abnormality that is present at birth (congenital) and is often diagnosed during prenatal ultrasound.
Reflux is graded according to its severity:

• Grade I – reflux into non-dilated ureter
• Grade II – reflux into the renal pelvis and calyces without dilatation
• Grade III – mild/moderate dilatation of the ureter, renal pelvis and calyces with minimal blunting of the fornices
• Grade IV – dilation of the renal pelvis and calyces with moderate ureteral tortuosity
• Grade V – gross dilatation of the ureter, pelvis and calyces; ureteral tortuosity; loss of papillary impressions

The younger the age of the patient and the lower the grade at presentation the higher the chance of spontaneous resolution. Most (approx. 85%) of grade I & II cases of VUR will resolve spontaneously. Approximately 50% of grade III cases and a lower percentage of higher grades will also resolve spontaneously.
Since many children will outgrow their reflux they can be followed carefully, with their reflux monitored at intervals by tests such as VCUG, renal ultrasound, or nuclear voiding cystogram. All children aged 1-5 years with reflux grades I-IV should be treated initially with continuous prophylactic antibiotics. 

Explanation:

Spermatocele (spermatic cyst) usually occurs at the upper of the testis adjacent to the epididymis and appears as a cystic scrotal mass. Generally painless and noncancerous (benign), a spermatocele usually is filled with milky or clear fluid that may contain dead sperm.
Most spermatoceles require no treatment. If it causes discomfort, over-the-counter pain medications, such as acetaminophen or ibuprofen are appropriate. A common condition, a spermatocele doesn´t impair fertility, nor does it require treatment unless s grows large enough to cause discomfort.
Repairing a spermatocele requires surgery to remove the cyst. A procedure called a spermatocelectomy generally is performed on an outpatient basis, using local or general anesthetic. The surgeon makes an incision in the scrotum and separates the spermatocele from the epididymis.

Explanation:

Minimal change disease (Lipoid Nephrosis, Nil Disease) causes abrupt onset of edema and heavy proteinuria, mostly in children. Renal function is typically normal.
Minimal change disease (MCD) is the most common cause of nephritic syndrome (NS) in children 4 to 8 years, but it also occurs in adults. The cause is almost always unknown, although rare cases may occur secondary to drug use (especially NSAIDs) and hematologic malignancies.
Albumin is lost in the urine of patients with MCD more so than larger serum proteins, probably because MCD causes changes in the charge barrier rather than the size barrier in the glomerular capillary wall. Lipiduria and hyperlipidemia will also be present.
Diagnosis is made empirically or by renal biopsy. Prognosis is excellent. Treatment is with corticosteroids or, in patients who do not respond, Cyclophosphamide or cyclosporine.

Explanation:

Vesicoureteral reflux (VUR) is a cause of recurrent urinary tract infections in children. VUR predisposes children to recurrent Pyelonephritis and renal scarring. Some children with renal scarring develop hypertension and renal insufficiency. Recommendations have been made to identify VUR early to stop this cascade of events, with interventions to prevent renal scarring, hypertension, and renal insufficiency.

Explanation:

Recurrent UTIs are sometimes seen in conjunction with conditions, such as; vesico-ureteral reflux (VUR) and hydronephrosis.
VUR which is found in 30% to 50% of children diagnosed with a UTI and is a congenital condition in which urine flows backward from the bladder to the ureters and sometimes reaches the kidneys. If the urine in the bladder is infected with bacteria, VUR can lead to pyelonephritis. Hydronephrosis, which is an enlargement of one or both kidneys due to backup or blockage of urine flow and is usually caused by severe VUR or a blocked ureter.
Children with hydronephrosis are sometimes at risk of recurrent UTIs and may need to take daily low doses of antibiotics to prevent UTIs. Diagnostic workup should include ultrasound and voiding cystourethrogram.

Explanation:

There are several types of medications used to treat congestive heart failure in children. A diuretic like furosemide (Lasix), which helps the kidneys to eliminate extra fluid in the lungs, is often the first medicine given both in babies and older children.
Sometimes medicines to lower the blood pressure like an ACE inhibitor (Captopril) or more recently beta-blockers (Propranolol) are used. Theoretically, lowering the blood pressure will decrease the workload of the heart by decreasing the amount of pressure against which it has to pump. Sometimes Digitalis is used to help make the heart squeeze better, and help pump blood more efficiently. Since weight gain is a major challenge for infants with congestive heart failure, giving babies high calorie formula or fortified breast milk can help give the extra nutrition they require.

Explanation:

Nephritis treatment involves a diet that ls low in protein and sodium. and may be necessary until kidney function recovers. Dluretlcs may be prescribed to help the kidneys excrete excess sodium and water and to treat high blood pressure.
For rapidly progressive glomerulonephrltis, drug: to suppress the im une system are started promptly. High doses of corticosteroids are usually given intravenously. Since some patient with nephritlc syndrome will have oligurla, fluid restriction is usually not the mainstay ot treatment.

Explanation:

Proteinuria is protein, usually albumin, in urine. In many renal disorders, it occurs with other urinary abnormalities {eg, hematuria). Isolated proteinuria is urinary protein without other symptoms or abnormalities. Causes may be categorized as glomerular, tubular, overflow, or physiologic. Exercise proteinuria, sometimes with hematuria, hemoglobinuria, or myoglobinuria, is proteinuria of unknown cause that may occur in runners, boxers, and other people engaged in vigorous exercise Proteinuria may be transient, orthostatic (occurring only when upright and almost always between adolescence and age 30), or persistent. Most patients with physiologic causes (and many with acute tubulointerstitial disorders) have transient proteinuria; those with transient or orthostatic proteinuria usually excrete < 1 g protein/day with no deterioration of renal function, and the proteinuria resolves spontaneously.

Explanation:

Recurrent UTIs are sometimes seen in conjunction with conditions, such as: vesico-ureteral reflux (VUR) and hydronephrosis.
VUR which is found in 30% to 50% of children diagnosed with a UTI and is a congenital condition in which urine flows backward from the bladder to the ureters and sometimes reaches the kidneys. If the urine in the bladder is infected with bacteria, VUR can lead to pyelonephritis.
Hydronephrosis, which is an enlargement of one or both kidneys due to backup or blockage of urine flow and is usually caused by severe VUR or a blocked ureter. Children with hydronephrosis are sometimes at risk of recurrent UTIs and may need to take daily low doses of antibiotics to prevent UTIs.
Diagnostic workup should include ultrasound and voiding cystourethrogram.

Explanation:

Explanation:

Wilms tumor is an embryonal cancer of the kidney composed of blastemal, stromal, and epithelial elements. Genetic abnormalities have been implicated in the pathogenesis, but familial inheritance accounts for only 1 to 2% of cases. Wilms´ tumor usually presents in children < 5 yr but occasionally in older children and rarely in adults. Wilms´ tumor accounts for about 6% of cancers in children < 15 yr. The most frequent presentation is a painless, palpable abdominal mass. Less frequent findings include abdominal pain, hematuria, fever, anorexia, nausea, and vomiting. Diagnosis is made by ultrasound and abdominal CT scan and confirmed by biopsy. Treatment may include surgical resection, chemotherapy, and radiation therapy.

Explanation:

Post-streptococcal glomerulonephritis (PSGN) is a disorder of the kidneys that occurs after infection with certain strains of Streptococcus bacteria. The infection causes the tiny blood vessels called glomeruli in the kidneys to become inflamed, making the kidneys less able to filter and remove wastes.
Post-streptococcal glomerulonephritis is uncommon these days because infections that can lead to the disorder are commonly treated with antibiotics. The disorder may develop 1 – 2 weeks after an untreated throat infection, or 3 – 4 weeks after a skin infection. Symptoms include cough, with sputum, decreased urine output, edema (swelling), rust-colored urine and visible blood in the urine. Diagnostic tests can show blood pressure is often high, serum ASO lay be raised, serum complement levels usually decrease; urinalysis shows protein and blood in the urine with red blood cell casts.

Explanation:

Exercise proteinuria is transient in nature and is not associated with a pathological condition. The magnitude of proteinuria varies from near normal to heavy, with the greatest levels (up to 100 times that of rest) observed after high-intensity exercise. An increased quantity of protein in the urine may be due to an increased filtration of plasma protein through the renal glomerulus, and into the renal tubule. This is termed “glomerular proteinuria” with albumin comprising the greatest proportion of excreted proteins (albuminuria). Glomerular proteinuria regularly occurs in response to dynamic exercise, regardless of the exercise intensity. In an athlete with proteinuria, urinalysis should he repeated after a period of 48 to 72 hours free from exercise.

Explanation:

Explanation:

Explanation:

Vesicoureteral reflux is retrograde passage of urine from the bladder back into the ureter and renal pelvis. This may damage the upper – urinary tract by bacterial infection and occasionally by increased hydrostatic pressure. Bacteria in the lower urinary tract can easily be transmitted by reflux to the upper tract) leading to recurrent parenchymal infection with potential scarring and renal dysfunction. Chronically elevated emptying pressures (> 40 cm H20) and increased bladder volume and pressure often cause progressive kidney damage, even without infection or reflux.
Symptoms and signs are typically those of UTI; these may include fever, abdominal or flank pain, dysuria or flank pain with voiding, frequency, and urgency. Pyuria, hematuria, proteinuria, and bacteriuria may be present on urinalysis.
Tests for reflux include filling and voiding cystourethrogram (which is best to diagnose bladder outflow obstruction) and radioisotope cystogram. Renal ultrasonography evaluates for size, hydronephrosis and scarring.
Vesicoureteral reflux is usually mild to moderate. Mild cases often resolve spontaneously over months to several years while daily antibacterial prophylaxis is maintained

Explanation:

The mesonephric tubules give rise to the ductus epididymidis, ductus deferens, ureter, pelvis, and calyces in the male. The mesonephric duct gives rise to the appendix of the epididymis and the ejaculatory duct. The paramesonephric duct gives rise to the prostatic utricle and the appendix of the testis. The urogenital sinus gives rise to the urinary bladder and urethra, as well as the prostate gland and bulbourethral glands. The urogenital folds give rise to the ventral side of the penis and the penile urethra.

Explanation:

Congenital ureteral reflux allows return of urine from the bladder to the kidneys and predisposes to recurrent infections. Down´s syndrome is not associated with UTIs. Short length of urethra is a normal female anatomy that puts female good victims for UTI but it is not a congenital anomaly. There is no specific association between polycystic kidneys or situs inversus and UTIs.

Explanation:

The mesonephric tubules give rise to the ductus epididymidis, ductus deferens, ureter, pelvis, and calyces in the male. The mesonephric duct gives rise to the appendix of the epididymis and the ejaculatory duct. The paramesonephric duct gives rise to the prostatic utricle and the appendix of the testis. The urogenital sinus gives rise to the urinary bladder and urethra, as well as the prostate gland and bulbourethral glands. The urogenital folds give rise to the ventral side of the penis and the penile urethra.

Explanation:

The urogenital sinus gives rise to the female urinary bladder, urethra, urethral glands, and vestibular glands. The mesonephric duct does not give rise to any significant anatomic structures in the female. The paramesonephric duct gives rise to the upper part of the female vagina. The genital tubercle gives rise to the vestibule and the clitoris in the female and the urogenital folds give rise to the labia minora in the female.

Explanation:

The urogenital folds give rise to the ventral side of the penis and the penile urethra. The mesonephric tubules give rise to the ductus epididymis, ductus deferens, ureter, pelvis, and calyces in the male. The mesonephric duct gives rise to the appendix of the epididymis and the ejaculatory duct. The paramesonephric duct gives rise to the prostatic utricle and the appendix of the testis. The urogenital sinus gives rise to the urinary bladder and urethra, as well as the prostate gland and bulbourethral glands.

Explanation:

The mesonephric duct gives rise to the appendix of the epididymidis and the ejaculatory duct. The mesonephric tubules give rise to the ductus epididymidis, ductus deferens, ureter, pelvis, and calyces in the male. The paramesonephric duct gives rise to the prostatic utricle and the appendix of the testis. The urogenital sinus gives rise to the urinary bladder and urethra, as well as the prostate gland and bulbourethral glands. The urogenital folds give rise to the ventral side of the penis and the penile urethra.

Explanation:

Explanation:

This patient clearly has recurrent episodes of urinary tract infection (UTI). From the presentation, it does not appear to be pyelonephritis; therefore, the evaluation and treatment may be done on an outpatient basis. Children, especially very young children under 5 years of age, are likely to have vesicoureteral reflux (VUR) with even a single episode of a UTI. With recurrent UTIs we see progression of the VUR. Because of this, we are now very aggressive in confirming the cure of a UTI, looking for a possible underlying cause and for the presence of VUR. The physician in this question uses an appropriate oral antibiotic for the treatment of this UTI, where we would expect the organism to be E. coil. With repeated UTIs, as in this patient, and the presence of worsening reflux, other gram-negative organisms may appear as the pathogen. Other acceptable first-line oral antibiotics are sulfa/trimethoprim drugs and nitrofurantoin. It is essential to follow up with the child 48 to 72 hours after treatment for improvement or resolution of symptoms and to repeat a urine culture at the end of treatment to document sterilization of the urine. In addition for recurrent episodes of UTI, we need to look for an underlying anatomic abnormality (e.g., duplicated ureter) that may predispose to a UTI. This can be done non-invasively and relatively inexpensively with an ultrasound of the urinary tract. The current recommendations for performing renal ultrasound includes patient´s who have poor response to therapy, children with an abdominal mass or abnormal voiding, children in whom follow-up cannot be assured, children with a UTI showing organisms other than E. Coil, or children with recurrence of a febrile UTI after they have had satisfactory response to treatment in addition, for any child except a school-age girl with her first UTI, a voiding cystourethrogram (VCUG) is also performed. Both the ultrasound and the VCUG may be scheduled for the end of the treatment of the UTI. The VCUG will document the presence and severity of reflux. If reflux is present, then a renal scan with 2,3- dimercaptosuccinic acid (DMSA) is performed to determine if there is any renal scarring. It is the most sensitive and accurate study to determine the presence of renal scarring.
A renal scan would not be performed at this stage. It would be needed with a diagnosis of reflux, and may also be used if the diagnosis of pyelonephritis is uncertain.
An ultrasound would be performed as stated above, but a VCUG is also needed. A VCUG is needed because this is a UTI in a younger-than-school-age girl, but an ultrasound is also required because of her history of recurrent UTIs. KUB X Ray is done when one suspects renal colic.

Explanation:

Although major urologic injury is unlikely, this history warrants an investigation. In children, microhematuria that follows minor trauma may be an indication that a congenital anomaly is present. In this work-up, the first step would be a sonogram.
CT of the abdomen and pelvis is unwarranted as no major intra-abdominal or pelvic injuries are suspected. Reassurance, on the other hand, would miss the significance of this laboratory finding.
Serial hemoglobins should be considered if there was gross hematuria. Since the blood loss in this case is not as significant, serial measurements of hemoglobin is unnecessary.
Retrograde studies are invasive tests that should not be used as an initial test. If the sonogram is insufficient an intravenous pyelogram should be considered.

Explanation:

The patient appears to have cystinuria, which is a heritable condition leading to excretion of excessive amounts of cystine in the urine. This leads to formation of cystine stones. These stones are radio-opaque because of the sulfur content of the stones.
They are less radio-opaque than calcium stones, however, and appear grayish fuzzy on a plain film.
Hexagonal crystals seen on the urinalysis are characteristic of cystine crystals. To confirm the diagnosis, a 24-hour urine for cystine and if possible a stone analysis should be done. Normal cystine excretion is less than 30 mg/day. Patients with cystine stones typically excrete more than 300 mg of cystine in a day.
Patients with cystinuria have impairment in cystine transport, leading to decreased proximal tubular reabsorption and increased cystine excretion.
In most cases both parents are asymptomatic heterozygotes who excrete abnormal amounts of cystine, but typically less than 300 mg in a day and therefore the parents do not have a history of stone formation. Twenty-four-hour urine for creatinine tells us the adequacy of the 24-hour collection. It does not give us an idea of the etiology of the patient´s nephrolithiasis.
Uric acid stones re radiolucent and are not seen on a plain film. It is unlikely that the 24-hour urine for uric acid or the serum uric acid will be abnormal in this patient A CT KUB reveals multiple bilateral stones. It does not help us determine the metabolic abnormality that has led to the formation of these stones.
The hexagonal crystals seen on the urinalysis point toward cystine stones rather than calcium-containing stones. The intact PTH level is expected to be normal in this patient.

Explanation:

Explanation:

This patient most likely has developed a pyelonephritis. A renal ultrasound (RUS) is the best initial step to evaluate an episode of urinary tract infection (UTI), diagnosed from urinalysis (UA). UA is done to detect the presence of hydronephrosis, renal abscess, urinary calculi, or surgically correctable anatomic abnormalities or obstruction. However, UA is not reliable in detecting renal scarring or vesicoureteral reflux (VUR). Thus, a voiding cystourethrogram (VCUG) is indicated once the episode is successfully treated.
Indications for routine imaging (RUS and VCUG) include:

• Girls <3 years of age with a first UTI (children older than 3 years are expected to be able to verbalize urinary symptoms) Boys of any age with a first UTI a Children of any age with a febrile UTI
• Children with recurrent UTI (if the child has not been imaged previously)
• First UTI in a child of any age with a family history of renal disease, abnormal voiding pattern, poor growth, or abnormalities of the urinary tract

VCUG is the most appropriate test to evaluate the presence and degree of VUR. During a VCUG, contrast is introduced by catheter into the bladder and the patient is monitored for the reflux of contrast into the ureters after filling or during voiding. At the time of infection, however, the VCUG may cause retrograde infection into the kidneys; so VCUG is contraindicated during the episode of UTI. VCUG is done only after the episode has been treated and sterilization of urine has been confirmed by re-culture after treatment.
An immunodeficiency workup is unnecessary because generalized infections rather than isolated recurrent UTIs would be expected in the setting of immunodeficiency.
In the past,intravenous pyelogram was used to evaluate structure of the kidneys, calyces, and ureters, but it is almost obsolete these days because it is time-consuming and requires the administration of contrast RUS provides the same or even more detailed information.
A left sided nephrostomy tube placement would be necessary if RUS had detected the development of a perinephric or renal pelvic abscess or obstruction.
Renal scintigraphy or renal scan or Tc-DMSA scan is done to detect the presence of renal scarring alter diagnosing and grading VUR by VCUG.
Although a computed tomography of the abdomen may identify anatomic or congenital anomalies such as horseshoe kidneys, it is far too expensive for an initial diagnostic workup. The renal ultrasound is a much cheaper and quicker way to detect the same findings.

Explanation:

Bacterial vaginosis (BV) is characterized by excessive discharge and odor. Although BV is seen predominantly in sexually active premenopausal women, it does not appear to be closely associated with sexual activity and is not considered a sexually transmitted disease. For many years, the exact microbiologic cause of this infection was unknown; however, it is now regarded as a result of the synergism among various bacteria, including Gardnerella vaginalis anaerobic gram-negative rods, Peptostreptococcus species, Mycoplasma hominis, Ureaplasma urealyticum, and Mobiluncus species. G. vaginalis is found as part of the vaginal flora in approximately one-third of sexually active women. The replacement of lactobacilli by G, vaginalis anaerobes, Mobiluncus, and genital mycoplasmas is characteristic feature of bacterial vaginosis. Patients with BV may have variety of symptoms or none at all. Some are asymptomatic, whereas some complain of an unpleasant fishy or musty vaginal odor. They also report increased vaginal discharge. The onset of odor and discharge associated with BV is evenly distributed throughout the menstrual cycle, and local discomfort is rarely a problem.
The diagnosis of BV is made by examination of the patient and the discharge. The discharge is typically homogeneous, grayish-white to yellowish-white, and partially adherent to the vulva and vaginal walls.
Underlying edema or erythema of the vulva or vagina is atypical since this an “-osis” and not an “-itis” (inflammation). The pH of this vaginal discharge is greater than 4.7. When 1 drop of KOH is added to 1 drop of the discharge, an intense amine odor produces a positive whiff- test result. Typically, on normal saline wet preparation, this discharge has a paucity of leukocytes and a predominance of clue cells (stippled birefringence that so densely covers the epithelial cell that the normal borders and nuclei are obscured), produced by the adherence of G. vaginalis to epithelial cells. By Gram stain, clue cells can be identified as epithelial cells almost totally covered by small, gram- negative rods. A paucity of other organisms can be seen in the background. The single most reliable sign is the presence of clue cells. Culture on a specific medium is rarely useful.
The most effective treatment for BV is metronidazole increasing experience suggests that vaginal therapy with metronidazole gel or clindamycin cream is also effective. The risk factors in recurrence are not completely understood, but BV may develop more often in users of diaphragms. Gram-negative diplococci are seen in gonorrhea. Women with gonorrhea may complain of mucopurulent vaginal discharge, dyspareunia, and dysuria.
Lactobacilli are normal vaginal flora. They are not seen in patients with active BV.
Pseudo hyphae are seen in the potassium hydroxide preparation of a vaginal discharge of patients with candidiasis. Candidiasis presents with itching, irritation, and dyspareunia Discharge is white and clumpy.
Trichomonas are seen in trichomoniasis, which presents with a copious, pooling, and frothy gray-white or yellow-green discharge. An itching, strawberry cervix is occasionally seen. Saline preparation of the discharge reveals motile trichomonads.

Explanation:

Renovascular disease is the most frequent cause of hypertension in young children. Ailments such as polycystic kidney disease, congenital vascular disease, tumors and infections can all lead to hypertension, and a urologic evaluation is imperative. Albuterol usage would be associated with jitteriness or tachycardia.
Chronic lung disease would not elevate the blood pressure. Associated symptoms would include dyspnea, cyanosis, and symptoms of right heart failure.
Coarctation of the aorta can cause hypertension, but is a less common cause of the disease in this age group. Blood pressure measurement in all the extremities would be helpful in the diagnosis. Congenital heart disease such as an atrial septal defect or ventricular septal defect is rare, and would be associated with dyspnea, cyanosis, murmurs and general ill health.

Explanation:

Unilateral renal agenesis is not usually of any major concern, as long as the other kidney is healthy. The odds of a person being born with this condition are roughly 1 in 5000. Adults with unilateral renal agenesis have considerably higher chances of hypertension and high blood pressure. Most contact sports would be advised against. Failure to visualize the renal arteries with color renal Doppler is the recommended diagnostic test in suspected cases of both with bilateral and unilateral agenesis.

Explanation:

Nocturnal enuresis is a common problem that can be troubling for children and their families. A genetic component is likely in many affected children. Research also indicates the possibility of two subtypes of patients with nocturnal enuresis: those with a functional bladder disorder and those with a maturational delay in nocturnal arginine vasopressin secretion. The evaluation of nocturnal enuresis requires a thorough history, a complete physical examination, and urinalysis.
Treatment options include nonpharmacologic and pharmacologic measures.
Continence training should be incorporated into the treatment regimen.
Use of a bed-wetting alarm has the highest cure rate and the lowest relapse rate; however, some families may have difficulty with this treatment approach. Desmopressin and imipramine are the primary medications used to treat nocturnal enuresis, but both are associated with relatively high relapse rates.

Explanation:

Nocturnal enuresis is a common problem that can be troubling for children and their families. Recent studies indicate that nocturnal enuresis is best regarded as a group of conditions with different etiologies. A genetic component is likely in many affected children. Research also indicates the possibility of two subtypes of patients with nocturnal enuresis: those with a functional bladder disorder and those with a maturational delay in nocturnal arginine vasopressin secretion.
The evaluation of nocturnal enuresis requires a thorough history, a complete physical examination, and urinalysis. Treatment options include nonpharmacologic and pharmacologic measures. Continence training should be incorporated into the treatment regimen. Use of a bed-wetting alarm has the highest cure rate and the lowest relapse rate; however, some families may have difficulty with this treatment approach. Desmopressin and imipramine are the primary medications used to treat nocturnal enuresis, but both are associated with relatively high relapse rates.

Explanation:

Labial adhesion occurs in children when the inner vaginal lips (labia minors) fuse to each other. It often gives the appearance that the opening of the vagina has closed off. It may be noticed incidentally by a parent or by a physician during a medical examination or the child may complain of irritation or difficulty urinating. Because the fusion sometimes creates a little pouch in front of the vagina where urine can collect, some children experience dribbling when they stand up after urinating. Occasionally a child will get a bladder infection or will have difficulty passing urine due to the obstruction but most often labial adhesions are not significant enough to obstruct the flow of urine.
The most likely cause is that inflammation of the labia minors creates two raw surfaces at the edges of the lips, which eventually heal together in the middle, partly or fully covering the opening of the vagina.
Many factors can lead to inflammation and irritation of the vaginal lips. Exposure to irritants like fabric softener residue, perfumed soaps, or bits of stool; or a prolonged exposure to damp (as in wet diapers) all can cause irritation of the area. The lack of estrogen (which is normal before puberty) probably plays a role in this process.

Explanation:

Urinary tract infections (UTIs) are among the most common bacterial infections encountered by primary care physicians. Although UTIs do not occur with as great a frequency in children as in adults, they can be a source of significant morbidity in children.
For reasons that are not yet completely understood, a minority of UTIs in children progress to renal scarring, hypertension and renal insufficiency. The diagnostic work-up should be tailored to uncover functional and structural abnormalities such as dysfunctional voiding, vesicoureteral reflux and obstructive uropathy.
A more, aggressive work-up, including renal ultrasound and voiding cystourethrography6, is recommended for patients at greater risk for pyelonephritis and renal scarring, including infants less than one year of age and all children who have systemic signs of infection concomitant with a UTI.

Explanation:

The urinalysis in this scenario is significant for a tea-colored appearance, concentrated urine, proteinuria, hematuria, and red blood cell casts. The presence of red blood cell casts indicates that the origin of the bleeding is glomerular in nature, and thus is pathognomonic for acute glomerulonephritis. Postinfectious glomerulonephritis is the most common cause of acute glomerulonephritis in children; with group A beta-hemolytic streptococci being the most frequently associated bacterial etiology. Presenting clinical signs can include an asymptomatic individual with microscopic hematuria, or symptoms such as low-grade fever, malaise, lethargy, abdominal pain, and headache.

Explanation:

Orthostatic proteinuria accounts for up to 60% of all cases of asymptomatic proteinuria reported in children, with an even higher incidence in adolescents.

Explanation:

The urogenital sinus gives rise to the female urinary bladder, urethra, urethral glands, and vestibular glands. The mesonephric duct does not give rise to any significant anatomic structures in the female. The paramesonephric duct gives rise to the upper part of the female vagina. The genital tubercle gives rise to the vestibule and the clitoris in the female, and the urogenital folds give rise to the labia minora in the female.

Explanation:

Failure of development of kidneys, either unilateral or bilateral, is known as renal agenesis. Unilateral agenesis is an uncommon anomaly that is compatible with normal life if no other abnormalities exist. The opposite kidney is usually enlarged as a result of compensatory hypertrophy. Bilateral agenesis, which is incompatible with life, is usually encountered in stillborn infants.

Explanation:

Henoch-Schonlein purpura is the likeliest cause of this child´s illness. It is a vasculitis that occurs in children. Ankylosing spondylitis does not produce purpura or abdominal symptoms. Rheumatoid arthritis would not present in this fashion. Leukemia is not usually associated with palpable purpura or hematuria. This is not the pattern of Kawasaki´s disease. Berger´s Disease or IgA Nephropathy does not purpura, is followed usually by infection and has recurrent episodes of Hematuria.

Explanation:

The urogenital folds give rise to the labia minora in the female. The mesonephric duct does not give rise to any significant anatomic structures in the female. The paramesonephric duct gives rise to the upper part of the female vagina. The urogenital sinus gives rise to the female urinary bladder, urethra, urethral glands, and vestibular glands. The genital tubercle gives rise to the vestibule and the clitoris in the female.

Explanation:

Nephroblastoma, Wilm´s tumor, is often associated with the WAGR findings: Wilm´s tumor, aniridia, genitourinary problems, and retardation. While all of the other choices are also seen in children, none present with the WAGR findings.

Explanation:

This patient has nephrotic syndrome, based upon the presence of edema, hypoalbuminemia, hyperlipidemia, and proteinuria. Nephrotic syndrome in children is most often idiopathic and is common between the ages of 1 and 8 years. Most cases are due to minimal-change disease where the renal biopsy reveals few or no changes on light microscopy. The urine shows a large amount of protein and no abnormal urinary sediment or hematuria. Children between 1 and 8 years of age are likely to have steroid-responsive nephrotic syndrome, and thus initial therapy with prednisone is the most appropriate choice.
Parents should be advised to restrict salt intake until the edema subsides.
Some children with nephrotic syndrome will develop severe edema with ascites or pleural effusions, and will require hospitalization when there is risk of respiratory compromise, albumin infusion followed by a potent diuretic (such as furosemide) is necessary to mobilize the edema fluid. In most cases, however, prednisone treatment alone is sufficient to produce resolution of edema Cyclophosphamide is an immunosuppressive drug that is useful for children who suffer from frequent relapses of nephrotic syndrome despite steroid treatment. It is not used as the primary agent for treatment of nephrotic syndrome. A high-protein diet; has no role in managing the hypoproteinemia seen in nephrotic syndrome due to continued large losses of albumin in the urine.

Explanation:

Orthostatic proteinuria is very common. It occurs when the total urinary protein excretion rate is higher while the child is in an upright position. It is asymptomatic, and there is no associated increase in renal disease. Diagnosis is made by obtaining a “first mornings urine before the child has had much time in an upright position.”
Acute Glomerulonephritis usually presents with gross hematuria and may or may not be associated with edema. Severe glomerular injury would be associated with proteinuria.
IgA nephropathy usually presents with episodic, asymptomatic gross hematuria, with microhematuria occurring between episodes. Proteinuria occurs in more severe, atypical cases.
Minimal change disease is characterized by proteinuria, hyperlipidemia, edema, and hypoproteinemia. The proteinuria is usually greater than 2+.
A urinary tract infection may present with 1 + proteinuria but the patient would also more typically have hematuria. The fact that there are no bacteria would make a urinary tract infection less likely.

Explanation:

This boy has glomerular hematuria (dysmorphic RBCs) together with hearing loss and a family history of renal failure. These are consistent with a diagnosis of Alport syndrome. Alport syndrome is a progressive glomerular disease that is commonly accompanied by sensorineural hearing loss and ocular abnormalities. The diagnosis of Alport syndrome is usually suspected from the family history of renal failure and deafness. The best initial step to diagnose Alport syndrome is a skin biopsy by immunohistochemical analysis. The diagnosis of Alport syndrome can then be confirmed or excluded in the majority of cases by a renal biopsy with analysis of type IV collagen expression in the kidney. On electron microscopy, there is longitudinal splitting of the lamina densa of the glomerular basement membrane. The primary defect in Alport syndrome is a defect in the genes encoding the chains responsible for formation of type IV collagen. The inheritance of Alport syndrome is mainly X-linked.
However, it could also be autosomal recessive or autosomal dominant.
The initial clinical manifestation of Alport syndrome is microscopic hematuria. With time, patients develop hypertension, proteinuria, and progressive renal failure. The most common extrarenal manifestations are sensorineural hearing loss and anterior lenticonus.
Attention deficit hyperactivity disorder is incorrect. Even though the mother gives a history of the boys not paying attention, this is due to the deafness of Alport syndrome.
Patients with hemorrhagic cystitis typically have gross hematuria. However, this patient has dysmorphic RBCs, which would not be seen in hemorrhagic cystitis.
The CT of the abdomen is normal, ruling out a diagnosis of kidney stone
The patient has no WBC on the urinalysis. It is not likely that he has a urinary tract infection.

Explanation:

This infant developed acute renal failure (ARF) in the immediate postoperative period, as manifested by the increase in blood urea nitrogen and serum creatinine and the decrease in urine output. ARF can be classified into prerenal, renal, and postrenal. Prerenal causes include hypovolemia secondary to severe dehydration, hemorrhage, and hypotension secondary to shock. Renal causes include acute tubular necrosis (ATN), parenchymal disorders (e.g., glomerulonephritis), and vascular disorders (e.g., renal artery thrombosis or renal vein thrombosis). Postrenal causes include ureteral or urethral obstruction. This infant most likely has ATN, which is caused by ischemic or toxic injury to the nephrons ischemia can be caused by hypovolemia, low cardiac output states, or renal vasoconstriction. Toxins include contrast agents, antibiotics, uric acid, and myoglobin. ATN is characterized by mild proteinuria, microscopic hematuria, and the presence of coarse granular casts in the urine. A fractional excretion of sodium greater than 2% (or 2.5% in neonates) is consistent with renal causes of ARF.
Renal ultrasonography is the imaging study of choice for this patient, because it provides anatomic and structural information about the kidneys. The study is noninvasive and can be done-easily at the bedside. Doppler studies can also; be done with ultrasound technology to assess blood flow in the renal vessels, the aorta, and the inferior vena cava.
CT of the abdomen and pelvis can provide more anatomic details, but it is not a good initial imaging study, especially in this case. The contrast dye needed for CT can cause further damage to the kidneys and thus worsen renal failure. The same argument applies to intravenous pyelography.
Cystourethrography provides structural details of the urinary bladder and the urethra, but it is not indicated in this case.
Voiding cystourethrography is indicated in pediatric patients who present with UTI in which retrograde urinary flow is suspected to be the etiology.
Renal Biopsy is the gold standard of diagnosing renal disease, but it is not indicated as an initial study. It might be useful in prolonged renal failure with an unidentified cause.

Explanation:

Red urine can be caused by gross hematuria, hemoglobinuria, myoglobinuria, certain foods or medications (e.g. rifampin, nitrofurantoin, chloroquine, azo dyes, beets, and blackberries), and the presence of urates. The strip-test for blood in a urinalysis does not test directly on red blood cells; rather it tests the presence or absence of hemoglobin. It is sensitive to 5-20 red blood cells per high power field (HPF) in the urine, but it is even more sensitive to free hemoglobin. Because of the structural similarity of myoglobin and hemoglobin, the strip-test reagents also react to myoglobin. Therefore, positive test for “blood´ in r strip test of urinalysis can mean red blood cells, hemoglobin, or myoglobin. It is important to perform microscopic analysis of the urine to distinguish between these possibilities.
In this case, the absence of a significant number of red blood cells (1 RBC/HPF) does not qualify for hematuria, and the presence of 4+ blood on the strip test is consistent with myoglobinuria or hemoglobinuria.
The fact that it happens abruptly after vigorous exercise further suggests that the red urine might be secondary to myoglobinuria, which happens not uncommonly after exercise. It is important to confirm with a quantitative test of urine myoglobin. The serum creatinine phosphokinase (CK) level should also be tested for possible rhabdomyolysis. If rhabdomyolysis is present with elevated creatinine phosphokinase; the patient should be admitted for aggressive IV hydration and treatment with sodium bicarbonate to alkalinize the urine to prevent precipitation of the myoglobin in the renal tubules.
The absence of more than 3-5 RBC/HPF rules out glomerulonephritis (choice A) and hematuria. Glomerulonephritis would also be characterized by red cell casts upon urinalysis. Ingestion of food coloring is possible but less likely without any supporting history, and the urinalysis should be negative for blood in that case.
The presence of urates in the urine can cause “red diaper syndrome” in infants younger than 6 months. It is due to physiologic high excretion of uric acid in infants. However, the urinalysis should be negative for blood.
Trauma can cause renal contusion and various degrees of hematuria. Urinary tract infection occasionally causes gross hematuria. Urinalysis is usually positive for nitrite, leukocyte esterase, and WBCs.

Explanation:

From listening to this history and performing the examination, the most probable diagnosis that comes to mind is the nephrotic syndrome. In children, the overwhelming etiology of nephrosis is minimal change (basement membrane, nil) disease. The development of the nephrotic syndrome commonly occurs titer resolution of a nonspecific viral illness. The child then develops edema, typically dependent edema. This may be mild or more severe and present with anasarca. There may be pleural effusions, pericardial effusion, and ascites. The diagnostic features are heavy proteinuria (>40 mg/m2 /h), hypoalbuminemia (2.5 g/dL), edema, and hyperlipidemia. Urinalysis will show 3 to 4 proteinuria. There may be microscopic hematuria, but gross persistent hematuria indicates another process. Serum creatinine is usually normal, unless it is decreased due to significantly diminished renal perfusion from contraction of the intravascular volume.
Serum cholesterol and triglycerides are elevated, and C3 and C4 levels are normal Children with mild to moderate edema during a first episode may be managed as outpatients. A low-sodium diet should be prescribed and may be normalized upon remission. Onset between 1 and 8 years of age will most likely respond to corticosteroids, so the patient should be started on oral prednisone without renal biopsy. If not done already for confirmation, a total protein in a 24-hour urine collection should be obtained. Initial therapy is given for 4 to 6 weeks, whereupon the vast majority of patients will enter remission. After this, therapy is slowly tapered over 2 to 3 months.
This patient is not severely ill to warrant hospital admission. If admission is needed, however, then it is because of significant intravascular volume depletion with large extra vascular fluid collections. If the patient is admitted, albumin may be infused, followed by a diuretic to bring fluid beck into the intravascular compartment and present it to the kidney for diuresis.
There is no evidence of renal insufficiency in this patient, so he does not need to be admitted to the hospital.
Of course the patient needs to be followed but it would be inappropriate to not proceed further with the diagnosis and to institute therapy.
As stated above, renal biopsy is not required initially. Children with features that make minimal change disease less likely- i.e., hematuria, hypertension, renal insufficiency, low complement levels, age younger then l year or older than 8 years-should be considered for a renal biopsy prior to treatment.

Explanation:

This infant most likely has posterior urethral valves (PUV). PUV are the most common reason for a newborn boy not to urinate during the first day of life. Meatal stenosis should also be considered; however, that should be seen on physical examination. PUV are mucosal folds that look like thin membranes and they may cause varying degrees of obstruction when the child attempts to void. The first step in the management of this infant is to drain the bladder so, that renal function may be preserved. This is best done by immediately placing a catheter (usually a feeding tube is used because regular Foley catheters are too large) per urethra and into the bladder. Once the obstruction is treated then further evaluation may be performed.
VCUG is the single best imaging modality to detect PUV. Along with the valves, the patient may have vesicoureteral reflux and bladder trabeculations, if the obstruction is severe, and this may be seen on VCUG. On VCUG, the valves will also cause elongation and dilatation of the posterior urethra, with a prominent bladder neck.
Renal-bladder ultrasound will show a distended bladder, and if reflux is present, possibly dilated ureters and renal collecting system. Because this infant has a distended bladder, drainage should not be delayed while an ultrasound is obtained RUG is used to evaluate the urethra of men, especially if trauma has occurred. Because of the way the valves lie, they prevent the flow of urine out the bladder but do not impede the passage of contrast or a catheter into the bladder. For this reason, RUG is of little value.
A VCUG will be necessary to confirm the diagnosis. The most important thing to do at this time, however, is to preserve renal function. This is best done with immediate drainage of the bladder.
After appropriate diagnosis is made, the patient should undergo cystoscopy with endoscopic fulguration or resection of the valves. As long as a catheter can be placed, then cystoscopy is not an emergency.