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paediatrics cabinetchip > paediatric nephrology > Flashcards

paediatric nephrology Flashcards

1
Q

4 functions of the kidney

A

fluid and electorlyte homeostasis

excreiton of waste products and drugs

hormonal

acid-base homeostasis

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2
Q

hormones involves in the kidneys 4

A

vit d

ertyhrypoetin

renin

prostaglandin

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3
Q

top 5 renal disease presentations

A
  1. Flank mass
  2. Haematuria
  3. Proteinuria with/without oedema
  4. Polyuria/oliguria
  5. Hypertension
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4
Q

name for bilateral absent kidneys

A

potters syndrome
-renal agenesis

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5
Q

how do kidneys appear in muticystic dysplastic kidneys

A

irregular cysts w no normal renal tissue

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6
Q

define a duplex kideny

A

two ureters coming from one kidney

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7
Q

describe the ureters in a duplex kidney and how they can lead to pathology

A

upper pole ureter
-obstruct and can be assocated with a ureterocoele

lower pole ureter
-tends to reflux
-vesicoureteric reflux

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8
Q

what causes a horseshoe or pelvic kidney

A

abnormal caudal migration

-causes kdineys to fuse together and cause this shape

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9
Q

where do horseshoe kidneys tend to fuse

A

in the midline at the lower poles

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10
Q

what can an obsturction of teh urinary tract cause 3

A

bladder diverticulae

hydroureters

hydronephrosis

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11
Q

three common obstructions of the urinary tract (anatomically)

A

posterior urethral valves

vesicoureteric obstruction

pelviureteric obstruction

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12
Q

what does an obstruction from posterior urethral valves cause 3

A

bladder hypertrophy

unilateral or bilateral hydronephrosis

renal failure

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13
Q

top 4 cuases of oedema in children

A

heart failure

nephrotic syndrome

liver failure

malnurition

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14
Q

values indicitative of nephrotic syndrome 3

A

proteinuria >1g/m^2/day

hypoalbuinaemia <25g/L

high protein to creatinet ratio in early morning urine sample (>150mg/mmol)

*-also oedema

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15
Q

classifications of nephrotic syndrome 3

A

idiopathic

secondary

congenital

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16
Q

types of idopathic nephrotic syndrome 2

A

minimal change disease (80-90%)

focal segmental glomeruloscelrosis (10-20%)

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17
Q

types of secondary nephrotic syndrome 2

A

HSP

SLE

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18
Q

investigations for nephrotic syndrome 7

A

FBC,

UEs,

LFTs,

C3/C4

varicella status

ASOT

urine -protein creatine ratio
-culture

BP

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19
Q

complications of nephrotic syndrome 4

A

hypovolaemia - intravuascualry depleted

thrombosis

infection (loss of Ig and complement in urine)

hypertension

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20
Q

treatment for nephrotic syndrome 5

A

prednisolone - inital high dose w reducing course

20% albuim + furosemid for hypovolaemia or symptomatic oedema

pneumococcal vaccination

penicillin prophlyaxis for risk of encapsulated organism infection

salt/fluid restirction

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21
Q

presenation of nephrotic syndrome in children

A

suually swelling of face

-then followed by swelling of the entire body

foamy urine

22
Q

triad of nephrotic syndrome

A

oedema, substantial proteinuria (> 3.5 g/24 hours) and SERUM hypoalbuminaemia (< 30 g/L)

23
Q

causes of proteinuria 3

A

glomerular disease -Glomerulosclerosis, Glomerulonephritis (GN), Nephrotic
syndrome, Familial haematuria, Disease related

tubular

physilogical stress- strenous exercise, exposure to cold, febrile illness or CHF

24
Q

how can haematuria be split

A

macro and microscopic

25
Q

non-glomerular cuases of haematuria 9

A

o Infection (commonest)
o Trauma
o Stones
o Sickle Cell
o Coagulopathy/Bleeding disorder
o Renal Vein Thrombosis
o Tumour
o Structural abnormality (PUJ obstruction)
o Munchausen by proxy

26
Q

glomerular causes of haematuria

A

acute or chornic glomeruonephritis

IgA nephropahty

familial nephritis

27
Q

history of haematuria 7

A

pain -presence, site and nature

timing - at begining middle or end of micturition

trauma

recent URTI

rash

meds

FHx of renal disease or early deafness

28
Q

investgations for haematuria
blood tests 6

A

-FBC,

UnEs

Coag

ASOT

ANF (ANA ab)

complement

29
Q

investigations for haematuria
Urine 5

A

MC&S

oxalate

calcium

phosphate and urate levels

calcium creatine ration

30
Q

other investigations for haematuria excluding blood and urine 3

A

AXR

renal USS ± renal biopsy

31
Q

which children commonly get UTIS 1

A

ones with structular urinary tract abnormalities

-slightly more girls than boys 3% v 1%

32
Q

when can a UTI in a child lead to scarring

A

in the prescence of a vesicoureteric reflux

-imaging is needs to exclude a VUR

33
Q

main phyiological cause of UTI

A

incomplete bladder emptying

34
Q

why do children have imcomplete bladder empyting 6

A

infrequent voiding

vulvitis

hurried mictrution

constipation

VUR

neuropathic bladder

35
Q

top 5 bacteria causing UTIs in children

A

o E-Coli (85%)
o Proteus (common in boys)
o Staphylococcus
o Klebsiella, Enterococcus
o Pseudomonas (may indicate structural abnormality)

36
Q

symptoms of a UTI during infancy 7

A

fever

vomitng

lethargy

irritabilituy

poor feeding

failure to thrive

sepsis ± shock

37
Q

symptoms of UTI in older children 10

A

frequency

dysuria

change in continence

abdo pain

loin tenderness

fever

malaiase

vomiting

haematuria

38
Q

symptoms of upper tract UTI 3

A

bacteruira

fever

loin pain

39
Q

investgations for UTI

A

urgent micrsopy and cultre in <3mnths

urine dipstick

MSSU culture and sensitity -GOLD STANDARD

imaging

40
Q

regarding UTI culture what results would indicate a positive diagnosis of a UTI 3

A

Bacteruria (organisms seen) ± Pyuria (pus cells)
-treat as UTI

Pyuria + clinical features - treat as UTI

41
Q

what urine dipstick results would indicate treatment for a UTI - 3 different scenarios

A

 If leukocyte and nitrite positive – culture and treat
 If Nitrite positive and leukocyte negative – culture and treat
 If leukocyte positive and nitrite negative – culture but only treat if
clinically UTI

42
Q

what value indicates a positve MSSU

A

> 10(x5) organism/ml

43
Q

USS in a UTI for <6mnth old

A

acute USS if reccurent or atypical UTI

otherwise USS at 6 weeks

44
Q

USS in a UTI for >6mnth old

A

Atypical infection: USS acutely and DMSA at 4-6 months (if less than
3 years)
 Recurrent infection: USS 6 weeks post infection and DMSA at 4-6
months

DMSA- scintigraphy scan - also uses technetium

45
Q

treatment for UTI in children

A

IV ABx if <3mnths

guided by sensitivites and cultures

AWARE-most UTIs are resistant to Amox

46
Q

prevention of reccurrent of UTi in children 4

A

o Fluids
o Prevention or treatment of constipation
o Complete bladder emptying
o Good perineal hygiene in girls

47
Q

methods of collecting urine in children and babies 5

A

 Clean catch- sterile silver foil dish placed strategically and patiently wait whilst
encouraging oral fluids. Used in young children and babies unable to do an MSSU.
 MSSU (mid-stream specimen urine/clean catch): ‘Gold standard’ mid stream urine
into a sterile pot
 CSU (catheter specimen urine): sample taken from a catheter
 SPA (suprapubic aspiration)- rarely if ever used
 Urine Bags – not sterile, better for volume measurement

48
Q

define acute renal failure and a value

A

sudden reduction in renal function

oliguira <0.5ml/kg/hr

49
Q

pre-renal causes of acute renal failure 2

A

hypovolaemia

cardiac faliure

50
Q

renal causes of acute renal failure 4

A

vascular - HUS

tubular -Acute tubular necrosis

glomerular -eg glomerulonephritis

interstitial - Drugs (NSAIDs)

51
Q

post renal causes of acute renal failure 1

A

urinary obstruction

52
Q

5 indications for dialysis

A

severe volume overload

severe hyperkalaemia

symptomatic uraemia

severe metabolic acidosis

removal of toxins

paediatrics cabinetchip (80 decks)

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