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Y5 Paediatrics > Kidney > Flashcards

Kidney Flashcards

(66 cards)

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1
Q

What is GFR like in infants?

A

LOW

Reaches normal levels at age of 1 or 2

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2
Q

What are three key radiological investigations for the kidney/urinary tract?

A

USS
DMSA
MCUG

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3
Q

What is a DMSA scan

A

Dimercaptosuccinic acid scan

Static scan of the renal cortex
Detects functional defects e.g. scars
It is very sensitive so wait 2 months to not diagnose false scars

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4
Q

What is a MCUG

A

Micturating Cystourethrogram

Contrast induced into bladder through urethral catheter
visualises bladder and urethral anatomuy

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5
Q

What defects can an MCUG detect?

A

vescicoureteric defect

urethral obstruction

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6
Q

What is renal agenesis

A

absence of both kidneys

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7
Q

What is Potter syndrome?

A

oligohydramnnios due to renal agenesis (as amniotic fluid is mainly derived from foetal urine)

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8
Q

what is multi cystic dysplastic kidney

A

SINGLE kidney does not develop properly

Formation of non-functioning structure: large fluid filled cyst, no renal tissue, no connection to bladder

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9
Q

What is PKD

A

BOTH kidneys affected
multiple cysts on both kidneys
maintain SOME function

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10
Q

What is a horseshoe kidney?

A

lower poles of two kidneys fuse at midline

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11
Q

What is a duplex kidney?

A

two ureters insert into the same kidney

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12
Q

What is bladder exstrophy

A

Due to failure of fusion of midline structures

Leads to exposed bladder mucosa

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13
Q

What is prune belly syndrome?

A

Absence of anterior abdominal wall muscles

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14
Q

Where could obstruction to urine flow occur?

A

Pelvi-ureteric junction
Vescico-ureteric junction
Bladder neck
Posterior urethra

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15
Q

What is a posterior urethral valve

A

An obstructing membrane in the posterior male urethra

Causes outlet obstruction

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16
Q

What are negative consequences of a posterior urethral valve in the foetus

A 
Renal failure (oligohydramnios) 
Rest failure / pulmonary hypoplasia (due to insufficient lung development )
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17
Q

What is postnatal tx for congenital renal abnormalities?

A

Prophylactic antibiotics (prevent UTIs)
USS (after few weeks)
US/MCUG if required

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18
Q

What are sx of UTI in infant?

A 
fever 
vomiting 
lethargy/irritability 
poor feeding/faltering growth 
jaundice 
septicaemia 
offensive urine 
febrile seizure
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19
Q

What are sx of UTI in children

A 
Urinary: dysuria, freq, urgency 
Cloudy/offensive urine 
Eneuresis
Abdo pain, loin tenderness 
Vomiting, diaghrroea 
Fever without rigors
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20
Q

How do you collect sample for ix in UTI

A

Clean catch
adhesive plastic bag
urethral catheter
Suprapubic aspiration

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21
Q

What further investigations can you do for UTI

A

urine dip

MC&S

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22
Q

What are commonest organisms for UTI

A

E coli
Klebsiella
Proteus

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23
Q

What are other factors that contribute to incomplete bladder emptying > UTI?

A 
infrequent voiding 
vulvitis 
obstruction from loaded rectum from constipation
neuropathic bladder
vescicoureteric reflux
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24
Q

What is vescicoureteric reflux?

A

abnormality of vescicoureteric junction - ureters are displaced laterally and inter directly into bladder

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25
Why does vescicoureteric reflux occur?
familial / with bladder pathology
26
What are investigations of rVUR
USS | MCUG if obstruction is suspected
27
What outcomes of urine dip require antibiotics?
nitrites +, LE+ | nitrites +, LE-
28
What do you do if nitrite-, LE + occurs?
do not start antibiotics unless good clinical evidence
29
What features indicate pyelo?
bacteriuria + fever >38 / + loin tenderness
30
what is daytime enuresis?
lack of bladder control during the day in a child that is old enough to be continent (3-5 yo)
31
What are causes of daytime eneuresis?
``` lack of attention to bladder sensation (developmental problem) detrusor instability bladder neck stiffness neuropathic bladder UTI constipation ``` ectopic ureter
32
How do you investigate daytime enuresis
MC&S USS urodynamic studies MRI (if need to exclude spinal defect>)
33
Once you exclude neuro cause, what do you do for child with daytime enuresis?
star chart bladder training pelvic floor exercise
34
What is the main cause of secondary enuresis
emotional upset
35
What are other causes of secondary eneuresis
UTI | polyuria
36
What are benign causes of proteinuria
``` Orthostatic proteinuria (standing upright all day) Transient proteinuria (during febrile illness / after exercising) ```
37
What are other causes of proteinuria?
``` Glomerular abnormalities increased GFR Reduced renal mass in CKS HTN Tubular proteinuria ```
38
What is nephrotic syndrome TRIAD PHO
proteinuria hypoalbuminaemia oedema
39
What are clinical features of nephrotic syndrome
periorbital oedema (first sign) oedema (leg, scrotum, vulva) ascites breathlessness
40
What is management of nephrotic syndrome
PO corticosteroids
41
What are complications of nephrotic syndrome
- hypovolaemia - thrombosis - infection - high cholesterol
42
what are features of glomerular haematuria
brown urine presence of deformed red cells (as they pass through glomerulus) casts
43
what are features of lower urinary tract haematuria
red at beginning / end of stream NOT accompanied by proteinuria unusual in children
44
what are causes of glomerular haematuria
glomerulonephritis (acute/chronic) IgA nephropathy Familial nephritis
45
causes of non glomerular haematuria
``` infection sickle cell disease bleeding disorder renal vein thrombosis trauma ```
46
What are investigations for haematuria
``` MC&S Protein, calcium excretion USS U&E, creat, calcium, phosphate, albumin FBC, platelets, coagulation screen, sickle cell screen ```
47
What does acute nephritis present as
HTN oedema haematuria, proteinuria
48
causes of acute nephritis
post infectious vasculitis IgA nephropathy Goodpastruses
49
What is henoch Schonein purpura caused by
UNKNOWN
50
What are features of henoch Schonein purpur
PAGAP ``` purpuric rash arthlagia abdo pain periarticular oedema glomerulonephritis ```
51
What is rash like in henoch Schonein purpura
symmetrical over buttock and extensor surfaces trunk is spared
52
What is arthralgia (joint pain) like in henoch Schonein purpura
knees and ankles | with periarticular oedem
53
what is abdominal pain like in henoch Schonein purpur
tx with corticosteroids | causes haematemesis, malaena
54
what is management for henoch Schonein purpura
most resolve spontaneously in 4 weeks | joint pain relief with paracetamol/ibuprofen
55
What is the most common cause of familial nephritis
Alport syndrome (X linked recessive(
56
What autoantibody is present in SLE
anti-dsDNA
57
What is complement levels like in SLE
LOW
58
what is HTN defined as in children
above 95th percentile for height, age, sex
59
What are causes of unilateral palpable kidney
``` multi cystic kidney compensatory hypertrophy obstructed hydronephrosis Wilms tumour Renal vein thrombosis ```
60
What are causes of bilateral palpable kidney
PKD tuberous sclerosis renal vein thrombosis
61
What is falconi syndrome
loss of excess molecules from proximal tubule (amino acids, glucose, ophsophate, bicarb, sodium, calcium, K+)
62
How do you manage AKI
STOP AKI Sepsis - perform septic screen Toxins - identify and stop nephrotoxic drugs Optimise volume status and BP Prevent harm - treat reversible causes e.g. UTI
63
How do you manage UTI in infants <6 weeks
IV ampicillin + gent / cefotaxime | ADMIT TO HOSPITAL
64
What are two markers of post-strep nephritis
anti-streptolysin O titre | anti-DNAase B titre
65
what are causes of HTN in chilòdren
Renal: renal parenchymal disaease, renal artery stenosis, PKD Aortic coarctation Catecholamine excess (phaeo, neuroblastoma) Endocrine (CAH, Cushings, steroids, hyperthyroid)
66
Which form of inheritance has a worse prognosis for PKD
Autosomal RECESSIVE has worse prognosis

Y5 Paediatrics (30 decks)

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