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Year 4 Paeds > Nephrology > Flashcards

Nephrology Flashcards

(61 cards)

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1
Q

Any red coloured urine, or positive on a dipstick should be tested by microscopy. What is a positive result?

A

> 10 erythrocytes per field

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2
Q

What are the two types of Haematuria?

A

Glomerular

Lower UTI

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3
Q

How would Glomerular Haematuria present?

A

Brown Urine
Red deformed cells
Casts
Proteinuria

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4
Q

How would Haematuria due to Lower UTI present?

A

Red in colour
Occurring at beginning or end of stream
No Proteinuria

(Unusual in children)

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5
Q

Give four glomerular causes of Haematuria

A

Acute/Chronic Glomerulonephritis
IgA Nephropathy
Alport Syndrome
Thin Basement Membrane

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6
Q

Give four non glomerular causes of Haematuria

A

Infection
Trauma
Bleeding Disorder
Sickle Cell

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7
Q

Other than Urine Microscopy and Culture, what three other investigations should be done in Haematuria?

A

Protein and Calcium Excretion
Kidney and Urinary Tract USS
Range of bloods

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8
Q

What further investigations might you do for Haematuria if indicated?

A

Throat Swabs
Anti Streptolysin titre
Hearing Test (Alport)
Renal Biopsy

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9
Q

In Acute Nephritis, glomerular blood flow is restricted which reduces Urine Output and Increases Blood Pressure. Give four causes

A

Post Infectious (Strep)
Vasculitis (HSP, SLE, Wegener)
IgA
Good pastures

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10
Q

What is characteristic of Post Strep Glomerulonephritis?

A

Follows sore throat or skin infection

Raised ASOT and reduced C3

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11
Q

How does HSP present?

A

Characteristic skin rash on extensor surfaces
Arthralgia
Periorbital Oedema
Colicky Abdominal Pain

Usually aged 3-10 with preceding URTI

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12
Q

How is HSP managed?

A

Analgesia

If severe then steroids

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13
Q

What is the pathophysiology of HSP?

A

Raised IgA and disruption of IgG interact and deposit causing inflammation

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14
Q

How should Acute Nephritis be treated in Children?

A

Monitor fluid and electrolytes and correct where appropriate

Diuretics

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15
Q

What is the normal pattern of Enuresis?

A

Normally controlled daytime urination by 2 years old, and nighttime at 3-4 years old

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16
Q

What is Primary Enuresis? Give three possible causes

A

Never managed to be consistently dry at night

FH, Pre Bed Fluid Intake, Cerebral Palsy

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17
Q

How is Primary Nocturnal Enuresis managed?

A

Keep a two week diary

Reassure parents that if they’re less than 5 years old it’s likely to self resolve

Lifestyle changes and positive reinforcement

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18
Q

What is Secondary Nocturnal Enuresis? Give four causes.

A

Child begins wetting the bed when they’ve been previously dry for 6 months

UTI, Constipation, T1DM, New Psychosocial

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19
Q

What is Diurnal Enuresis? Give three examples

A

Person is dry at night but has episodes of incontinence throughout the day

Urge Incontinence, Constipation, UTI

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20
Q

One of the managements for Enuresis is Enuresis Alarms. How do these work?

A

Makes a noise at the first sign of bed wetting, waking the child and preventing further wetting

Needs to be used consistently for atleast 3 weeks

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21
Q

Describe three pharmacological managements of Enuresis and their MOA

A

Desmopressin - ADH Analogues taken at bed time
Oxybutinin - Anticholinergic, if underlying cause is OA bladder
Imipramine - TCA, relaxes bladder and lightens sleep

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22
Q

How does a UTI present in babies?

A 
Fever
Lethargy
Irritability
Vomiting
Poor Feeds
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23
Q

How does a UTI present in Older Children

A 
Fever
Suprapubic Pain
Vomiting
Dysuria
Frequency
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24
Q

In addition to some lower UTI symptoms, how would Pyelonephritis present?

A

Temp>38 degrees

Lion Pain/Tenderness

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25
What is typically present on a dipstick of UTI? Which is a better indicator?
Nitrites Leukocyte Esterase Nitrites are a better indicator (treat even if leukocyte esterase not present)
26
How should a UTI be managed depending on age group?
<3 months - Start immediate Sepsis management (Cefotaxime + Amoxicillin +/- Gentamicin) and full septic screen >3 months -12 y- 3 days Oral Cefalexin if otherwise well 12-17 - 3 days Nitrofurantoin
27
If a child has recurrent UTIs, name three investigations you could do
USS DMSA Micturating Cystourethrogram
28
When should USS be done?
If <6m with first UTI should have scan within 6 weeks Any child with recurrent/atypical UTIs should have USS within 6m
29
When should DMSA (Dimercaptosuccinic Acid Scan) be done?
Used 4-6 months after illness to assess for damage from recurrent/atypical infections Radioactive DMSA and Gamma Camera (areas of no uptake mean scarring)
30
When is a Micturating Cystourethrogram used?
To diagnose Vesicoureteric Reflux which could be a cause of recurrent UTIs
31
How is Vesicoureteric Reflux managed?
Avoid Constipation, Excessively full bladder, Prophylactic Abx, Urological Surgery
32
What is a Posterior Urethral Valve?
Tissue at the proximal end of urethra causes obstruction of urine output This creates pressure back into the bladder, causing hydronephrosis and increased UTI risk
33
What are the clinical features of Posterior Urethral Valve?
Mainly occurs in newborn boys May be asymptomatic Difficulty urinating, weak stream, chronic retention, recurrent UT
34
What are the clinical features of Severe Posterior Urethral Valve in Utero?
Bilateral Hydronephrosis Oligohydramnios Pulmonary Hypoplasia
35
Posterior Urethral Valves may be picked up Antenatally. How can it be investigated Post Natally?
Abdominal Ultrasound Micturating Cystourethrogram Cystoscopy(can also be used therapeutically to remove the tissue)
36
What is Nephrotic Syndrome?
Basement membrane and glomerulus become highly permeable to protein Triad: Low Serum Albumin, High Protein Content, Oedema May also have deranged lipid profile and hypercoaguability
37
Minimal Change Disease is the most common cause of Nephrotic Syndrome in children. How should it be investigated?
Urinalysis - small molecular weight proteins and hyaline casts Renal biopsy and microscopy DOESN’T detect abnormality
38
Name two other causes of Nephrotic Syndrome
Secondary to Intrinsic Disease (FSGS, Membranoproliferative) Secondary to Infection (HSP, Diabetes, Infection)
39
How is Neohrotic Syndrome managed?
High dose steroids for 4 weeks, then weaned over 8 weeks Low salt diet Diuretics for Oedema ?VTE/Abx prophylaxis
40
What is Steroid Dependent Nephrotic Syndrome?
Relapse as soon as weaned off steroids
41
What is Haemolytic Uraemic Syndrome?
Thrombosis within small vessels triggered by Shiga Toxin, commonly caused by E.Coli and Shigella
42
How does Haemolytic Uraemic Syndrome present?
Typically begins 5 days after Diarrhoea Triad: Haemolytic Anaemia, AKI, Thrombocytopenia (Reduces UO, Haematuria, Lethargy)
43
Haemolytic Uraemic Syndrome is a medical emergency with a 10% mortality. It’s managed supportively only, give examples.
Renal Dialysis (if required) Antihypertensives Maintenance of fluid balance Blood transfusions
44
What is Autosomal Recessive Polycystic Kidney Disease?
Presents in neonates, and is the result of PKHD1 mutation on Chromosome 6 (As opposed to autosomal dominant condition presenting in adulthood)
45
How does Autosomal Recessive Polycystic Kidney Disease present?
Cystic enlargement of Kidney Oligohydramnios and Pulmonary Hypoplasia Liver fibrosis
46
How is Autosomal Recessive Polycystic Kidney Disease managed?
Requires dialysis within first few days of life Most develop end stage renal failure before reaching adulthood 1/3 die in neonatal period
47
What is Multicystic Dysplastic Kidney?
One of baby’s kidneys is normal and other is normal Usually single healthy kidney is enough to lead a normal life, and often other kidney atrophies and disappears before the age of 5
48
Wilms Tumour is a specific type of tumour affecting kidney in children (typically under 5y). How does it present?
Mass in abdomen Abdominal pain Haematuria Weight loss
49
How is Wilms Tumour investigated?
US Abdomen Biopsy for histological analysis CT/MRI for staging
50
How are Wilms Tumours managed?
Nephrectomy of affected kidney Adjuvant Chemo/radiotherapy Early stage disease has a 90% cure
51
Define Hypospadias
Urethral meatus is abnormally displaced posteriorly on penis (normally close to Glans but can be anywhere along shaft) Often has associated foreskin abnormalities and Chordee (head of penis bends down)
52
How is Hypospadias managed?
May not require management Surgery between 3 and 4 months (Urethroplasty)
53
State three complications of Hypospadias
Bladder Spasms Urethral Fistulae Difficulty directing urination
54
A hydrocoele is a collection of fluid in tunica Vaginalis that surrounds testes. What are the two types?
Simple - common in newborns, fluid gets reabsorbed over time and hydrocoele disappears Communicating - Processus Vaginalis is patent, hydrocoele fluctuates in size
55
Give three differentials for Hydrocoeles
Partially descended testes Inguinal Hernia Torsion
56
How are hydrocoeles managed?
Simple - self resolves within 2 years Communicating - surgical ligation of processus Vaginalis
57
Give four features of Chronic Kidney Disease in children
Anorexia Lethargy Growth Failure Bone Deformities
58
How are the Bone abnormalities managed in children with CKD?
Decrease dairy Calcium Carbonate (phosphate binder) Activated Vitamin D (As phosphate retention leads to Hypocalcaemia, secondary hyperparathyridism and osteitis malacia)
59
What other medications may you consider giving in CKD?
Bicarbonate Supplements Erythropoietin Hormonal Abnormality correction (eg GH resistance)
60
What is required via microscopy to diagnose a UTI?
10^5 bacteria pure growth | 0-40 white cells
61
How can you prevent a UTI?
``` Stay hydrated Use potty every 2-3 hours Double voiding Cotton Underwear Avoid Bubble Baths ```

Year 4 Paeds (15 decks)

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