Nephrology Flashcards
(43 cards)
How does glomerulonephritis present in children?
1) Acute nephritic syndrome
2) Nephrotic syndrome
3) RPGN
4) Chronic nephritis
5) Asymptomatic hematuria
How do tubulointerstitial diseases present in children?
Tubular dysfunction syndromes
How do structural renal diseases present in children?
Usually antenatally detected but can present as:
1) UTIs
2) Voiding dysfunction
3) Abdo mass
What are 4 differentials for red/dark-coloured urine?
1) Haematuria
2) Haemoglobinuria
3) Myoglobinuria
4) Drugs/chemicals (eg. Rifampicin)
5) Bacteria (can be contaminated samples by
6) Food (beetroot,
What is the clinical definition of haematuria?
MUST HAVE 2/3 positive tests (can be transient due to any infection)
> 5 RBC/mm^3 in fresh uncentrifuged midstream urine (KKH)
OR
3 RBC/mm^3 in fresh centrifuged midstream urine (NUH)
What are 5 non-glomerular causes of haematuria?
1) UTI
2) Hypercalciuria
3) Trauma
4) Renal calculi
5) PCKD
6) Exercise-induced
7) Nutcracker syndrome
8) Coagulopathies
9) Malignancy (Wilm’s in kids, RCC in adults)
10) Factitious
What are 5 glomerular causes of haematuria?
1) Thin basement membrane disease (familial or non-familial)
2) GN (esp post-strep, SLE)
3) HUS (post-diarrhea, pneumonia), C3 glomerulopathy
4) Alports syndrome
5) Renal vein thrombosis
6) Interstitial nephritis
How does one differentiate between non-glomerular and glomerular haematuria?
(systemic vasculitis) Edema, HTN, Rash, Joint pain → Glomerular
Voiding symptoms: Pain, frequency, dysuria, fever → non-glomerular
How does one biochemically differentiate between causes of haematuria?
1) Confirm hematuria with urine microscopy
2) Urine culture
3) Urine phase contract microscope
4) Urine protein:Cr ratio
Isomorphic RBC, no casts, no proteinuria → non-glomerular
Dysmorphic RBC, cast, proteinuria → glomerular
What is nutcracker syndrome?
Very tall and thin child
→ no fat separating L renal vein from IVC
→ compression by superior mesentric artery when standing
→ ↑renal venous pressure
→ bursting of blood vessels
→ non-glomerular haematuria
(Exclude by taking urine sample from overnight coz was lying down)
What are 4 important negatives for haematuria Hx?
1) r/o menarche
2) Check for FHx of renal disease, hearing loss, renal stones
3) Differentiate between microscopic and gross haematuria
4) Differentiate between voiding symptoms (Glom) and systemic vasculitis symptoms (non-glom)
What are the relevant Ix for non-glomerular haematuria?
1) Urine calcium: creatitine (for hypercalciuria)
2) Renal US (stones)
3) Doppler US of renal vein (Nutcracker syndrome)
4) Abdominal XR (stones)
5) Cystoscopy
6) Coagulation screen (?haemophilia)
What are the Ix for glomerular haematuria?
1) Screen relatives
2) RP: Urea, Cr
3) Urine protein excretion
4) Serum complements
- ↓ in SLE, C3, Post-infectious GN
5) Audiometry
- high tone hearing loss → alports
6) Genetic analysis
7) Renal biopsy
When is a renal biopsy indicated in a child?
Proteinuria (>1g/day)
- or FHx of IgA nephropathy
What is the clinical definition of proteinuria?
1) Urine dipstick 1+ and above on 3 occasions
2) Urine protein:Cr
- >0.02g/mmol or >0.2g/g
3) Urine albumin: Cr
- >3mg/mmol
Why do you need to do couple renal studies with urine creatitine?
Urine creatinine must be done to adjust other findings eg. protein, electrolytes with hydration status
What is orthostatic proteinuria?
Benign cause of proteinuria due to compression of renal vein (esp in skinny)
- take in early morning
What is the significance of 24hr urinary total protein in haematuria?
Mild: 0.3g/day/1.73m²
Significant: 1.0g/day/1.73m²
Nephrotic: 3.5g/day/1.73m²
- SO MUST ADJUST FOR CHILD’S SIZE
What are 4 causes of intermittent proteinuria?
1) Postural (orthostatic)
2) Fever
3) Exercise
4) Emotional stress
What are 10 differentials for a persistent proteinuria?
Structural:
1) Cystic renal disease
2) Reflux nephropathy
Tubulointerstitial:
3) Proximal RTA (Hereditary)
4) Pyelonephritis
5) Interstitial nephritis
6) Acute tubular nephorsis
7) Analgesic abuse
8) Drugs eg. penicillinamine
9) Heavy metal poisoning
10) Vitamin D intoxication
Glomerular
11) MCD
12) FSGS
13) Mesangiocapillary GN
14) Membranous nephropathy
15) RPGN
16) Post-infectious GN
17) Lupus nephritis
18) IgA nephropathy
19) IgA vasculitis/HSP nephritis
20) Alport syndrome
21) Hep B/C/HIV nephropathy
22) HUS
23) DM
24) HTN
What is the standard sequence of day and night bowel and bladder continence?
1) Night bowel control
2) Day bowel control
3) Day bladder control
4) Night bladder control
How is intermittent nocturnal incontinence (enuresis) classified?
1) Primary
- never dry at night for 6mths before
2) Secondary
- wetting after dry period for at least 6mths
3) Monosymptomatic
- normal voiding
4) Polysymptomatic
- a/w daytime symptoms (eg. incontinence, urgency, frequency, holding maneuvers, straining, weak stream, chronic constipation, encopresis)
When is intermittent incontinence medically significant?
If >4years old
OR if previously attained bladder control
What are important questions for a child with intermittent incontinence?
1) Fluid intake before bed
2) Daytime voiding pattern
3) Frequency of bedwetting
4) Sleep Hx (bedtime, depth of sleep, alarm)
5) UTI
6) Bowel habits (constipation, encopresis/leaking)
7) Diet Hx (fluid, solid)
8) Psychosocial Hx
9) Emotional impact
