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Flashcards in Nephrology 3 Deck (20)
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1
Q

How are infants with UUTI age >3 months treated?

A

o Consider referral to a paediatric specialist
o Treat with oral antibiotics for 7-10 days- the use of antibiotics with low resistance patterns is recommended, i.e. cephalosporin and co-amoxiclav
o If oral antibiotics cannot be used, treat with IV antibiotics, such as cefotaxime or ceftriaxone for 2-4 days followed by oral antibiotics for a total duration of 10 days

2
Q

How are infants with LUTI age >3 months treated?

A

o Treat with oral antibiotics for 3 days i.e. trimethoprim, nitrofurantoin, cephalosporin or amoxicillin
o The parents or carers should be advised to bring the infant or child for reassessment if the infant or child is still unwell after 24-48 hours- if an alternative diagnosis is not made, a urine sample should be sent for culture to identify the presence of bacteria and determine antibiotic sensitivity if urine culture has not already been carried out
o Antibiotic prophylaxis should not be routinely recommended in infants and children following first- time UTI.

3
Q

What are the causes of vulvovaginitis?

A
o	Infection- bacterial or fungal
o	Specific irritants
o	Poor hygiene
o	Sexual abuse
Rarely associated with threadworm infection
4
Q

What is the management for vulvovaginitis?

A

hygiene, the avoidance of bubble bath and scented soaps and the use of loose-fitting cotton underwear
• Swabs should be taken to identify any pathogens, which can then be specifically treated-
salt baths may be helpful
• Oestrogen cream applied sparingly to the vulva may relieve the problem in resistant cases by increasing vaginal resistance to infection as prepubertal tissues tend to be atrophic

5
Q

What is AKI?

A

sudden reduction in glomerular filtration rate resulting in an increase in blood concentration of urea & creatinine and disturbed fluid & electrolyte haemostasis
oliguria (<0.5 ml/kg per hour)

6
Q

How can AKI be classified?

A

Prerenal (most common): hypovolaemia, burns, sepsis, haemorrhage, nephritic syndrome
Renal: HUS, vasculitis, embolus, renal vein thrombosis, ATN, glomerulonephritis, pyelonephritis
Postrenal: obstruction, congenital- posterior urethral valves, blocked urinary catheter

7
Q

How is prerenal failure managed?

A

suggested by hypovolaemia- the fractional excretion of sodium is very low as the body tries to retain fluid
• The hypovolaemia needs to be urgently corrected with fluid replacement and circulatory support if acute tubular necrosis is to be avoided

8
Q

How is renal failure managed?

A

• If there is circulatory overload- restriction of fluid intake and challenge with a diuretic may increase urine output sufficiently to allow gradual correction of sodium and water balance
• A high-calorie, normal protein feed will decrease catabolism, uraemia and hyperkalaemia
• Emergency management of metabolic acidosis, hyperkalaemia and hyperphosphataemia
a renal biopsy should be performed to identify rapidly progressive glomerulonephritis,as this may need immediate treatment with immunosuppression

9
Q

What are the commonest causes of renal failure in children in the UK?

A

HUS

ATN- usually in the setting of multisystem failure in the ICU or following cardiac surgery

10
Q

How is post renal failure managed?

A
  • This requires assessment of the site of obstruction and relief by nephrostomy or bladder catheterisation
  • Surgery can be performed once fluid volume and electrolyte abnormalities have been corrected
11
Q

What are the causes of CKD?

A
o	Structural malformation- 40%
o	Glomerulonephritis- 25%
o	Hereditary nephropathies- 20%
o	Systemic disease- 10%
o	Miscellanoeus/unknown- 5%
12
Q

What are the stages of CKD?

A

o Stage 1: normal GFR>90 mL/min per 1.73m2 and persistent albuminuria
o Stage 2: GFR 60-89 mL/min per 1.73m2 and persistent albuminuria
o Stage 3: GFR 30-59 mL/min per 1.73m2
o Stage 4: GFR 15-30 mL/min per 1.73m2
o Stage 5: GFR <15 mL/min per 1.73m2 or end stage renal disease

13
Q

What are the clinical features of CKD?

A
o	Anorexia or lethargy
o	Polydipsia and polyuria
o	Failure to thrive/grow
o	Bone deformities
o	Hypertension
o	Acute-on-chronic renal failure
o	Proteinuria
o	Normochromic, normocytic anaemia
14
Q

What are the diet recommendations in kidney disease?

A
  • Anorexia and vomiting are common- improving nutrition using calorie supplements and nasogastric or gastrostomy feeding is often necessary to optimise growth
  • Protein intake should be sufficient to maintain growth and a normal albumin, whilst preventing the accumulation of toxic metabolic by products
15
Q

How is renal osteodystrophy prevented?

A
  • Phosphate retention and hypocalcaemia due to decreased activation of vitamin D leads to secondary hyperparathyroidism, which results in osteitis fibrosis and osteomalacia
  • Phosphate restriction be decreasing the dietary intake of milk products, calcium carbonate as a phosphate binder and activated vitamin D supplements help to prevent renal osteodystrophy
16
Q

How is salt and water balance and acidosis controlled in CKD?

A

obligatory loss of salt and water- they need salt supplements and free access to water
• Treatment with bicarbonate supplements is necessary to prevent acidosis

17
Q

How is anaemia treated in CKD?

A

• Reduced production of EPO and circulation of metabolites that are toxic to the bone marrow result in anaemia, this responds well to the administration of recombinant human EPO

18
Q

What are the hormonal abnormalities in CKD?

A

growth hormone resistance with high growth hormone levels, but poor growth
• Recombinant human growth hormone has been shown to be effective in improving growth for up to 5yrs of treatment, but whether it improves final height remains unknown
• Many children with chronic renal failure have delayed puberty and a subnormal pubertal growth spurt

19
Q

When is transplantation carted out?

A

difficult in very small children and a minimum weight (10kg) needs to be reached before transplantation to avoid renal vein thrombosis- kidneys obtained from living related donors have a higher success rate
1st year graft survival is around 97% for living related and 93% for deceased kidneys in the UK
5yr graft survival is reduced to 91% for living related kidneys and 79% for deceased donor kidney transplants and some children need re-transplantation
• Current immunosuppression is mainly with combinations of prednisolone, tacrolimus and azathrioprine or mycophenolate mofetil

20
Q

What are the dialysis options for CKD?

A
  • Peritoneal dialysis- either by cycling overnight using a machine (continuous cycling peritoneal dialysis) or by manual exchanges over 24 h (continuous ambulatory peritoneal dialysis), can be done by the parents at home and is therefore less disruptive to family life and the child’s schooling
  • Haemodialysis is an alternative and is usually done in hospital 3–4 times a week