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Paediatrics > Nephrology > Flashcards

Flashcards in Nephrology Deck (44):
1

What are the functions of the kidney? 

  1. Waste handling - urea/creatine
  2. Water handling 
  3. Salt balance - sodium, potassium, calcium, phosphate
  4. Acid base control - bicarb
  5. Endocrine
    • red cells / blood pressure / bone health

2

How do patients present? 

Haematuria or Proteinuria 

3

What does proteinuria signify? 

Kidney damage

4

What is nephrotic syndrome? 

  • Nephrotic range of proteinuria
  • Causes albumin to drop (Hypoalbuminaemia)
  • Oedema 
  • [protein is like a magnet to water - less protein in blood, less water]

5

SSx of proteinuria? 

  • Frothy urine 
  • Periorbital oedema, pitting oedema legs, ascites, small pleaural effusions

6

How can we test for proteinuria? 

  1. Dipstix
    • >3+ is abnormal
  2. Protein creatinine ratio (this will confirm suspicions)
    • Early morning is best
  3. 24hr urine collection 

7

Minimal Change disease (MCD)

- Nephrotic syndrome

What are typical features? 

  • Age (2-5yrs)
  • Normal blood pressure
  • Resolving microscopic haematuria
  • Normal renal function

8

MCD

What are atypical features?

When would we biopsy? 

  • Suggestions of autoimmune disease
  • Abnormal renal function
  • Steroid resistance
  • Only biopsy if there is suggestion of atypical features! 

9

Rx for MCD

main side effect in kids

  • Prednisolone 8 weeks
  • Difficult behavior 

10

Outcomes of MCD

  • •Remission
    • –95% in 2-4 weeks
  • •Relapse
    • –80%
      • •50% frequent
  • •80% long term remission

11

What is a steroid resistant nephrotic syndrome? 

  • Acquired
    • Focal Segmental Glomeruloscerosis (FSGS)
  • Congenital
    • NPHS1 – nephrin 

    • NPHS 2 – podocin

12

What are the two different types of haematuria? 

How do we test? 

Microscopic and Macroscopic 

Do a urine dipstix 

13

What is persistant haematuria and proteinuria a sign of? 

glomerular disease

14

What is nephritic syndrome? 

  • Clinical diagnosis
    • describes glomerulonephritis
  • Haem + proteinuria 
  • Reduced GFR
    •  fluid overload: raised JVP, oedema 
    • Hypertension 

15

Main two causes of glomerulonephritis (nephritic)? 

  • Post infective GN
  • IgA nephropathy 

16

Who is affected by post infective GN and what is it caused by? 

  • Age of onset: 2-5
  • Cause: Usually Group A Strep
    • normally throat or skin 

17

Disease progression of post infective GN?

Ix? 

Self limiting

  • positive ASOT
  • low C3 normalises

18

Rx for post infective GN? 

  • Antibiotic – penicillin
  • Support renal functions
  • Overload / hypertension
    • Diuretics

19

What is the most common nephritic syndrome? (glomerulonephritis)

IgA nephropathy

20

IgA nephropathy

Who gets it? 

When does it present? 

What is seen on urine? 

  • Older kids and adults
  • 1-2 days after URTI 
  • Urine
    • Recurrent macroscopic haematuria

    • ± chronic microscopic haematuria

    • Varying degree of proteinuria

21

What is the pathogenesis of IgA nephropathy

  1. Increased levels of circulating Gd-IgA1
  2. Production of anti-IgA1 antibodies
  3. Immune complexes form in circulation
  4. Immune complexes form in situ
  5. Immune complexes in the mesangium cause local immune activation & injury 

22

Ix for IgA nephropathy

  • Clinical picture
    • Negative autoimmune workup
    • Normal compliment
  • Confirmation Biopsy

23

Rx for IgA

Mild: ACEi

Severe: Immunosuppresion 

24

What is HSP

Basically it is the same disease of IgA nephropathy except it is effecting the vessels (vasculitis). 

aka Henoch Schonlein Pupura

25

How can we identify HSP

  • Mandatory palpable purpura
  • Plus one of 4
    • Abdo pain, renal involvement, Arthritis, biopsy 

26

What are prodromal features of HSP

  • 1-3 days post trigger
    • Viral URTI in 70%
    • Streptococcus, drugs

27

Rx for HSP

  • Immmunosuppresion
    • Trial in moderate to severe renal disease
  • Long term
    • Hypertension and proteinuria screening

28

What is AKI?

  • Serum creatinine: > 1.5x age specific reference creatinine (or previous baseline if known)
  • Urine output<0.5 ml/kg for > 8hours
    • AKI 1: Measured creatinine >1.5-2x reference creatinine/ULRI

    • AKI 2: Measured creatinine 2-3x reference creatinine/ULRI

    • AKI 3: Serum creatinine >3x reference creatinine/ULRI

29

How do we prevent AKI

3 Ms

  • Monitor
    • Urine Output, PEWs, BP, weight
  • Maintain
    • good hydration
  • Minimise
    • drugs

30

Intrinsic causes of AKI?

  • Glomerular problem: HUS
  • Tubular injury
  • Interstitial nephritis

31

What is HUS

Haemolytic-Uraemic Syndrome

  • Occurs post diarrhoea
  • Entero-Haemorrhagic E.coli (EHEC)

32

Bloody diarrhoea is a medical emergency in children

Rx?

  • Assess for HUS risk (15% will develop)

33

Triad of features of HUS

  • Microangiopathic haemolytic anaemia
  • Thrombocytopenia
  • Acute renal failure / AKI

34

Rx for HUS

  • IV normal saline and fluid

35

What are main causes of CKD

  • Congenital Anomalies of the Kidney and Urinary Tract (CAKUT): reflux nephropathy, dysplasia

36

What factors can increase progression in CKD

  • Hypertension
  • Proteinuria

37

CKD

How do we assess BP in kiddo? 

Doppler – gold standard for under age 5years

38

at what eGFR does CKD become symptomatic? 

  • <60 

39

UTI

How does it present in neonates, pre-verbal kids and verbal kids? 

  • Neonates: vomiting, lethargy, fever, irratability
  • Pre-verbal: Abdo pain, lethary, irratability
  • Verbal: Abdo pain, frequency and dysuria 

40

UTI

How do we urgently obtain a urine sample from a kid?

  • Catheter samples or suprapubic aspiration  (USS)

41

UTI

How do we make a diagnosis? 

  • Dipstix
    • Leucocyte esterase activity, nitrites
    • unreliable < 2 yrs of age  
  • Microscopy
    • Pyuria >10 WBC per cubic mm
    • Bacturia
  • Culture > 105 Colony forming units

    • E.coli

42

Complications of UTI?

Scarring 

43

UTI

Rx? 

  • Oral – From 3 months of age - Trimethorim, Co-amoxiclav, cephalosporin
  • IV - 3rd generation Cephalosporin or Co-amoxiclav, IV Aminoglycosides effective (good renal excretion)
  • Prophylaxis – abnormal urinary tract / VUR grade 3 and above

44

What imaging can we use for kidneys? 

  • ultrasound for structure
  • DMSA (isotope) for scarring
  • MAG3 scan for dynamic