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Nephrology Flashcards

(67 cards)

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1
Q

What is nephrotic syndrome?

A

Heavy proteinuria

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2
Q

What is nephritic syndrome?

A

Haematuria

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3
Q

What are the 5 kidney functions?

A 
Waste handling
Water handling
Salt balance
Acid base control
Endocrine - adrenal
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4
Q

What are the 3 filtration layers of the glomerulus?

A

Endothelium - fenestrated
Glomerular basement membrane
Podocytes

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5
Q

What makes urine frothy?

A

Protein

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6
Q

What does proteinuria signify?

A

Glomerular injury

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7
Q

What glomerulopathy do you get as a result of podocyte dysfuction?

A

Minimal change disease

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8
Q

What glomerulopathy do you get as a result of basement membrane dysfunction?

A

Post infectious glomerular nephritis

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9
Q

What glomerulopathy do you get as a result of mesangial cell dysfunction?

A

IgA nephropathy

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10
Q

What level of proteinuria on dipstix is too high?

A

> 3+

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11
Q

What is the normal protein creatinine ratio?

A

<20mg/mmol

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12
Q

What is the gold standard for identifying extent of proteinuria?

A

24hr urine collection

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13
Q

What may be seen on examination with nephrotic syndrome?

A

Pale
Inflated weight
Oedematous
Frothy urine

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14
Q

What are typical deatures of nephrotic syndrome?

A

Age 1-10
Normal blood pressure
No frank haematuria
Normal renal fuction

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15
Q

What are atypical features of nephrotic syndrome leading to consideration of biopsy?

A

Suggestions of autoimmune disease
Abnormal renal function
Steroid resistance

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16
Q

How is nephrotic syndrome treated?

A

Prednisolone 8 weeks

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17
Q

What is risk of corticosteroid administration?

A

Iatrogenic Cushings

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18
Q

What do parents notice with high dose glucocorticoids?

A

Behaviour
Sleep disturbance
Mood instability

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19
Q

What percentage of children with nephrotic syndrome respond to treatment?

A

90%

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20
Q

Whatis the general outcome of nephrotic syndrome?

A

95% remission in 2-4 weeks

80% relapse

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21
Q

What acquired nephrotic syndrome will be steroid resistant?

A

Focal segmental glomerulosclerosis

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22
Q

Should frank haematuria always be investigated?

A

Yes

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23
Q

What are causes of haematuria?

A 
Systemic - clotting disorders
Renal - glomerulonphritis
Nephroblastoma
Cysts
UTI
Stones
Urethritis
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24
Q

How is nephritic syndrome diagnosed?

A

Haematuria and proteinuria

Reduced GFR - Oliguria, Fluid overload, Hypertension, progressive renal failure

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25
What is the most common glomerular area affected in nephritic syndrome?
Endothelial cells
26
What is the most common bacterial cause of post infectious glomerulonephritis?
Group A strep - throat 7-10 days after infection or skin 2-4 weeks after
27
How is post infectious glomerulonephritis diagnosed?
Bacterial culture Positive Anti streptolysin O titre Low complement normalises
28
How is post infectious glomerulonephritis treated?
Antibiotics Electrolyte/acid base maintenance Diuretics for fluid overload
29
How is IgA related vasculitis diagnosed?
``` Mandatory palpable purpura One of 4 of: Abdominal pain Renal involvement Arthritis or arthralgia Biopsy ```
30
How long does an episode of IgA vasculitis last?
4-6 weeks
31
How is IgA vasculitis treated?
Treat symptoms - joints and gut, ACEi to reduce proteinuria Corticosteroids for gut involvement Imunosuppression Hypertension and proteinuria screening
32
What causes IgA nephropathy?
Non strep post infectious glomerulonephritis - 1-2 days after URTI
33
What are urine features of IgA nephropathy?
Recurrent macroscopic haematuria Chronic microscopic haematuria Varying degree of proteinuria
34
Does treating strep prevent post infectious glomerulonephrtis?
No
35
What are clinical features of AKI?
Serum creatinine >1.5x age specific reference creatinine | Urine output <0.5ml/kg for 8 hours
36
What is grade 1 AKI?
Measured creatinine >1.5-2x reference creatinine
37
What is grade 2 AKI?
Measured creatinine >2-3x reference creatinine
38
What is grade 3 AKI?
Measured creatinine >3x referenced creatinine
39
How is AKI managed?
3Ms; Monitor - PEWS etc Maintain - hydration Minimise - drugs
40
What re intrinsic causes of AKI?
``` Haemolytic uraemic syndrome Glomerulonephritis Acute tubular necrosis Drugs Autoimmune ```
41
What drugs cause AKI?
NSAIDs
42
What causes acute tubular necrosis?
Hypoperfusion
43
What is the main post renal cause of AKI?
Obstructive uropathies
44
What causes haemolytic uraemic syndrome?
E.Coli producing verotoxin or shigatoxin | Pneumococcal infection
45
How does HUS present?
E.coli O157 infection | Bloody diarrhoea
46
What is the triad of HUS?
Microangiopathic haemolyic anemia Thrombocytopenia AKI
47
What is the most important part of managing HUS?
Maintenance - maintain hydration and salt
48
What are consequences of AKI?
Blood pressure Proteinuria Evolution to CKD
49
What is the most common cause of CKD in children?
Congenital Anomalies of the Kidney and Urinary Tract (CAKUT)
50
What are risk factors for CAKUT?
Turner Trisomy 21 Branchio-oto-renal Prune belly syndrome
51
What is used to stage CKD?
GFR
52
How does uraemia present?
Loss of appetite Weight loss Itch
53
How does salt/acid base imbalance present?
Lethargy - hyperkalaemic
54
How do neonates with UTI present?
Fever Vomiting Lethargy Irritability
55
How do pre-verbal children present with UTI?
``` Fever Abdo pain/tenderness Vomiting Poor feeding Lethargy Irritability ```
56
How do verbal children present with UTI?
Abdominal/loin pain or tenderness Fever Malaise Vomiting
57
What tests can be used for UTI diagnosis?
Dipstix - leukocyte esterase activity, nitrites Microscopy - pyuria, bacturia Culture >10^5 of the same organism
58
What does a high grade of vesico-ureteric reflux mean?
Increased risk of AKI
59
What can happen as a result of UTI?
Scarring
60
What 3 factors lead to scarring?
UTI Vulnerable kidney Vesico-ureteric reflux
61
What kidney investigations can be done?
USS - structure | DMSA isotope scan - scarring and function
62
How is lower tract UTI treated?
3 days oral antibiotic
63
How is upper tract UTI treated?
Antibiotics 7-10 days | Fluids, hygiene, constipation
64
What are the 2 main factors affecting CKD?
Hypertension | Proteinuria
65
What is the gold standard for blood pressure measurement?
Sphigmamometer
66
How is CKD managed?
Minimise weight loss - keep well nourished | Low potassium diet, avoid hyper calcaemia, reduce phosphate
67
What happens to phosphate in kidney damage?
Increases

Paediatrics (25 decks)

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