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Paediatrics > Nephroology > Flashcards

Nephroology Flashcards

1
Q

What GFR do children have?

A

20-30ml/min

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2
Q

When do the kidneys fully mature?

A

2 years

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3
Q

What are the 5 kidney functions?

A 
Waste handling
Water handling
Salt balance
Acid-base control
Endocrine
-RBC's, BP and bone health
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4
Q

What is the glomerular filtration barrier?

A

Endotheial cells
GBM
Podocytes
Mesagial cells

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5
Q

How do patients present?

A

Haematuria

Proteinuria

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6
Q

What is glomerulopathy

A

Blood and protein in varying amounts dictates the presentation and diagnosis

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7
Q

What does proteinuria signify?

A

Glomerular injury

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8
Q

What is nephritic syndrome?

A

Increasing haematuria

Intravascular overload

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9
Q

What is nephrotic syndrome?

A

Increasing protienuria
Hypoalbuminaemia
Oedema (increasing 3rd space fluid volume)

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10
Q

What is acquired glomerulopathy?

A 
Common 
Affects:
-Epithelial (minimal change disease)
-BM (Post infections glomerulonephritis)
-Endothelial cell (PIGN or haemolytic uraemic syndrome)
-Mesangial cell  (HSP, IgA nephropathy)
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11
Q

What is congenital glomerulopathy?

A

Rare

  • Podocyte cytoskeleton integrity (cngenital nephrotic syndrome)
  • BM proteins (alport syndrome, thin BM disease)
  • Endothelial integrity (MPGN)
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12
Q

What is the normal vs. nephrotic protein:creatinine ratio range?

A 
Normal = <20mg/mmol
Nephrotic = >250mg/mmol
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13
Q

What is the typical paediatric presentation?

A

Gastroenteritis
3-4 days = swelling face, eyes closed in the morning and legs
Looked well but pale
Perioribital oedema and pitting oedema, ascites and pleural effusion
Frothy urine

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14
Q

How to diagnose nephrotic syndrome?

A

Oedema
Proteinuria (protein cratinine ratio and Na)
Blood (albumin low, normal creatinine)

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15
Q

What are the typical features of nephrotic syndrome?

A

Age 1-10
Normal BP
No frank haematuria
Normal renal function

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16
Q

What are the atypical features of nephrotic syndrome?

A

Suggestions of autoimmune disease
Abnormal renal function
Steroid resistance

-Consider biopsy

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17
Q

What are the treatments for nephrotic syndrome?

A

If typical features = pred for 8 weeks

There are side effects from high dose glucocorticoids (Cushing’s)

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18
Q

What does treatment for nephrotic syndrome depend on?

A

Sensitivity to steroids

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19
Q

What happens in steroid sensitive nephrotic syndrome?

A

Interactions between lymphocytes and podocytes = loss of size and charge barrier

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20
Q

What happens in steroid resistant nephrotic syndrome?

A

Aquired = focal segmental glomeruloscerosis = podocyte loss and progressive inflammation and sclerosis

Congenital = Podocyte loss, NPHS1 - nephrin and NPHS2 podocin

21
Q

What are the causes of haematuria?

A

Clotting disorders
Renal = glomerulonephritis, tumour or cysts

Malignancies, stones, UTI, trauma or urethritis

22
Q

What is haematuria with associated proteinuria assocaited with?

A

Glomerular disease

23
Q

What are some aquired glomerulopathy?

A
  • Epithelial cell (MCD/SSNS, FSGS or lupus)
  • BM (PIGN, membranous glomerulopathy)
  • Endothelial cells (PIGN, haemolytic uraemic syndrome)
  • Mesangial cell (HSP / IgA nephropathy)
24
Q

What is post infectious glomerulonephritis?

A

Usually group A strep

Beta haemolytic

25
Q

How to diagnose Post infectious glomerulonephritis?

A

Bacterial culture
Positive AOST
Low C3 normalises

26
Q

What is the treatment for Post infectious glomerulonephritis?

A

AB’s
Support renal function
Overload / hypertension = diuretics

Outcome is self limiting and not recurrent

27
Q

What is henoch schonelin purpura IgA related vasculitis?

A 
Non streptococcal post infectious GN
Diagnosed on palpable purpura
-Abdominal pain
-Renal involvement
-Arthritis or arthralgia
-Biopsy = IgA deposition
28
Q

What is IgA vasculitis?

A

Most common childhood vasculitis in small vessels - 1-3 days post URTI = nephritis with meangial cell injury
There is also IgA nephropathy and IgA vasculitis with nephritis (HSP)

29
Q

How is IgA vasculitis treated?

A

Symptomatic - joints and gut
Glucocorticoid therapy
Immunosupression

Log term = hypertension and proteinuria screening

30
Q

What is IgA nephropathy?

A

Most common glomerulonephritis
1-2 days after URTI (non-strep)
Recurent and chronic microscopic haematuria
Varying proteinuria

31
Q

How is IgA nephropathy diagnosed and treated?

A

Biopsy to diagnose

Treatment = ACEi for proteinuria
Immunosupression

32
Q

What are the causes of AKI?

A

-Pre renal
-Perfusion problem
-Intrinsic renal problem (glomerular disease, tubular injury and interstitial
nephritis)
-Post-renal (obstructive uropathies)

33
Q

What is haemolytic uraemic syndrome caused by?

A

Entero-haemorrhagic E.coli

Shiga toxin

34
Q

When is the period risk for haemolytic uraemic syndrome?

A

14 days after diarrhoea

Bloody diarrhoea is a medical emergency

35
Q

What can the shiga toxin damage

A 
Kidneys
Brain
Lung
Pancreas
Adrenals
Heart
36
Q

What is the triad of haemolytic uraemic syndrome?

A

Microangiographic haemolytic anaemia
Thrombocytopenia
AKI or renal failure

37
Q

How to manage haemolytic uraemic syndrome?

A

Monitor
Maintain (IV saline)
Minimise

38
Q

What are the long term consequences of AKI?

A

BP
Proteinuria monitoring
Evolution to CKD

39
Q

What can cause CKD?

A

Congenital

  • Reflux nephropathy
  • Dysplasia
  • Obstructive uropathy

Heredirary conditions

Glomerulonephritis

40
Q

What can CAKUT be associated with?

A

Turner
Trisomy 21
Branchio-oto-renal
Prune belly syndrome

41
Q

What are the stages of CKD

A 
1 = 90-120
2 = 60-89
3 = 30-59
4 = 15-29
5 = <15 = ESRD
42
Q

Presentation of CKD

A 
Uraemic = loss of appetite, weight loss, itch
Water = polyuria
Balance = lethargy
Endocrine = lethargy
Bladder = UTI's
43
Q

How to diagnose UTI in children

A

Clinical signs plus

  • Bacterial culture from MSSU
  • Growth on supra-pubic aspiration or catheter
44
Q

What are upper urinary tract symptoms?

A

Fever, vomiting, lethargy, irritability, abdo pain, poor feeding

45
Q

What are UTI upper tract symptoms?

A

Fever, vomiting, lethargy, irritability, abdo pain, poor feeding

46
Q

How to investigate a UTI

A

USS
DMSA for scaring and function
MAG 3 scan for assessing renal drainage and obstruction

47
Q

What are the treatments for UTI?

A

Lower tract = 3 days AB’s

Upper tract = 7 days AB’s, prevention, fluids, hygiene and constipation

48
Q

What are the factors that affect progression of CKD

A 
Late referral 
Hypertension 
Proteinuria
High intake of protein, phosphate and salt
Bone health
Acidosis
Recurrent UTI's

Paediatrics (15 decks)

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