paediatric nephrology Flashcards by Laurence Forsyth

4 functions of the kidney

fluid and electorlyte homeostasis

excreiton of waste products and drugs

hormonal

acid-base homeostasis

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hormones involves in the kidneys 4

vit d

ertyhrypoetin

renin

prostaglandin

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top 5 renal disease presentations

Flank mass
Haematuria
Proteinuria with/without oedema
Polyuria/oliguria
Hypertension

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name for bilateral absent kidneys

potters syndrome
-renal agenesis

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how do kidneys appear in muticystic dysplastic kidneys

irregular cysts w no normal renal tissue

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define a duplex kideny

two ureters coming from one kidney

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describe the ureters in a duplex kidney and how they can lead to pathology

upper pole ureter
-obstruct and can be assocated with a ureterocoele

lower pole ureter
-tends to reflux
-vesicoureteric reflux

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what causes a horseshoe or pelvic kidney

abnormal caudal migration

-causes kdineys to fuse together and cause this shape

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where do horseshoe kidneys tend to fuse

in the midline at the lower poles

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what can an obsturction of teh urinary tract cause 3

bladder diverticulae

hydroureters

hydronephrosis

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three common obstructions of the urinary tract (anatomically)

posterior urethral valves

vesicoureteric obstruction

pelviureteric obstruction

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what does an obstruction from posterior urethral valves cause 3

bladder hypertrophy

unilateral or bilateral hydronephrosis

renal failure

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top 4 cuases of oedema in children

heart failure

nephrotic syndrome

liver failure

malnurition

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values indicitative of nephrotic syndrome 3

proteinuria >1g/m^2/day

hypoalbuinaemia <25g/L

high protein to creatinet ratio in early morning urine sample (>150mg/mmol)

*-also oedema

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classifications of nephrotic syndrome 3

idiopathic

secondary

congenital

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types of idopathic nephrotic syndrome 2

minimal change disease (80-90%)

focal segmental glomeruloscelrosis (10-20%)

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types of secondary nephrotic syndrome 2

HSP

SLE

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investigations for nephrotic syndrome 7

FBC,

UEs,

LFTs,

C3/C4

varicella status

ASOT

urine -protein creatine ratio
-culture

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complications of nephrotic syndrome 4

hypovolaemia - intravuascualry depleted

thrombosis

infection (loss of Ig and complement in urine)

hypertension

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treatment for nephrotic syndrome 5

prednisolone - inital high dose w reducing course

20% albuim + furosemid for hypovolaemia or symptomatic oedema

pneumococcal vaccination

penicillin prophlyaxis for risk of encapsulated organism infection

salt/fluid restirction

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presenation of nephrotic syndrome in children

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suually swelling of face

-then followed by swelling of the entire body

foamy urine

triad of nephrotic syndrome

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oedema, substantial proteinuria (> 3.5 g/24 hours) and SERUM hypoalbuminaemia (< 30 g/L)

causes of proteinuria 3

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glomerular disease -Glomerulosclerosis, Glomerulonephritis (GN), Nephrotic
syndrome, Familial haematuria, Disease related

tubular

physilogical stress- strenous exercise, exposure to cold, febrile illness or CHF

how can haematuria be split

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macro and microscopic

non-glomerular cuases of haematuria 9

o Infection (commonest) o Trauma o Stones o Sickle Cell o Coagulopathy/Bleeding disorder o Renal Vein Thrombosis o Tumour o Structural abnormality (PUJ obstruction) o Munchausen by proxy

glomerular causes of haematuria

acute or chornic glomeruonephritis IgA nephropahty familial nephritis

history of haematuria 7

pain -presence, site and nature timing - at begining middle or end of micturition trauma recent URTI rash meds FHx of renal disease or early deafness

investgations for haematuria blood tests 6

-FBC, UnEs Coag ASOT ANF (ANA ab) complement

investigations for haematuria Urine 5

MC&S oxalate calcium phosphate and urate levels calcium creatine ration

other investigations for haematuria excluding blood and urine 3

AXR renal USS ± renal biopsy

which children commonly get UTIS 1

ones with structular urinary tract abnormalities -slightly more girls than boys 3% v 1%

when can a UTI in a child lead to scarring

in the prescence of a vesicoureteric reflux -imaging is needs to exclude a VUR

main phyiological cause of UTI

incomplete bladder emptying

why do children have imcomplete bladder empyting 6

infrequent voiding vulvitis hurried mictrution constipation VUR neuropathic bladder

top 5 bacteria causing UTIs in children

o E-Coli (85%) o Proteus (common in boys) o Staphylococcus o Klebsiella, Enterococcus o Pseudomonas (may indicate structural abnormality)

symptoms of a UTI during infancy 7

fever vomitng lethargy irritabilituy poor feeding failure to thrive sepsis ± shock

symptoms of UTI in older children 10

frequency dysuria change in continence abdo pain loin tenderness fever malaiase vomiting haematuria

symptoms of upper tract UTI 3

bacteruira fever loin pain

investgations for UTI

urgent micrsopy and cultre in <3mnths urine dipstick MSSU culture and sensitity -GOLD STANDARD imaging

regarding UTI culture what results would indicate a positive diagnosis of a UTI 3

Bacteruria (organisms seen) ± Pyuria (pus cells) -treat as UTI Pyuria + clinical features - treat as UTI

what urine dipstick results would indicate treatment for a UTI - 3 different scenarios

 If leukocyte and nitrite positive – culture and treat  If Nitrite positive and leukocyte negative – culture and treat  If leukocyte positive and nitrite negative – culture but only treat if clinically UTI

what value indicates a positve MSSU

>10(x5) organism/ml

USS in a UTI for <6mnth old

acute USS if reccurent or atypical UTI otherwise USS at 6 weeks

USS in a UTI for >6mnth old

Atypical infection: USS acutely and DMSA at 4-6 months (if less than 3 years)  Recurrent infection: USS 6 weeks post infection and DMSA at 4-6 months DMSA- scintigraphy scan - also uses technetium

treatment for UTI in children

IV ABx if <3mnths guided by sensitivites and cultures AWARE-most UTIs are resistant to Amox

prevention of reccurrent of UTi in children 4

o Fluids o Prevention or treatment of constipation o Complete bladder emptying o Good perineal hygiene in girls

methods of collecting urine in children and babies 5

 Clean catch- sterile silver foil dish placed strategically and patiently wait whilst encouraging oral fluids. Used in young children and babies unable to do an MSSU.  MSSU (mid-stream specimen urine/clean catch): ‘Gold standard’ mid stream urine into a sterile pot  CSU (catheter specimen urine): sample taken from a catheter  SPA (suprapubic aspiration)- rarely if ever used  Urine Bags – not sterile, better for volume measurement

define acute renal failure and a value

sudden reduction in renal function oliguira <0.5ml/kg/hr

pre-renal causes of acute renal failure 2

hypovolaemia cardiac faliure

renal causes of acute renal failure 4

vascular - HUS tubular -Acute tubular necrosis glomerular -eg glomerulonephritis interstitial - Drugs (NSAIDs)

post renal causes of acute renal failure 1

urinary obstruction

5 indications for dialysis

severe volume overload severe hyperkalaemia symptomatic uraemia severe metabolic acidosis removal of toxins

paediatric nephrology Flashcards

(52 cards)