paediatric nephrology

Question 1

At what age does the egfr begin to match what it is in adulthood

Answer 1

2 years old

Question 2

What are the functions of the kidney

Answer 2

• waste handling (urea + creatinine)
• water handling
• salt balance (sodium / potassium / calcium / phosphate)
• Acid base control (bicarbonate)
• endocrine (Renin aldosterone angiotensin system / PTH / activation of Vitamin D (Vit D = sterole) / Erythropoietin)

Question 3

What is the classical sign of glomerular injury

Answer 3

Proteinuria

Question 4

What proteinuria level on dipstick is abnormal

Answer 4

greater than or equal to 3+

Question 5

What is the best way to check protein creatinine ratio in children

Answer 5

Early morning urine is best

Question 6

What is a normal protein:creatinine ratio

Answer 6

Less than 20mg/mmol
Nephrotic range>250mg/mmol

Question 7

what is the gold standard for measuring proteinuria in children

Answer 7

24 hour urine collection

Question 8

What is nephrotic syndrome characterised by

Answer 8

• Nephrotic range proteinuria - protein 3+ or protein creatinine ratio 1200mg/mmol
• Hypoalbuminaemia
• Oedema
• Hyperlipidemia

Question 9

What is the most common nephrotic syndrome in children

Answer 9

Minimal change disease

Question 10

What is the presentation of nephrotic syndrome in children

Answer 10

• Normal blood pressure
• No frank haematuria
• Normal renal function
• Proteinuria and oedema

Question 11

What is the treatment of nephrotic syndrome

Answer 11

Prednisolone for 8 weeks

Question 12

What does a nephrotic syndrome which is very steroid responsive suggest

Answer 12

Minimal change disease

Question 13

What does a poor steroid response in nephrotic syndrome suggest

Answer 13

Focal segmental glomerulonephritis

Question 14

What is the presentation of nephritic syndrome

Answer 14

• Haematuria
• Porteinuria
• Reduced GFR
• Oliguria
• Fluid overload
• Hypertension

Question 15

What is the usual cause of post infectious glomerulonephritis (post streptococcal glomerulonephritis)

Answer 15

Group A strep

Question 16

What is the management of acute post infectious glomerulonephritis

Answer 16

• Antibiotics
• Electrolytes
• Diuretics for fluid overload

Question 17

What is the presentation of IgA nephropathy

Answer 17

• Occurs 1-2 days after URTI
• Recurrent macroscopic haematuria and chronic microscopic haematuria

Question 18

How is IgA nephropathy diagnosed

Answer 18

Biopsy

Question 19

What is the treatment of IgA nephropathy

Answer 19

• ACEi with mild disease
• Immunosuppression in severe disease

Question 20

What is the presentation of Henoch Schonlein Purpura - IgA related vasculitis

Answer 20

• Age 5-15 years
• Palpable purpura need to be present
  one of the following:
• Abdominal pain
• Renal involvement
• Arthritis or arthralgia

Question 21

What is the treatment of IgA vasculitis

Answer 21

• Symptomatic
• Glucocorticoids ie prednisolone

Question 22

What defines AKI

Answer 22

• Serum creatinine >1.5x normal baseline
• Anuria or oliguria <0.5ml/kg/hour for >8 hours
• Hypertension with fluid overload

Question 23

Describe AKI 1 in paediatrics

Answer 23

Creatinine 1.5/2x reference creatinine range

Question 24

Describe AKI 2 in paediatrics

Answer 24

Measured creatinine 2-3x reference creatinine

Question 25

Describe AKI 3 in paediatrics

Answer 25

Serum creatinine >3x reference creatinine

Question 26

What is the management of an AKI

Answer 26

3 Ms: - Monitor (BP, Urine output and weight) - Mantain (good hydration and acid base balance) - Minimise drugs

Question 27

What is a pre-renal cause of AKI

Answer 27

Perfusion problem

Question 28

What are the renal causes of AKI

Answer 28

- Glomerular disease: haemalytic uraemic syndrome + glomeluronephritis - Tubular injury: acute tubular necrosis - Interstitial nephritis: NSAID + autoimmune

Question 29

What are the post renal causes of AKI

Answer 29

Obstructive uropathies such as BPH or urethral stones etc...

Question 30

What is found on investigation in hameolytic uraemic syndrome

Answer 30

- Packed cell volume <30% - Haemoglobin < 10g/dl - fragmented erythrocytes on blood film - Platelets < 150x10 to the 9 - Serum creatinine raised - GFR<80 - Proteinuria

Question 31

What is the usual cause of HUS (haemolytic uraemic syndrome)

Answer 31

E.coli

Question 32

What is the usual presentation of Haemolytic uraemic syndrome (HUS)

Answer 32

Triad of: - Microangiopathic haemolytic anaemia - Thrombocytopenia - AKI

Question 33

What is the management to provent HUS

Answer 33

Intravascular volume expansion

Question 34

what is the management of haemolytic uraemic syndrome

Answer 34

- Monitor (kidney function) - Mantain (IV normal saline and fluid) - Minimise (no antibiotics or Damn drugs)

Question 35

What is the definition of a UTI according to NICE

Answer 35

Clinical signs + bacterial culture from Midstream urine sample

Question 36

Why are UTIs worrysome in paediatrics

Answer 36

Vesico-ureteric reflux which can result in the infection ascending

Question 37

What investigations are done in UTIs in children

Answer 37

- Ultrasound within 6 weeks - DMSA - Micturating cysto-urethrogram - takes image while child urinated

Question 38

What is the treatment for a lower tract UTI in children

Answer 38

3 day oral antibiotic

Question 39

What is the treatment of an upper tract UTI such as pyelonephritis

Answer 39

Antibiotics for 7-10 days orally if they are systemically well

Question 40

What is the gold standard device to measure blood pressure

Answer 40

Sphygmomanometer