Paediatric Nephrology

Question 1

What are the features of the glomerular filtration barrier?

Answer 1

Fenestrated endothelial cells
Glomerular basement membrane
Podocytes

Question 2

What are some causes of acquired glomerulopathy?

Answer 2

SLE

IgA nephropathy

Question 3

What are the differences between nephritic syndrome and nephrotic syndrome?

Answer 3

Nephritic syndrome (increasing haematuria, intravascular overload) 
Nephrotic syndrome (increasing proteinuria, intravascular depletion)

Question 4

What is nephrotic syndrome?

Answer 4

Nephrotic range proteinuria causing hypoalbuminaemia and oedema

Question 5

What is the presentation of nephrotic syndrome?

Answer 5

Oedema (periorbital, pitting oedema legs)
Pale
Frothy urine

Question 6

How is proteinuria tested?

Answer 6

Dipstix
Protein creatinine ratio (early morning urine best)
24hr urine collection

Question 7

What other investigations can be used for proteinuria?

Answer 7

Bloods (low albumin, normal creatinine)

Question 8

What is the treatment for nephrotic syndrome?

Answer 8

Prednisolone 8 weeks

Question 9

What are the side effects from high dose glucocorticoids?

Answer 9

Behaviour
Susceptibility to infection (varicella status, pneumococcal vaccinated)
Hypertension

Question 10

What are the causes of macroscopic haematuria?

Answer 10

UTI 
Trauma 
Stones 
Glomerularnephritis 
Clotting abnormalities

Question 11

What are the causes of microscopic haematuria?

Answer 11

UTI 
Trauma 
Stones 
Nephrotic syndrome 
Sickle cel disease 
Glomerularnephritis 
HSP

Question 12

What are the features of nephritic syndrome?

Answer 12

Haematuria 
Proteinuria 
Oliguria 
Rased JVP 
Oedema 
Hypertension 
Worsening renal failure

Question 13

What investigations should be used to diagnose nephritic syndrome?

Answer 13

Bloods (raised creatinine)
Urine culture
US

Question 14

What are the causes of glomerulonephritis?

Answer 14

Post Infect GN
IgA nephropathy / HSP
Membranoproliferative GN
Lupus Nephritis  
ANCA positive vasculitis
Haemolytic uraemic syndrome
Alport’s syndrome
Thin Basement Membrane Disease

Question 15

What is the common cause of acute post infectious GN?

Answer 15

Group A strep

Question 16

How is a diagnosis acute post infectious GN?

Answer 16

Bacterial culture

Question 17

What is the treatment for acute post infectious GN?

Answer 17

Antibiotics

Diuretics for hypertension and overload

Question 18

What are the features of IgA nephropathy?

Answer 18

Recurrent macroscopic haematuria
Chronic microscopic haematuria
Varying degree of proteinuria

Question 19

How is a diagnosis of IgA nephropathy made?

Answer 19

Biopsy

Question 20

What is the treatment for IgA nephropathy?

Answer 20

ACE inhibitors

Question 21

What are the features of HSP (IgA related vasculitis)?

Answer 21

Palpable purpura - mandatory 
Abdominal pain 
Renal involvement 
Arthritis or arthralgia 
Biopsy (IgA deposition)

Question 22

What is the treatment for IgA vasculitis?

Answer 22

Symptomatic treatment of joints and gut
Glucocorticoid therapy
Immunosuppression
Long term hypertension and proteinuria screening

Question 23

What are the main features of acute kidney injury?

Answer 23

Anuria/oliguria
Rapid rise in plasma creatinine
Hypertension with fluid overload

Question 24

What is the management for acute kidney injury?

Answer 24

Prevention
Monitor urine output, PEWs, BP, weight
Maintain good hydration
Minimise drugs

Question 25

What are the causes of acute kidney injury?

Answer 25

``` Glomerulonephritis HUS Acute tubular necrosis NSAID Autoimmune Obstructive (post renal) ```

Question 26

What are the causes of haemolytic uraemia syndrome?

Answer 26

E Coli Pneumococcal infection Drugs

Question 27

What are the presenting symptoms of HUS?

Answer 27

Bloody diarrhoea Abdominal pain Fever Vomiting

Question 28

What occurs with HUS?

Answer 28

Microangiopathic haemolytic anaemia Thrombocytopenia Acute renal failure

Question 29

What is the management of HUS?

Answer 29

``` Monitor fluid balance, electrolytes, acidosis, hypertension Maintain IV normal saline and fluid, renal replacement therapy Minimise drugs (no antibiotics) ```

Question 30

What are the long term consequences of acute kidney injury?

Answer 30

Blood pressure Proteinuria monitoring Evolution to CKD

Question 31

What are the causes of chronic kidney disease?

Answer 31

Congenital anomalies of kidney and urinary tract (CAKUT) Glomerulonephritis Cystic kidney disease

Question 32

What are the stages of CKD?

Answer 32

2 GFR 60-89 3 GFR 30-59 4 GFR 15-29 5 end stage renal disease

Question 33

What is the presentation of CKD?

Answer 33

Bladder dysfunction

Question 34

How is a urine sample obtained in children?

Answer 34

Clean catch urine or mid stream sample Collection pads, urine bags Cather samples Suprapubic aspiration

Question 35

How is a diagnosis of UTI made in children?

Answer 35

Dipstix Microscopy Culture

Question 36

What investigations can be used in children for urology?

Answer 36

US DMSA (isotope scan) Micturating cystourethrogram (MAG)

Question 37

What is the treatment for children with UTIs?

Answer 37

3 days oral antibiotics (lower tract) 7-10 antibiotics (upper tract/ pyelonephritis) Prevention with fluids, hygiene

Question 38

What factors affect the progression of CKD?

Answer 38

``` Late referral Hypertension Proteinuria High intake of protein, phosphate and salt Bone health Acidosis Recurrent UTIs ```