Paediatric Nephrology Flashcards
(44 cards)
What is the normal GFR for a neonate and a 2yr old?
- Neonate: 20-30ml /min/1.73m2
- 2yrs: equals adult 90-120
What are the five functions of the kidneys?
- Waste handling
- Water handling
- Salt balance
- Acid base control
- Endocrine: red cells/ blood pressure/ bone health
Name the components of the glomerular filtration barrier
- Endothelial cell
- GBM
- Podocyte
- Mesangial cells
What is proteinuria a sign of?
Glomerular injury
What are the features of nephritic syndrome?
- Increasing haematuria
- Intravascular overload
What are the features of nephrotic syndrome?
- Increasing proteinuria
- Intravascular depletion
Name some of the common acquired glomerulopathies and which component they affect
- Minimal change disease: podocytes
- Post infectious glomerulonephritis: basement membrane and endothelial cell
- Haemolytic uraemic syndrome: endothelial cell
- HSP/IgA nephropathy: mesangial cell
Name some of the congenital (rare) glomerulopathies
- Congenital nephrotic syndrome
- Alport syndrome
- Thin basement membrane disease
- Membranoproliferative glomerulonephritis
How can proteinuria be measured and how much is abnormal?
- Dipstix: > 3+
- Protein creatinine ration >250mg/mmol is nephrotic
- 24hr urine collection > 1g/m2/24hrs
What are the features of nephrotic syndrome?
- Nephrotic range proteinuria
- Haematuria (not frank)
- Hypoalbuminaemia
- Oedema
- Low albumin
- Normal creatinine, blood pressure and renal function
What are the atypical features of nephrotic syndrome?
- Suggestion of autoimmune disease
- Abnormal renal function
- Steroid resistance
How can nephrotic syndrome be treated?
Prednisolone for 8 weeks (if typical features)
What are the side effects of high dose glucocorticoids?
- Personality changes
- Hypertension
- Increased in GI acid
- Reduced growth
- Increased susceptibility to infection (think of varicella status, pneumovax and antibiotic prophylaxis)
- Sleep disturbance
What are the causes of steroid resistant nephrotic syndrome
- Acquired: focal segmental glomerulosclerosis
- Congenital: infant presentations, NPHS1/2 and podocyte loss
What are the causes of haematuria?
- Clotting disorders
- Glomerulonephritis
- Tumours
- Cysts
- Stones
- UTI
- Trauma
- Urethritis
How can frank haematuria be investigated?
- Bloods: creatinine, U&Es, FBC and albumin
- Urine: urine culture and protein creatinine ratio
What are the features of nephritic syndrome?
- Haematuria
- Proteinuria
- Oliguria
- Fluid overload: raised JVP and oedema
- Hypertension
- Self limiting
How can post infectious glomerulonephritis be investigated?
- Renal USS
- ASOT
- Throat swab fro group A strep
- C3
- Autoimmune immunology
- Biopsy is not required
How can acute post infectious glomerulonephritis be treated?
- Antibiotics
- Support of renal function (electrolyte and acid base)
- Diuretics (overload/hypertension)
What are the features of IgA related vasculitis (Henoch Schonlein purpura)?
- Non strep post infectious GN (1-3 days after infection)
- Palpable purpura plus one of:
- Abdo pain
- Renal involvement
- Arthritis or arthralgia
- Biopsy
How can IgA vasculitis be treated?
- Symptomatic
- Glucocorticoid (not in mild)
- Immunosuppression
- Long term hypertension and proteinuria screening
How does IgA nephropathy present?
- Older children and adults
- Recurrent macroscopic haematuria +/- chronic microscopic haematuria
- Varying degree of proteinuria
How can IgA nephropathy be diagnosed?
- Clinical picture
- Negative autoimmune workup
- Confirmation biopsy
How can IgA nephropathy be treated?
- Mild: ACE inhibitors
- Moderate to severe: immunosuppression
