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paediatric nephrology Flashcards

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1
Q

functions of kidneys

A
  • waste handling
  • water handling
  • salt balance
  • acid base control
  • endocrine
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2
Q

neonate GFR

A

20-30ml/min/1.73m2

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3
Q

3 major components of glomerular basement membrane

A
  1. fenestrated endothelial cells
  2. glomerular basement membrane
  3. podocyte with slit diaphragms
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4
Q

what does proteinuria indicate

A

glomerular injury

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5
Q

features of nephritic syndrome

A
  • increasing haematuria

- intravascular overload

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6
Q

features of nephrotic syndrome

A
  • increasing proteinuria

- intravascular depletion

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7
Q

what component of glomerular filter is damaged in minimal change disease

A

epithelial cell

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8
Q

what component of glomerular filter is damaged in post infectious glomerulonephritis

A

basement membrane

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9
Q

what component of glomerular filter is damaged in haemolytic uraemic syndrome

A

endothelial cell

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10
Q

what component of glomerular filter is damaged in IgA nephropathy

A

mesangial cell

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11
Q

ways of measuring proteinuria

A
  1. dipstix
  2. protein creatinine ratio
  3. 24hr urine collection (gold standard
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12
Q

what is a normal Pr:CR ratio

A

<20mg/mmol

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13
Q

what is a normal nephrotic range

A

> 250mg/mmol

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14
Q

what effect does nephrotic syndrome have on albumin levels

A

hypoalbuminaemia

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15
Q

typical features of paediatric nephrotic syndrome

A
  • age 1-10
  • normal blood pressure
  • no frank haematuria
  • normal renal function
  • proteinuria
  • hypoalbuminaemia
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16
Q

atypical features of paediatric nephrotic syndrome

A
  • suggestions of autoimmune disease
  • abnormal renal function
  • steroid resistance
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17
Q

treatment of nephrotic syndrome with typical features

A

prednisolone 8 weeks

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18
Q

side effects from high dose glucocorticoids

A
  • change of behaviour
  • sleep disturbance
  • increased infection risk
  • hypertension
  • ‘moon face’
  • GI distress
  • increased growth
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19
Q

what percentage of paediatric nephrotic syndromes relapse

A

80%

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20
Q

name an acquired type of steroid resistant nephrotic syndrome

A

focal segmental glomerulosclerosis

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21
Q

when would you investigate paediatric microscopic haematuria

A

trace on 2 occasions

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22
Q

when would you immediately investigate paediatric haematuria

A

macroscopic/ frank

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23
Q

lower urinary tract causes of haematuria

A
  • sarcomas
  • stones
  • uti
  • trauma
  • urethritis
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24
Q

renal causes of haematuria

A
  • glomerulonephritis
  • tumour
  • cysts
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25
components of nephritic syndrome
- haematuria - proteinuria - reduced GFR - fluid overload - raised JVP - hypertension - worsening renal failure
26
what component of glomerular filter is damaged in lupus
epithelial cell endothelial cell mesangial cell
27
what component of glomerular filter is damaged in FSGS
epithelial cell
28
what component of glomerular filter is damaged in post infectious glomerulonephritis (PIGN)
basement membrane | endothelial cell
29
what component of glomerular filter is damaged in membranous glomerulopathy
basement membrane
30
what component of glomerular filter is damaged in haemolytic uraemic syndrome
endothelial cell
31
what component of glomerular filter is damaged in membranoproliferative glomerulonephritis
endothelial cell
32
what component of glomerular filter is damaged in ANCA vasculitis
endothelial cell
33
how long would a throat infection take to develop into acute post-infectious glomerulonephritis
7-10 days
34
how long would a skin infection take to develop into acute post-infectious glomerulonephritis
2-4 weeks
35
treatment of acute post-infectious glomerulonephritis
- antibiotics - support 5 renal functions - manage fluid overload/ hypertension with diuretics
36
what is required for clinical diagnosis of Henoch Schonlein Purpura
``` mandatory palpable purpura 1/4 of: 1. abdo pain 2. renal involvement 3. arthritis or arthralgia 4. biopsy (IgA deposition) ```
37
what is Henoch Schonlein Purpura
IgA related vasculitis
38
treatment of IgA vasculitis
- immunosuppression (trial in moderate to severe renal disease) - long term screening for hypertension and proteinuria
39
whats the most common glomerulonephritis
IgA nephropathy
40
treatment of IgA nephropathy (mild disease)
proteinuria with ACEI
41
treatment of moderate to severe IgA nephropathy
immunosuppression
42
define acute kidney injury
abrupt loss of kidney function, resulting in the retention of urea and other nitrogenous waste products and in the dysregulation of extracellular volume and electrolytes
43
define acute renal failure
- anuria/ oliguria (<0.5ml/kg/hr) - hypertension with fluid overload - rapid rise in plasma creatinine
44
AKI 1
measured creatinine >1.5-2x reference
45
AKI 2
measured creatinine 2-3x reference
46
AKI 3
serum creatinine >3x reference
47
management of acute kidney injury
- paediatric early warning scores - urine output - weight - good hydration - drugs
48
intrinsic renal problem acute kidney injury
- Haemolytic uraemic syndrome - glomerulonephritis - acute tubular necrosis - NSAIDs - autoimmune - drugs
49
post renal causes of AKI
obstructive uropathies
50
typical cause of haemolytic-uraemic syndrome
post diarrhoea (e.coli), up to 14 days after onset of diarrhoea
51
clinical presentation of haemolytic-uraemic syndrome
triad of: - microangiopathic haemolytic anaemia - thrombocytopenia - AKI/ acute renal failure
52
what is this the clinical presentation of: - microangiopathic haemolytic anaemia - thrombocytopenia - AKI/ acute renal failure
haemolytic-uraemic syndrome
53
management of haemolytic-uraemic syndrome
3Ms 1. Monitor: - 5 kidney functions - aware of other organs 2. maintain - IV normal saline and fluid - renal replacement therapy 3. minimise - no antibiotics/ NSAIDs
54
potential other organ complications of haemolytic-uraemic syndrome
- seizures - acute abdomen - diabetes - adrenal crisis
55
chronic kidney disease 2
GFR 60-89
56
CKD3
30-59
57
CKD4
15-29
58
CKD5
0-15
59
below what GFR will you start to experience symptoms
<60
60
diagnosis of UTI
``` - clinical signs plus - bacteria culture from MSSU or - any growth on suprapubic aspiration or catheter ```
61
test results suggestive of UTI
- leucocyte esterase activity, nitrates - pyuria - bacturia
62
what could UTIs in children indicate
vescico-ureteric reflux
63
what UTIs to investigate in paeds
- upper tract symptoms - younger - recurrent
64
recurrent UTI investigations
- USS - DMSA (isotope scanning) - micturating cysto-urethrogram
65
treatment of lower tract UTI
3 days oral antibiotics (trimethoprim)
66
upper tract UTI/ pyelonephritis
- antibiotics 7-10 days - no role for prophylaxis - hydration - hygiene - manage voiding dysfunction
67
factors affecting progression of CKD
- delayed referral - hypertension - proteinuria - high intake of protein, phosphate and salt - bone health - acidosis - recurrent UTIs
68
treatment principles of metabolic bone disease
- low phosphate diet - oral phosphate binders - active vitamin D - growth hormone?

Paediatrics (23 decks)

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