Paediatric Nephrology Lecture Flashcards
(30 cards)
eGFR for children
- Current labs give age range for that child
- But not always relevant as child may be larger/smaller than others their age
- Use creatinine based on height instead - more relevant
Investigations post UTI for children to find cause
- US kidneys - ?hydronephrosis
- Anyone definitely under 6 months NICE recommend imaging, recurrent or atypical
Imaging for hydronephrosis to find cause
- Micturating cystourethrogram
- Fill bladder with fluroscent dye
- See what happens
- Give prophylactic antibiotics for catheter insertion
Cause of hydronephrosis in children
- Obstructive cause
- Reflux cause - vesicoureteric reflux
Management of vesicoureteric reflux
- Prophylactic abx
- Surgical - deflux (narrowing ureteric orifices), re-implantation of ureter (bury into muscle)
Complication of hydronephrosis
- Reflux nephropathy
Places where obstruction often occur
- Ureter joins kidney - uretropelvic junction
- Ureter joins bladder - ureterovesical junction
- Posterior urethra - posterior urethra valves (esp younger boys)
Severe posterior urethral valve cases can present as
Detected on antenatal scans during pregnancy with oligohydramnios and hydronephrosis.
How to scan for damage to kidneys post severe infection?
- DMSA - nuclear medicine scan
- Do post 4-6 months
Nephrotic syndrome triad
- Oedema
- Proteinuria
- Hypoalbuminaemia
Usually + hypercholestrolaemia
Most common cause of nephrotic syndrome in children
Idiopathic
Management of idiopathic nephrotic syndrome
- High dose steroids
- 4 weeks
- Then alternate days for 4 weeks
- Home monitoring of proteinuria
Investigations for ?idiopathic nephrotic syndrome
- Check antibody levels
- Check immunity to chicken pox - can make unwell if immunosupressed on steroids
- If no antibodies - give aciclovir for contacts and IgG if have chicken pox
What can occur after treatment for nephrotic syndrome in children?
- Remission - negative protein urine for 3 days in a row
- Relapse - urine 3+ or more for 3 days
- Frequent relapse - 2 or more relapses in 6 months, 4 or more in 12
- Steroid dependence - relapse whilst on steroids or within weeks of stopping them
What can be done for severe oedema that is not resolving in nephrotic syndrome?
- IV albumin infusions
- With diuretics (after fluid is then within vessels) - do not give if dehydrated
Minimal change disease vs idiopathic neprhotic syndrome
- Minimal change disease diagnosis can be done after biopsy
- Most children do not have biopsy due to risk
- Therefore could be underlying cause of this but don’t know
Risk factors for nephrotic syndrome
Estimating normal BP in children
- Use chart with height
- Anything over 120 is not normal
Triad nephritis
- Haematuria
- Proteinuria
- Reduced kidney function
Two most common causes of nephritis in children
- Post streptococcal glomerulonephritis
- IgA nephropathy
Investigations for ?post strep GN
- Complement levels C3 and C4 - usually falls and then recovers
- Anti-streptolysin O level - elevated
- Renal US - check for renal tumour
When does post strep GN occur?
- 1-3 weeks following group A streptococcus (GAS) infection
- e.g., tonsillitis caused by Streptococcus pyogenes
Management of nephritis
- Diuretics - improves urine output and HTN
Other causes of nephritis syndrome
- Henoch schloen purpura - rash, vasculitis, joint pains, abdo pain, blood stool
- SLE
- ANCA
- Anti glomerular basement membrane disease
- MPGN type 1 or 2
