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Pediatric Nephrology Flashcards

(55 cards)

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1
Q

How much of the cardiac output does the nephron in the neonate receive ?

A

20-30ml/min

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2
Q

What are the 5 functions of the kidney ?

A 
Waste handling (Urea and creatinine)
Water handli9Sodium and potassium)ng 
Salt balance 
Acid base balance
Endocrine (Red cells/blood pressure/bone health)
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3
Q

In glomerular filtration what is the purpose of the endothelial cells ?

A

Fenestrated
Filter
Vulnerable to immune mediated injury

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4
Q

What 2 proteins are found in the basement membrane ?

A

Type IV collagen (COL4) and Laminin

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5
Q

What cells in the basement membrane of the glomerulus synthesize the proteins ?

A

Podocytes and endothelial cells

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6
Q

What is the role of mesangial cells in the glomerulus ?

A

They are smooth muscle cells within the basement membrane which are structural support of the glomerulus.

They regulate blood flow of the glomerular capillaries.

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7
Q

Proteinuria signifies what ?

A

Glomerular injury

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8
Q

What is the cause of Haematuria and what is the name of the syndrome ?

A

Increasing haematuria and intravascular overload - Nephritic syndrome

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9
Q

What is the cause of Proteinuria and what is the name of the syndrome?

A

Increasing proteinuria and intravascular depletion - Nephrotic syndrome

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10
Q

In an acquired Glomerulopathy which disease/condition attacks the epithelial ells (podocytes) ?

A

Lupus
Focal segmental glomerulitis
Minimal change disease (MCD)

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11
Q

In an acquired Glomerulopathy which disease/condition attacks the basement membrane ?

A

Membranous glomerulopathy
Membranoproliferative Glomerulonephritis.
Post infectious Glomerulonephritis.

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12
Q

In an acquired Glomerulopathy which disease/condition attacks the endothelial cells ?

A

Infection associated glomerulonephritis (PIGN), Haemolytic Uraemic Syndrome (HUS), Membranoproliferative Glomerulonephritis (MPGN), Lupus

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13
Q

In an acquired Glomerulopathy which disease/condition attacks the mesangial cells ?

A

Henoch-Schonlein purpura (HSP)
IgA nephropathy
Lupus

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14
Q

What is nephrotic syndrome?

A

Nephrotic range proteinuria which leads to Hypoalbuminaemia and finally oedema

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15
Q

What are the 3 ways in which we would test for proteinuria in children ?

A

Dipstix
Protein Creatinine Ratio (Early morning urine is best)
24 hour urine collection

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16
Q

What are the clinical signs and symptoms of nephrotic syndrome ?

A

Oedema
Proteinuria
Increased protein creatinine ratio
Low albumin

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17
Q

What are the typical features of minimal change disease?

A

Age 2-5
Normal BP
Resolving microscopic haematuria
Normal renal function

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18
Q

What are the atypical features of Minimal change syndrome ?

A

Suggestions of autoimmune disease
Abnormal renal function
Steroid resistance

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19
Q

What would be the treatment of minimal change disease if the child present with typical signs and symptoms ?

A

Prednisalone for 8 weeks

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20
Q

What are some of the symptoms to glucocorticoid treatment ?

A 
GI side effects
Glucose intolerance 
Hypertension
Risk of adrenal crisis
Growth issues
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21
Q

What is the pathological process of nephrotic syndrome ?

A

Interaction between lymphocytes and podocytes - The glomerular filtration barrier changes size (shrinks) .

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22
Q

What is the second line treatment for nephrotic syndrome ?

A

Immunosupression

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23
Q

What is a form of acquired steroid resistant nephrotic syndrome ?

Study These Flashcards
A

Focal segmental Glomerulosclerosis (FSGS)

Podocyte loss
Progressive inflammation and sclerosis

24
Q

What is a forms/s of congenital steroid resistant nephrotic syndrome ?

Study These Flashcards
A

Presents <3 months of age
Mutations in nephrin and podocin genes
i.e. HPHS 1 and 2

25
What are the types of idiopathic nephrotic syndromes ?
Minimal change FSGS MPGN
26
What are the types of acquired nephrotic syndromes ?
HSP/IgA Lupus Post infectious
27
What are the clinical signs of glomerulonephritis ?
``` Haematuria and proteinuria Reduced GFR Oliguria Fluid overload (Raised JVP and oedema) Hypertension ```
28
What are the causes of GN ?
``` Post infectious GN HSP/IgA nephropathy Membraniproliferative GN Lupus nephritis ANCA +ve vasculitis ```
29
What are the causes of Acute Post Infectious Golmerulonephritis ?
Group A Strep (Throat) | Beta hemolytic
30
How do you diagnose acute post-infectious glomerulonephritis ?
Bacterial culture Positive ASOT Low C3 normaises
31
What is the treatment for acute post-infectious glomerulonephritis ?
Antibiotic Support renal function Overload/hypertension
32
What is the most common glomerulonephritis ?
IgA Nephropathhy
33
What are the clinical signs and symptoms of IgA nephropathy ?
``` Usually occurs 1-2 days after URTI Usually in older children and adults Recurrent macroscopic haematuria Chronic microscopic haematuria Varying degree of proteinuria ```
34
What is the pathogenesis/steps of IgA nephropathy ?
1. Increasing IgA in circulation 2. Production of Anti-IgA antibodies 3a. Immune complexes form in the circulation. 3b. Immune complexes form in situ 4. Immune complexesin the mesangium cause local activation and injury
35
How do you confirm the diagnosis of IgA nephropathy ?
Confirmation via biopsy
36
What is the treatment for IgA nephropathy ?
Mild disease - Proteinuria with ACEi Moderate/severe disease - Immunosuppression
37
What is the clinical picture for a child with IgA related vasculitis ?
``` Age of onset 5-15 Mandatory palpable purpura and one of the following 4: 1. Abdominal pain 2. Renal involvement 3. Arthritis or arthralgia 4. Biopsy (IgA deposition) ```
38
What is HSP ?
IgA vasculitis with Nephritis
39
What is the treatment for IgA Vasculitis ?
Symptomatic (Joints and gut) Glucocorticoid therapy Immunosuppression Hypertension and proteinuria screening
40
Define acute kidney injury (AKI)
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
41
What are the 3 cardinal symptoms of an AKI ?
Anuria/oliguria Hypertension with fluid overload Rapid rise in plasma creatinine
42
What is the management of AKI ?
3 M's Monitor (Urine output) Maintain (good hydration) Minimise (Drugs)
43
What are the causes of AKI ?
Pre-renal | Perfusion problem
44
What are some of the intrinsic renal problems which cause AKI ?
``` Glomerular disease (HUS and GN) Tubular injury (Acute tubular necrosis) Interstitial nephritis (NSAID or autoimmune) ```
45
What is a post-renal cause of an AKI ?
Obstructive
46
When is Haemolytic-Uraemic Syndrome (HUS) typical ?
Post-diarrhoea (Caused by E.coli)
47
What are the presenting symptoms of HUS ?
``` Bloody diarrhoea Triad of: 1. Microangiopathic haemolytic anaemia 2. Thrombocytopenia 3. Acute renal faulire/AKI ```
48
What is the treatment of HUS ?
``` 3 M's: 1. Monitor (5 kidney functions) Fluid balance Electrolytes Acidosis Hypertension 2. Maintain IV Normal saline and fluid Renal relacement therapy 3. Minimise No antibiotics ```
49
What are the long-term consequences of AKI ?
Blood pressure Proteinuria monitoring Evolution to CKD
50
What are the congenital causes of CKD ?
Congenital Anomalies of the Kidney and Urinary Tract (CAKUT) Reflux nephropathy Dysplasia
51
What kinds of investigations are appropriate in analyzing the kidneys ?
USS DMSA (Isotope scan) MAG 3 Scan
52
What is the treatment for lower tract infection of the urinary tract?
3 days PO antibiotics
53
What is the treatment for upper tract infections/pyelonephritis ?
Antibiotics for 7-10 days
54
How do we prevent urinary infections in children ?
Fluids Hygiene Relive constipation Voiding dysfunctin
55
What is the management of CKD ?
``` Waste handling Water handling Salt balance Acid base control Endocrine ```

Paediatrics (17 decks)

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