10. Nephrology part 2 Flashcards
What is haemolytic uraemic syndrome?
Triad of microangiopathic haemolytic anaemia
Thrombocytopenia
Acute kidney injury/ Acute renal failure
What causes haemolytic uraemic syndrome?
Typically E.coli 0157 or shiga toxin
can also be caused by pneumococcal infections and drugs
How do you treat haemolytic uraemic syndrome?
3 M's Monitor Fluid balance- hypertension Electrolytes Acidosis Waste Hormones- hypertension
Miantian IV saline and fluid
Renal erplacement therapy
Minimise antibiotics/ NSAIDS
What are the different types of chronic kidney disease?
Congenital anomalies of the kidney and the urinary tract (CAKUT)- reflux nephropathy, dysplasia, obstructive uropathy (posterior urethral valves)
Hereditary conditions- 17%, cystic kidney diseasem cystinosis
Glomerulonephritis
What is important to note about CAKUT?
May not be isolated: Turner Trisomy 21 Branchio-oto-renal Prune belly syndrome
How does CKD present?
Different symptoms depending on what kidney function is most affected? e.g. thirst, oliguria, anaemia, increased BP
How do children present with a UTI?
Fever Vomiting Lethargy Irritabilty Abdo pain
How do you diagnose a UTI?
Dipsitx leucocyte esterase activity and nitrites (unreliable under 2 years)
Micrsocopy pyuria, bacturia
Culture- e.coli
How do you investigate a child with suspected vesico-ureteric reflux
USS
DMSA isotope scan
Micturating cysto urethrogram MAG 3 scan (dynamic)
How do you treat a UTI?
lower tract 3 day antibiotics
Upper tract/pylonephritis- antibiotics for 7-10 days
What factors negatively impact CKD?
Late referral Hypertension Proteinuria high intake of protein, phosphate and salt Acidosis Recurrent UTI's
Why is bone disease common in kidney problems?
What do you treat metabolic bone disease in people with kidney problems
Increased PTH pathway due to high phosphate levels
In order to help bone growth you must give a low phosphate diet, oral phosophate binders
Also give active vitamin D
If poor growth give growth hormone
What are the cardiovascular problems associated with chronic kidney disease?
Accelerated atheroscleoris
Traditional risk factors plus Anaemia/metabolic bone disease
What are your takehome messages for CKD?
Acute kidney injury predisposes to CKD
Proteinuria and hypertension are a predictor of ongoing kidney injury
Manage the 5 renal functions
Waste handling Water handling Salt balance Acid base balance Endocrine (red cells/blood pressure/ bone development)
What is cystic renal disease?
wait for later……
