12. Kids and Kidneys

Question 1

Functions of kidneys (6)

Answer 1

• water
• solute control
• BP RAAS
• EPO production
• Activation vit D- bone health
• growth - IGF- GH axis

Question 2

What are BP percentiles based on in children?

Answer 2

gender, height and age

Question 3

potential complications of malignant hypertension?

Treatment?

Answer 3

• congestive cardiac failure
• apo
• encephalopathy
  TX
• admit to hosp
• slow reduction BP with close monitoring

Question 4

definition of micro vs macroscopic haematuria

Answer 4

micro: > 10 RBC/ul
macro: visible - > 1,000,000/ul

Question 5

renal associations with haematuria

Answer 5

• htn

- proteinuria

Question 6

Causes of haematuria

Answer 6

• artefact
• transient
• UTI
• medical renal disease:
  hypercalciuria, glomuleronephritis (IgA), HSP , DM, coagulopathy
• Urological:
• calculi
• tumour
• stricture
• trauma

Question 7

Definition of haematuria

Answer 7

24hr collection > 150mg

or spot collection

Question 8

What is nephrotic syndrome

Answer 8

• excessive proteinuria
• hypoalbuminaemia
• oedema
• hypercholesterolemia

Question 9

Cause of nephrotic syndrome

Answer 9

different glomerulonephritis types - incl SLE

main childhood cuase - minimal change disease

Question 10

Epidemiology of Minimal Change Disease

Answer 10

2-10y.o
atopic
trigger by infection
90% respond to steroids, but takes at least 1-2 wks

Question 11

definition of nephRITIC syndrome

Answer 11

Acute inflam (glomerulonephritis) > impaired filtration

• hypertension
• haematuria macroscopic
• proteinuria
• raised creatinine
• oliguria

Question 12

Causes of nephritic syndrome

Answer 12

infection - MSU
autoantibodies - sle/IgA
post strep glomerulonephritis (classic in children)
- 2-4 weeks post strep infection skin/throat
- main risk is htn and K
treatment: frusemide

Question 13

What is haemolytic uraemic syndrome?

Answer 13

A disease characterised by a triad of hemolytic anemia (anemia caused by destruction of red blood cells), acute kidney failure (uremia), and a low platelet count (thrombocytopenia), Toxin mediated - shiga toxins eg E coli

Question 14

What is Henoch Schonlein Purpura?

Answer 14

Small vessel vasculitis affecting GIT, skin and joints, with long term nephritis risk

Question 15

Management of HSP

Answer 15

If child is well, do basic tests to exclude bleeding disorder and meningitis.

• UEC
• Urine MCS
• follow up renal funciton

Question 16

Categories of acute kidney injury

Answer 16

• pre renal: vascular insufficiency (commonest cause in children)
• renal: ATN, GN, TIN, HUS
• post renal: obstruction

Question 17

Clinical features of AKI

Answer 17

• retention water> oedema
• htn
• K > arrhythmias
• acid> hyperventilation
• urea> nausea, vomiting
• phosphate> dc Ca, seizures

Question 18

Main complications of chronic kidney disease

Answer 18

• anaemia
• bone disease (hyperparathyroidism)
• growth impairment
• electrolytes/acid base problems

Question 19

Basic differences between nephrotic and nephritic syndrome

Answer 19

nephrotic - loss of a lot of protein; nephritic= loss of a lot of blood.

NEPHROTIC
Hypoalbuminaemia:
Albumin is lost in the urine.
Gaps in podocytes allow proteins to leak into the urine.

Oedema:
Albumin is lost into the urine.
Hypoalbuminemia results in decreased intravascular oncotic pressure.
As a result fluid moves out of the intravascular compartment and into the surrounding tissues causing oedema.

Hyperlipidemia

Due to hypoalbuminaemia, the liver compensates and increases production, however this has the side effect of also increasing the production of lipids, hence causing hyperlipidaemia.

NEPHRITIC:
Haematuria:

+++ Blood – microscopic or macroscopic haematuria
Red cell casts – distinguishing feature, form in nephrons and indicate glomerular damage

Haematuria occurs due to podocytes developing large pores which allows blood and protein to escape into the urine.

Proteinuria:

++ Protein (small amount)
Hypertension21`
Usually only mild

Low urine volume <300ml/day

Due to reduced renal function.