12. Kids and Kidneys Flashcards
Functions of kidneys (6)
- water
- solute control
- BP RAAS
- EPO production
- Activation vit D- bone health
- growth - IGF- GH axis
What are BP percentiles based on in children?
gender, height and age
potential complications of malignant hypertension?
Treatment?
- congestive cardiac failure
- apo
- encephalopathy
TX - admit to hosp
- slow reduction BP with close monitoring
definition of micro vs macroscopic haematuria
micro: > 10 RBC/ul
macro: visible - > 1,000,000/ul
renal associations with haematuria
- htn
- proteinuria
Causes of haematuria
- artefact
- transient
- UTI
- medical renal disease:
hypercalciuria, glomuleronephritis (IgA), HSP , DM, coagulopathy - Urological:
- calculi
- tumour
- stricture
- trauma
Definition of haematuria
24hr collection > 150mg
or spot collection
What is nephrotic syndrome
- excessive proteinuria
- hypoalbuminaemia
- oedema
- hypercholesterolemia
Cause of nephrotic syndrome
different glomerulonephritis types - incl SLE
main childhood cuase - minimal change disease
Epidemiology of Minimal Change Disease
2-10y.o
atopic
trigger by infection
90% respond to steroids, but takes at least 1-2 wks
definition of nephRITIC syndrome
Acute inflam (glomerulonephritis) > impaired filtration
- hypertension
- haematuria macroscopic
- proteinuria
- raised creatinine
- oliguria
Causes of nephritic syndrome
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
What is haemolytic uraemic syndrome?
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
What is Henoch Schonlein Purpura?
Small vessel vasculitis affecting GIT, skin and joints, with long term nephritis risk
Management of HSP
If child is well, do basic tests to exclude bleeding disorder and meningitis.
- UEC
- Urine MCS
- follow up renal funciton
Categories of acute kidney injury
- pre renal: vascular insufficiency (commonest cause in children)
- renal: ATN, GN, TIN, HUS
- post renal: obstruction
Clinical features of AKI
- retention water> oedema
- htn
- K > arrhythmias
- acid> hyperventilation
- urea> nausea, vomiting
- phosphate> dc Ca, seizures
Main complications of chronic kidney disease
- anaemia
- bone disease (hyperparathyroidism)
- growth impairment
- electrolytes/acid base problems
Basic differences between nephrotic and nephritic syndrome
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.
