13.1. Paediatric Nephrology - Nephritic / Nephrotic Syndrome Flashcards
What are the Common Paediatric Causes of:
- Proteinuria / Haematuria?
- Acute Kidney Injury?
- Chronic Kidney Injury?
- Glomerular Disease - Nephrotic / Nephritic Syndrome
- Haemolytic Uraemic Syndrome
- Developmental Anomalies - Reflex Nephroapthy
What is the Glomerular Filtration Rate in a:
- Neonate?
- 2 Year Old?
- 20-30ml/min/1.73m^2
2. 80-120ml/min/1.73m^2
What are the Different Cells of the Kidney, Related to Excretory Function?
- Endothelial Cell - Fenestrated
- Glomerular Basement Membrane
- Podocyte - Proteins
- Mesangial Cell - Structural Support embedded in the Glomerular Basement Membrane
What are the Common Acquired Glomerulopathies affecting the Epithelial Cells (Podocytes)?
- Minimal Change Disease (MCD)
- Focal Segmental Glomerulosclerosis (GSGS)
- Lupus
What are the Common Acquired Glomerulopathies affecting the Basement Membrane Cells?
- Membranous Glomerulopathy
- Membranoproliferative Glomerulonephritis (MPGN)
- Post-Infectious Glomerulonephritis (PIGN)
What are the Common Acquired Glomerulopathies affecting the Endothelial Cells?
- Infectious Associated Glomerulonephritis (PIGN)
- Haemolytic-Uraemic Syndrome
- Membranoproliferative Glomerulonephritis (MPGN)
- Lupus
What are the Common Acquired Glomerulopathies affecting the Mesangial Cells?
- Henoch-Schönlein Purpura (HSP)
- IgA Nephropathy
- Lupus
What is Altered in Congenital Glomerulopathy?
- Podocyte Cytoskeletal Integrity
- Basement Membrane Proteins
- Endothelial / Micro-vascular Integrity
Note - This is Rare
What are the Features of Nephrotic Syndrome?
- Proteinuria - Protein 3+ / Blood 2+ (not Frank)
- Hypoalbuminaemia - Normal Creatinine
- Oedema
How is Proteinuria Tested for?
- Urinalysis - Dipstix
- Protein Creatinine Ratio
- 24 Hour Urine Collection
What are the Typical Features of Minimal Change Disease?
- Age - Most common in Children
- Blood Pressure
- Haematuira
- Normal Renal Function
What is the Treatment of Minimal Change Disease?
- Prednisolone (Steroids) - it is Steroid Sensitive
2. Immunosuppression - Steroid Resistant
What are the Causes of Steroid Resistant Nephrotic Syndrome?
- Idiopathic - Focal Segmental Glomerulosclerosis
2. Congenital
What are the Common Causes of Haematuria?
- Urinary Tract Infection
- Trauma
- Stones / Hypercalciuria
- Glomerulonephritis - Post-Infective / IgA / HSP / Membranoproliferative / Lupus Nephritis
What are the Features of Nephritic Syndrome?
- Haematuria and Proteinuria
2. Reduced Glomerular Filtration Rate - Oliguria / Fluid Overload / Hypertension
If Nephritic Syndrome is suspected, what Investigations would be done?
- Blood Workup - Creatinine / FBC / Albumin
- Urine Workup - Exclude UTI
- Renal Ultrasound
- Biopsy
What are the Features of Acute Post-Infectious Glomerulonephritis:
- Aetiology?
- Investigations?
- Treatment?
- a) Age of Onset
- b) Cause - Usually Group A Strep.
- c) Self-Limiting
- Diagnosis Made by Bacterial Culture
- Treatment = Antibiotics +/- Diuretics
What are the Features of IgA Nephroapthy:
- Aetiology?
- Clinical Features?
- Investigations?
- Treatment?
- a) Most Common Glomerulonephritis
- b) Occurs 1-2 Days after URTI
- Clinically:
- a) Recurrent Macroscopic Haematuria
- b) +/- Chronic Microscopic Haematuria
- c) Varying Degree of Proteinuria
- Diagnosed by Clinical Picture / Biopsy
- Treated with ACE Inhibitor
What are the Clinical Features of Henoch-Scholein Purpura?
IgA Related Vasculitis:
1. Age of Onset - 5-15 Years Old
2. Palpable Purpura
3. One of: Abdominal Pain / Renal Involvement / Arthritis / Arthalgia / Biopsy (IgA Deposition)
4. 1-3 Days Post-Trigger - Viral URTI / Strep.
5. Lasts for 4-6 Weeks
Note - Nephritis caused by Mesangial Cell Injury
What is the Treatment of Henoch-Scholein Purpura?
- Symptomatic - Joints / Abdomen
- Glucocorticoid Therapy - Help G.I.
- Immunosuppression
- Long-Term - Hypertension / Proteinuria Screening
