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3rd Year - Paediatrics > 13.2. Paediatric Nephrology - Acute Kidney Injury / Chronic Kidney Disease > Flashcards

13.2. Paediatric Nephrology - Acute Kidney Injury / Chronic Kidney Disease Flashcards

1
Q

What is acute Kidney Injury?

A

Abrupt Loss of Kidney Function, resulting in Retention of Urea and other Nitrogenous Waste Products (and in the Dysregulation of Extracellular Volume) and Electrolytes
Note - Largely Replaced by Acute Renal Failure

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2
Q

What are the Features of Acute Kidney Injury?

A
  1. Anuria / Oliguria (<0.5ml/Kg/Hour)
  2. Plasma Creatinine Rise - >1.5 x Age Specific Reference
  3. Hypertension and Fluid Overload
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3
Q

What is the Management of Acute Kidney Injury?

A 
1. Prevention
3 M's:
2. Monitor - Urine Output / PEW's / B.P. / Weight
3. Maintain good Hydration
4. Minimize Drugs
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4
Q

What are the 3 Categories of Acute Kidney Injury Causes?

A
  1. Pre-Renal - Perfusion Problem (Renal Artery Stenosis)
  2. Intrinsic Renal Problem - Glomerular Disease / Tubular Injury / Interstitial Nephritis
  3. Post-Renal - Obstructive
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5
Q

What are the Types of Intrinsic Renal Problems which can cause Acute Kidney Injury?

A
  1. Glomerular Disease - Haemolytic-Uraemic Syndrome / Glomerulonephritis
  2. Tubular Injury - Acute Tubular Necrosis (consequence of Hypoperfusion / Drugs)
  3. Interstitial Nephritis - NSAID / Autoimmune
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6
Q

What are the Causes of Haemolytic-Uraemic Syndrome?

A
  1. Post Diarrhoea - Entero-Haemorrhagic E. Coli
  2. Pneumococcal Infection
  3. Drugs
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7
Q

What are the Timeline of Haemolytic-Uraemic Syndrome?

A

Day (-3) - Ingestion
Day 0 - Diarrhoea / Abdominal Pain / Fever / Vomiting
Day 2.5 - Bloody Diarrhoea
Day 3 - Culture
Day 4.5 - Positive Culture
Day 7 - Haemolytic-Uraemic Syndrome / Spontaneous Resolution

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8
Q

What is the Clinical Triad of Haemolytic-Uraemic Syndrome?

A
  1. Microangiopathic Haemolytic Anaemia
  2. Thrombocytopenia
  3. Acute Renal Failure
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9
Q

What is the Management of Haemolytic-Uraemic Syndrome?

A 
Monitor:
1. a) Fluid Balance / Electrolytes / Acidosis
1. b) Hypertension
1. c) Aware of Other Organs
Maintain:
2. a) I.V. Normal Saline and Fluid
2. b) Renal Replacement Therapy
Minimize:
1. No Antibiotics
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10
Q

What are the Long Term Consequences of Acute Kidney Injury?

A
  1. Blood Pressure
  2. Proteinuria Monitoring
  3. Evolution to Chronic Kidney Disease
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11
Q

What are the common Chronic Kidney Diseases seen in Paediatrics?

A
  1. Congenital Anomalies of the Kidneys and Urinary Tract (CAKUT)
  2. Hereditary Conditions
  3. Glomerulonephritis
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12
Q

What are the Types of Congenital Anomalies of the Kidneys and Urinary Tract (CAKUT) causing Chronic Kidney Disease?

A
  1. Reflux Nephropathy
  2. Dysplasia
  3. Obstructive Uropathy
    Note - May be associated with Syndromes - e.g. Turner / Trisomy 21 / Branchio-Oto-Renal / Prune Belly Syndrome
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13
Q

What are the Types of Hereditary Conditions causing Chronic Kidney Disease?

A
  1. Cystic Kidney Disease

2. Cystinosis

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14
Q

What is the Presentation of Chronic Kidney Disease?

A
  1. Bladder Dysfunction - Increased UTI’s
  2. Excretory - Waste (Urea / Creatinine) / Water / Electrolytes / Acid-Base Balance / Proteinuria
  3. Metabolic - Renin / Activation of Vitamin D / Erythropoietin
    Note - Depends on what function is impaired
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15
Q

What are the Grade of Vescico-Ureteric Reflex?

A 
Grade 1 - Ureter Only
Grade 2 - Ureter / Pelvis / Calyces
Grade 3 - Dilated Ureter
Grade 4 - Moderate Dilation of Ureter +/- Pelvis
Grade 5 - Gross Dilation / Tortuosity
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16
Q

What are the Investigations into the Renal Tract?

A
  1. Ultrasound - Structure
  2. DMSA - Scarring
  3. MAG3 - Drainage / Dynamic
17
Q

What is the Treatment of:

  1. Lower Urinary Tract Infections?
  2. Upper Urinary Tract Infections / Pyelonephritis?
A
  1. 3 days Oral Antibiotics
  2. 7 Days (Oral if well) Antibiotics
    Note - Prevention = Fluids / Hygiene / Constipation Treatment / Voiding / Dysfunction
18
Q

What Factors affect the Progression of Chronic Kidney Disease?

A
  1. Late Referral
  2. Hypertension
  3. Proteinuria
  4. High Intake of Protein / Phosphate / Salt
  5. Bone Health - Vitamin D / PT Hormone / Phosphate
  6. Acidosis
  7. Recurrent UTI’s
19
Q

What are the Different Types of Cystic Renal Disease?

A
  1. Simple
  2. Developmental - Dysplasia / Multicystic Dysplastic
  3. Genetic - Autosomal Recessive or Dominant (AR(or D)PKD) / Syndromic
  4. Acquired - Cancer
20
Q

What are the Features of Developmental Multicystic Dysplastic Kidney (MCDK)?

A
  1. Sporadic
  2. Non-Functioning Kidney
  3. Ureteric Atresia
  4. Hypertrophy of the Normal Contralateral Kidney
21
Q

What are the Features of Autosomal Recessive Polycystic Kidney Disease?

A
  1. Antenatally Large Bright Kidney
  2. Oligohydramnios
  3. Severe Respiratory Distress - Pulmonary Hypoplasia / Nephromegaly Mass Effect

3rd Year - Paediatrics (40 decks)

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