27. Childhood continence, proteinuria and haematuria & Renal Failure Flashcards
Continence:
- Dry in day by 3 yrs – but accidents are common
* Dry at night by 5-6 yrs but much more variable
Incontinence:
- Primary: never have been dry
* Secondary: incontinence after >6 months dry
Enuresis:
Disorder of inability to control frequent urination especially at night
Enuresis diagnosis:
- Urine dip stick, urine - test culture and glucose
- Early morning urine osmolality (To exclude diabetes insipidus, If >300 able to concentrate urine therefore not DI)
- Renal USS (Anatomy and bladder emptying)
Enuresis – underlying pathology:
- UTI
- Diabetes
- Pelvic mass
- Renal failure
- Psychological abuse
Management of enuresis:
- Regular toilet, avoid fizzy drinks, avoid bedtime drinks
- Desmopressin for short term use
Causes of proteinuria:
- Nephrotic syndrome
- Nephritis
- Renal failure
Test for proteinuria:
Dipstick test or 24h urine collection
Nephrotic syndrome:
Heavy proteinuria with hypoalbuminaemia and oedema (ascites, pulmonary, peripheral)
Acute complications of nephrotic syndrome:
- Hypovolaemia
- Infection
- Thrombosis
Management of nephrotic syndrome:
- High dose steroid 6 week course
- Steroid sensitive might relapse but long term prognosis
- If not steroid sensitive -> ESRF
Nephrotic syndrome OR Nephritic syndrome - discern
Haematuria
Nephritis – intrinsic kidney disease:
- Post streptococcal
- Henoch Schoenlein Purpura
- SLE
- IgA nephropathy
Nephritis symptoms:
- Haematuria
- Oedema
- Hypertension
- Renal failure
Acute renal failure (3 types)
- Pre-renal: hypovolaemia
- Renal: haemolytic uraemic syndrome (anaemia, thrombocytopenia, uraemia)
- Post-renal: obstruction
Chronic renal failure presentation:
- Anorexia
- Poor growth
- Hypertension
Conditions causing CKD
- Structural abnormalities
- Nephritis
- Haemolytic uremic syndrome
Renal replacement:
- Done once approaching ESKF + sometimes pre-emptive transplant
- Peritoneal dialysis
- Haemodialysis
- Transplant
Peritoneal dialysis:
2/3 paediatric dialysis, indwelling peritoneal catheter, overnight cycling for ~12h, continuous ambulatory – small volume continuous fills.
Complications of peritoneal dialysis:
- Peritonitis
- Catheter blockage
- Tunnel infections
- Omental blockage
- Hernia
- Parental burnout
Haemodialysis:
1/3 paediatric dialysis, significant disruption to life, challenge of vascular access – indwelling catheter or fistula, haemodialysis at home – for older children with highly motivated family; 4 hours / session 3x / week
Haemodialysis complications:
- Haemolysis
- Air embolism
- Hypotension
- Disequilibrium
Transplant types:
- Live related donation
- Deceased donor (difficult if significant hypertension)
Advantages of transplant:
- Better quality of life
- Reduced mortality and morbidity vs dialysis
Complications of transplant:
- Perioperative complications
- Drug side effect and immunosuppression
- Acute and chronic rejection
- Recurrent of renal disease
Transplant outcomes
- Living donor: 87% 5 yr survival, 73% 7 year survival, 60% 10 year survival
- Deceased Donor: 76% 5 yr survival, 60% 7 year survival, 50 % 10 year survival
- Adolescence and early adulthood show peaks of graft loss
