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Paeds > AKI & CKD > Flashcards

AKI & CKD Flashcards

1
Q

What are the criteria of AKI? [3]

A

Anuria/Oliguria
HTN + Fluid overload
Rapid rise in Creatinine

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2
Q

How do you diagnose AKI? [3]

A

Serum creatinine at least 1.5x age specific reference creatinine (or previous baseline)

And UO <0.5ml/Kg for >8hrs (urine output)

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3
Q

How do you classify AKI?

A

1-3
AKI 1 = Creatinine 1.5 ULRI (upper limit reference interval)
AKI 2 = 2-3x
AKI 3 = 3x

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4
Q

What can you do to prevent/reduce AKI? [3]

A
  • Maintain good hydration
  • Minimise drugs
  • Monitor UO, PEWS, BP & weight
    (Paeds early warning score)
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5
Q

What are the major causes of AKI in kids? [3]

A
  • Pre-renal Hypoperfusion e.g. volume depletion or hypotension
  • Intrinsic e.g. HUS, ATN or interstitial nephritis (NSAIDs, autoimmune)
  • Obstructive
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6
Q

What organisms lead to HUS? [2]

A

Enterohaemorrhagic E.coli (O157:H7)
Shigella
Due to toxins

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7
Q

What are the features of HUS? (Triad)

A
  • Haemolytic Anaemia
  • Thrombocytopenia
  • AKI
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8
Q

How do you manage HUS to prevent AKI? [3Ms]

A

3Ms:

  • Monitor Fluid balance, U&Es, blood gas & BP
  • Maintain IV saline & RRT
  • Minimise = No Abx
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9
Q

Long term management following AKI? [3]

A

BP & Proteinuria monitoring

Watching out for progression to cKD

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10
Q

What causes CKD? [3]

A

55% CAKUT (oft with systemic syndromes e.g. turner’s or Trisomy 21)
Congenital anomalies of the kidney and urinary tract

17% hereditary e.g. cystic kidney disease

10% glomerulonephritis

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11
Q

How do we grade CKD? [5] What is it based on?

A 
G1-5 based on eGFR:
1 = normal 90+ml/min/1.73m^2
2 = 60-89
3 = 30-59
4 = 15-29
5 = ESRD
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12
Q

Kids with CKD will tend to be due to reflux nephropathy from CAKUT e.g. VUR. How is this likely to present?

A

Lots of UTIs from VUR

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13
Q

How could UTIs present in kids [5] and neonates [4]?

A

Neonates - Fever, vomiting, lethargy & irritability

Children:

  • Fever, vomiting
  • Abdo/loin pain
  • Poor feeding
  • Lethargy, irritability
  • Dysfunctional voiding
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14
Q

How can you diagnose a UTI? [4]

A

Clean catch urine or midstream urine sample (if very sick, catheter sample or suprapubic aspiration)
Dipstix for leucocytes & nitrites
Microscopy for pyuria & bacteria
Urine culture

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15
Q

What organisms cause most UTIs in kids?

A

85% are E.Coli

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16
Q

How do we grade Vesicoureteric Reflux? [2]

A

1-5 and Unilateral vs bilateral

17
Q

Which kids with UTIs would get imaging? [3]

A

Upper tract symptoms (systemically unwell, high temp etc)
<6months old
Recurrent

18
Q

How do we image in UTIs? [4]

A

US for structure
DMSA - renal scarring
Micturating Cystourethrogram - VUR
MAG 3 - Only works in older kids who are continent

19
Q

How are childhood UTIs treated? [2]

A

Lower Tract = 3 days oral Abx (trimethoprim or Co-amoxiclav)

Upper tract = 7-10days Abx (Oral if well or IV if systemically unwell)

20
Q

How can we prevent further UTIs? [4]

A

Hydration
Hygiene
Treat constipation
Image for abnormal Urinary tract

21
Q

What do we monitor in kids with recurrent UTIs in case of CKD? [2]

A
  • HTN (Doppler is gold standard test)

- Proteinuria

22
Q

What is HTN in a kid? [2]

A

> 95th percentile

>90th is borderline

23
Q

What do we need to manage in CKD? [7]

A
  • High urea
  • Fluid balance
  • Salt & Electrolytes
  • Acid-base balance
  • BP
  • Erythpoietin deficiency
  • Bone health
24
Q

How do we treat high urea in CKD? [1]

A

Control protein intake with nutrition

25
Q

How do we handle the water balance in CKD? [1]

A

Restrict or give fluids as needed

26
Q

How do we handle electrolyte imbalance in CKD? [2]

A

Restrict Salt intake

Give K because hypokalemia

27
Q

How do we handle acid base balance in CKD? (and what’s the abnormalitiy)? [2]

A

You get Metabolic Acidosis in CKD due to bicarbonate loss

So give bicarbonate

28
Q

How do we control BP in CKD? [1]

A

ACEI

29
Q

How do we handle the RBC effects of CKD? [1]

A

Give Erythropoietin

30
Q

How is bone health damaged by CKD? [4]

A

Can’t excrete phosphate

  • > High phosphate
  • > High PTH
  • > Metabolic bone disease & CVD
31
Q

How do we manage bone health in CKD? [5]

A

Low phosphate diet
Phosphate binder
Active Vit D

Growth hormone if ongoing poor growth

Important to watch out for hypercalcaemia with these treatments

32
Q

Summary of management of CKD: [7]

A

1) Control protein intake (urea)
2) Give/restrict fluids (water balance)
3) Restrict Na & Give K (Electrolyte balance)
4) Give bicarbonate (Acidosis)
5) ACEI (BP)
6) Erythropoietin
7) Low phosphate diet, phosphate binders & Active Vit D (bone health)

33
Q

What is enuresis?

A

Involuntary discharge of urine at day or night or both in a child > 5y/o in the absence of congenital defects of the nervous system or urinary tract

34
Q

Nocturnal enuresis causes [6]

A 
Idiopathic
T1DM, Diabetes insipidus
Constipation, UTI
Overactive bladder, Neurogenic bladder
Functional small bladder
Emotional/social issues
35
Q

Nocturnal enuresis classification [2]

A
  • Primary: child has never achieved continence

* Secondary: child has been dry for at least 6 months before (particularly consider, UTI, constipation or DM)

36
Q

Nocturnal enuresis ix [3]

Mx

A

Urinalysis and MC&S
USS pre and post voiding
Random capillary glucose (DM)

Primary NE with no daytime sx:

  • Advice on fluid intake, diet, toileting behaviour
  • Reward systems
  • Enuresis alarm: 1st line if

Paeds (33 decks)

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