AKI, CKD and HUS

Question 1

Presentation of HUS (4)

Answer 1

triad:

• haemolytic anaemia
• AKI
• thrombocytopenia

can also get bloody diarrhoea

(HUS=most common cause of acute renal failure in children)

Question 2

Causes of HUS (7)

Answer 2

infection:

• E.coli 0157- most common
• shigella

pregnancy

tumours

the pill

ciclosporin

SLE

HIV

Question 3

Blood test results for HUS (2)

Answer 3

low platelets

clotting normal

Question 4

Mx of HUS (3)

Answer 4

supportive with low threshold for dialysis

good prognosis but will require followup as there may be presistent proteinuria, HTN and decreased renal function

DON’T GIVE ABX (>expression and release of more toxin)

Question 5

Causes of HTN in children (5)

Answer 5

renal parenchymal disease=most common

renal vascular disease

CAH

coarctation

phaeochromocytoma

Question 6

Ix for HTN in children

Answer 6

4th Korotkoff sound used to measure BP in children till adolescence then 5th sound is used.

Question 7

Presentation of CKD (8)

Answer 7

anorexia and lethargy

HTN

incidental proteinuria

normochromic, normocytic anaemia

acute on chronic renal failure

bone deformities (renal osteodystrophy)

FTT

polydipsia, polyuria

Question 8

Causes of CKD in children (4)

Answer 8

CONGENITAL MALFORMATION=40%

GN

hereditary nephropathies

systemic disease

Question 9

metabolic anomalies in CKD (6)

Answer 9

high K

low vit D

low Ca

high PO4

acidosis

low HCO3

Question 10

Mx of CKD (7)

Answer 10

Prevent metabolic anomalies

nausea/vomitting common: may need supplementary feeds

fluid and electrolyte balance:

• K restriction
• HCO3 supplements
• Na supplements

phosphate binders

vit D supplements

for anaemia:

• PO Fe
• SC EPO

if dialysis needed> peritoneal dialysis

Question 11

complications of CKD in children (2)

Answer 11

delayed puberty

GH resistance

Question 12

Mx of hypertensive emergency in CKD (2)

Answer 12

sodium nitroprusside (CI in severe hepatic impairment)

labetalol can be used (CI in phaeochromocytoma)

Question 13

Pre-renal causes of AKI, Ix and Mx (3)

Answer 13

hypovolaemia/circulatory failure

Ix:

• hyponatraemia
• oliguria

Mx: prompt fluid resuscitation

Question 14

Renal causes of AKI (5)

Answer 14

vascular:

• HUS
• vasculitis
• embolus/renal vein thrombosis

tubular: obstructive ATN/ischaemic/toxic

GN

interstitial nephritis/pyelonephritis

acute on chronic renal failure

Question 15

Ix for renal AKI

Answer 15

Ix w. renal biopsy if necessary to detect rapidly progressing glomerulonephritis caused by:

• Goodpasture’s (ANCA-ve)
• Churg-Strauss (p-ANCA) and Wegener’s (c-ANCA)

Question 16

Post-renal causes of AKI

Answer 16

obstruction

Question 17

Mx of AKI in children (3)

Answer 17

fluid restrict if overloaded

high calorie, low protein diet to reduce urea and K+

if hyperkalaemic:

• catheterise
• calcium gluconate
• insulin+dextrose

Question 18

When to dialyse in AKI (6)

Answer 18

failure to respond to conservative Mx

hyperkalaemia

severe hyper/hyponatraemia

pulmonary oedema/HTN

severe acidosis

multi-system failure

Question 19

Dialysis option for children

Answer 19

peritoneal dialysis preferred in children

can USS kidneys:

• small=CKD
• large, bright kidneys w. loss of medullary-cortical differentiation=acute problem