Child Health- Renal

Question 1

define oedema

Answer 1

increase of interstitial fluid
clinical presentation of swelling with pitting, facial oedema, ascites, pleural effusions, pulmonary oedema

Question 2

causes of increased interstitial fluid

Answer 2

lymph drainage
-lymphodema, obstruction or design
venous drainage
- obstruction eg DVT
lowered oncotic pressure
- low albumin/protein
-malnutrition
decreased production in liver
increased loss in the gut or kidney (nephrotic syndrome)

Question 3

describe the clinical signs of nephrotic syndrome

Answer 3

heavy proteinuria
hypoalbuminaemia
oedema

Question 4

what are the three types of nephrotic syndrome

Answer 4

congenital
steroid sensitive
steroid resistant

Question 5

what are the differences in teh clinical signs of steroid senstive and steroid resistant NS

Answer 5

blood pressure
-sens= normal
-resistant= elevated
haematuria
-sens= no macroscopic
- resistant= macroscopic
renal function
-sens= normal
-resistant= impaired

resistant has features to suggest nephritis
resistant has histological changes present eg. glomerulopathy, basement membrane abnormality

Question 6

clinical presentation of steroid sensitive NS

Answer 6

peak age of onset= 2-5 years
M>F
higher incidence in those from asian sub continent
unknown immunological aetiology
~5% continue into adult life
normal renal function if steroid responsive

Question 7

what is the treatment for sSNS

Answer 7

standard course of prednisolone for 1st episode
-60mg/m2 for 4 weeks
-40mg/m2 on alternate days for 4 weeks

also consider
- Na and water moderation
-diuretics
-Pen V
- measles and varicella immunity and pneumococcal immunisation

Question 8

describe the clinical presentation of acute glomerulonephritis

Answer 8

haematuria- often macroscopic (tea or coca cola coloured)

proteinuria- varying degrees

impaired GFR- rising creatinine. variable degree

salt and water retention- hypertension, oedema

Question 9

what can trigger glomerulonephritis?

Answer 9

streptococcus

acute post streptococcal glomerulonephritis

Question 10

where would a strep infection which triggers glomerulonephritis be located

Answer 10

nasopharyngeal or skin infection

Question 11

which strains of strep cause glomerulonephritis

Answer 11

Gp A Beta haemolytic streptococcus

nephritogenic

Question 12

what is the pathology of acute post streptococcal glomerulonephritis

Answer 12

antigen-antibody complexes form in the glomerulus, causing complement activation

clinical nephritis presents 10 days post infection
-haematuria, swelling, decreased urine output.
-oedema, hypertension, signs of cardiovascular overload

Question 13

describe the renin angiotensin aldosterone system

Answer 13

reduction of blood pressure causes renin release.

renin cleaves angiotensinogen to angiotensin I.

angiotensin-converting enzyme (ACE) cleaves angiotensin I to Angiotensin II.

AII acts on the adrenal glands to release aldosterone.

causes salt retention and therefore more water moves out of the tubules and back into the blood.

Question 14

what is Henoch-Schonlein Purpura (HSP)

Answer 14

a type of vasculitis
affects: skin, joints, gut, kidneys

Question 15

what is the pathology of HSP nephritis

Answer 15

IgA deposition in the kidneys

Question 16

what is the presentation of HSP nephritis

Answer 16

haematuria/proteinuria
nephrotic syndrome
acute nephritis
renal impairment
hypertension

can be steroid resistant, immunosuppression may be required.