Chronic kidney disease Flashcards
chronic KD is most likely?
congenital (kidney and urinary tract)
Congenital Anomalies of the Kidney and Urinary Tract (CAKUT) - 2 symptoms
renal dysplasia
Reflux nephropathy
obstructive uropathy -(eg post urethral valve in males)
cystic kidney disease is?
Autosomal Dominant Polycystic Kidney Disease
Prune-Belly syndrome, also known as Eagle-Barrett syndrome, is a rare disorder characterized by ?
- by partial or complete absence of the stomach (abdominal) muscles,
- failure of both testes to descend into the scrotum (bilateral cryptorchidism), and/or urinary tract malformations.
CAUKT may be associated with?
Turner
Trisomy 21
Branchio-oto-renal
Prune Belly syndrome
when does creatinine become abnormal?
lose a least 40%
normal CKD2?
GFR between 60-89
How do people present with CKD? (the 5 kidney functions)
Uraemic – loss of appetite, weight loss, itch
Water – polyuria
Salt / acid base – lethargy, poor growth
Endocrine – lethargy, reduced effort tolerance, anaemic,
Bladder - UTIs, spina bifida
Ureteric / bladder function is also known as?
- how do we diagnose?
UTI
- clinical signs and symptoms
- bacterial culture from midstream urine
- growth on suprapubic aspiration or catheter
Neonates will present with what symptoms with UTI
fever
vomiting
lethargy
irritability
Making a diagnosis of UTI?
Microscopy looks for?
gold standard?
Dipstix
Leucocyte esterase activity AND nitrites
- Pyuria
- Bacturia
culture - 105 Colony forming units/ml
Gram negative bacteria - E.coli
Pyuria WBC count?
> 10
organisms that cause UTI? (5)
E.coli Klebsiella Proteus (stones) Strep Faecalus Asymptomatic bacteriuria
Vescico-Ureteric Reflux grades 1-5
1-ureter only
2-ureter, pelvis, calyces
3-dilatation ureter
4-Moderate dilatation of ureter
± pelvis ±tortuous ureter,
obliteration of fornices
5-gross dilatation/tortuosity,
no papillary impression in calyces
What is the shape of papilla
concave associated with intra renal reflux and found in the renal poles the most common place for renal scaring.
What are we looking for as risk factors?
- progressive scaring - reflux nephropathy
- renal dysplasia
- Urological abnormalities
- Unstable bladder
(Voiding dysfunction)
who to investigate
- first time UTI Presentation
- Upper tract symptoms
- Younger <6 months
- Recurrent
- those at risk of scarring
Investigations for UTI?
gold standard test for scarring and reflux?
Ultrasound WITHIN 6 WEEKS
(look for VSR)
- DMSA (isotope scan)
Scaring / function - Micturating cysto-urethrogram - MAG 3 scan
dynamic
Treatment for UTI - LOWER TRACT
- examples
3 days oral antibiotic
- Trimethorim, Co-amoxiclav, cephalosporin
treatment for UTI - Upper tract / pyelonephritis
antibiotics for 7-10 days
Cephalosporin or Co-amoxiclav, IV Aminoglycosides
what can mimic UTI?
VulvovaginitiS
What factors affect progression of CKD?
Late referral
Hypertension
Proteinuria
- HIGH INTAKE OF SALT
- bone health - PTH
Phosphate
Vitamin D
Acidosis (untreated)
Recurrent UTIs
what causes proteinuria in UTI?
hyperfiltration of remaining glomeruli
how to measure BP in peads?
under age 5?
Sphigmanomter
(Doppler)
- Oscillomerty
- Technique
gold standard blood pressure test for under 5’s?
Doppler
what factors can affect BP?
sex, age, height specific
When is a child hypertensive - what are the criteria?
3 occasions
Hypertension:
≥95th percentile
Borderline
≥90 but <95th pc
How to control BP in children ?
ACE inhibitors!!
(ramipril)
reduces dysplasia and Glomerulonephritis
Management of CKD - the 5 functions of the kidney
- Waste – urea – nutrition / protein intake / minimise weight loss (catabolism)
Water – polyuria or oliguria
Salt – salt loosing / high potassium - low potassium diet / avoid hypercalcaemia / reduce phosphate in diet
Acid base – bicarbonate loss
What is metabolic bone disease?
Kidneys wee out phosphate
High phosphate increase PTH
Kidneys activate Vitamin D3
- HYPOCALCAEMIA
high PTH causes?
metabolic bone disease and cardiovascular disease
treatment of metabolic bone disease?
Low phosphate diet
Phosphate binders
Active Vitamin D
- may need to give growth hormone
cardiovascular risk with renal patients?
- what are the risk factors
Accelerated atherosclerosis
Traditional risk factors
PLUS
Anaemia / metabolic bone disease (PTH)
risks - hypertension, smoking, diabetes, dyslipidaemia, obesity
