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Paediatrics > Chronic kidney disease > Flashcards

Chronic kidney disease Flashcards

1
Q

chronic KD is most likely?

A

congenital (kidney and urinary tract)

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2
Q

Congenital Anomalies of the Kidney and Urinary Tract (CAKUT) - 2 symptoms

A

renal dysplasia
Reflux nephropathy
obstructive uropathy -(eg post urethral valve in males)

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3
Q

cystic kidney disease is?

A

Autosomal Dominant Polycystic Kidney Disease

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4
Q

Prune-Belly syndrome, also known as Eagle-Barrett syndrome, is a rare disorder characterized by ?

A
  • 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.
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5
Q

CAUKT may be associated with?

A

Turner
Trisomy 21
Branchio-oto-renal
Prune Belly syndrome

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6
Q

when does creatinine become abnormal?

A

lose a least 40%

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7
Q

normal CKD2?

A

GFR between 60-89

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8
Q

How do people present with CKD? (the 5 kidney functions)

A

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

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9
Q

Ureteric / bladder function is also known as?

  • how do we diagnose?
A

UTI

  • clinical signs and symptoms
    • bacterial culture from midstream urine
  • growth on suprapubic aspiration or catheter
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10
Q

Neonates will present with what symptoms with UTI

A

fever
vomiting
lethargy
irritability

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11
Q

Making a diagnosis of UTI?

Microscopy looks for?

gold standard?

A

Dipstix
Leucocyte esterase activity AND nitrites

  • Pyuria
  • Bacturia

culture - 105 Colony forming units/ml
Gram negative bacteria - E.coli

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12
Q

Pyuria WBC count?

A

> 10

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13
Q

organisms that cause UTI? (5)

A 
E.coli
Klebsiella
Proteus (stones) 
Strep Faecalus
Asymptomatic bacteriuria
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14
Q

Vescico-Ureteric Reflux grades 1-5

A

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

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15
Q

What is the shape of papilla

A

concave associated with intra renal reflux and found in the renal poles the most common place for renal scaring.

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16
Q

What are we looking for as risk factors?

A
  • progressive scaring - reflux nephropathy
  • renal dysplasia
  • Urological abnormalities
  • Unstable bladder
    (Voiding dysfunction)
17
Q

who to investigate

A
  • first time UTI Presentation
  • Upper tract symptoms
  • Younger <6 months
  • Recurrent
  • those at risk of scarring
18
Q

Investigations for UTI?

gold standard test for scarring and reflux?

A

Ultrasound WITHIN 6 WEEKS
(look for VSR)

  • DMSA (isotope scan)
    Scaring / function
  • Micturating cysto-urethrogram - MAG 3 scan
    dynamic
19
Q

Treatment for UTI - LOWER TRACT

  • examples
A

3 days oral antibiotic

- Trimethorim, Co-amoxiclav, cephalosporin

20
Q

treatment for UTI - Upper tract / pyelonephritis

antibiotics for 7-10 days

A

Cephalosporin or Co-amoxiclav, IV Aminoglycosides

21
Q

what can mimic UTI?

A

VulvovaginitiS

22
Q

What factors affect progression of CKD?

A

Late referral
Hypertension
Proteinuria

  • HIGH INTAKE OF SALT
  • bone health - PTH
    Phosphate
    Vitamin D

Acidosis (untreated)

Recurrent UTIs

23
Q

what causes proteinuria in UTI?

A

hyperfiltration of remaining glomeruli

24
Q

how to measure BP in peads?

under age 5?

A

Sphigmanomter
(Doppler)

  • Oscillomerty
  • Technique
25
Q

gold standard blood pressure test for under 5’s?

A

Doppler

26
Q

what factors can affect BP?

A

sex, age, height specific

27
Q

When is a child hypertensive - what are the criteria?

A

3 occasions
Hypertension:
≥95th percentile

Borderline
≥90 but <95th pc

28
Q

How to control BP in children ?

A

ACE inhibitors!!
(ramipril)
reduces dysplasia and Glomerulonephritis

29
Q

Management of CKD - the 5 functions of the kidney

A
  • 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

30
Q

What is metabolic bone disease?

A

Kidneys wee out phosphate
High phosphate increase PTH
Kidneys activate Vitamin D3

  • HYPOCALCAEMIA
31
Q

high PTH causes?

A

metabolic bone disease and cardiovascular disease

32
Q

treatment of metabolic bone disease?

A

Low phosphate diet
Phosphate binders
Active Vitamin D

  • may need to give growth hormone
33
Q

cardiovascular risk with renal patients?

  • what are the risk factors
A

Accelerated atherosclerosis
Traditional risk factors
PLUS
Anaemia / metabolic bone disease (PTH)

risks - hypertension, smoking, diabetes, dyslipidaemia, obesity

Paediatrics (49 decks)

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