Infant or child with generalised swelling

Question 1

Causes of hematuria

Answer 1

1. PSGN
2. PCKD
3. Nephrolithiasis
4. Renal tumor
5. Trauma
6. UTI
7. HSP
8. Thin-BMD
9. Alports
10. Sickle cell

Question 2

Causes of proteinuria

Answer 2

1. Nephrotic syndrome
2. Acute renal failure
3. Orthostatic proteinuria
4. UTI

Question 3

History in hematuria and proteinuria

Answer 3

1. Frank blood, pink/frothy, clots, positive dipstick
2. Colour of urine
3. Urinary symptoms
4. Severe pain
   5 Precipitants->trauma, throat, skin
5. FHx renal disease
6. Nephrotic
   Swelling around eyes noticed in the morning
   Any weight gain
   Urine output
   Fluid restriction
   First presentation or relapse
   Has the child been treated in the past

Question 4

Investigations and intepretation

Answer 4

1. FBE->anemia, exclude HUS
2. Urinalysis and culture->pyuria, bacteruria
3. ASOT, throat swab->GAS
4. UEC->renal function
5. Serum C3 complement->GN
6. Serum albumin->low in neprhotic
7. Urinary P:Cr high in nephrotic syndrome
8. TAG, cholesterol->high in neprhotic syndrome
9. Renal USS and AXR->may show renal sones
10. Renal biopsy->if renal function impaired, HTN, proteinuria and hematuria

Question 5

Examination

Answer 5

1. BP!!!
2. Abdominal examination->tumor, PCKD, obstruction, ascites
3. Pitting edema
4. Pleural effusions
5. Measure and compare weight
6. Purpuric rash->HSP, HUS

Question 6

Brief overview mx of PSGN

Answer 6

1. Phenoxymethylpenicillin
2. Manage ARF->fluids, electrolyte maintenance
3. Salt and fluid restriction
4. Manage HTN
5. If severe/failure->dialysis

Question 7

Findings on blood investigations in neprhotic

Answer 7

1. +protein in urine
2. Low albumin
3. +TAG, lipids
4. Normal C3 complement

Question 8

Most common cause of generalised swelling

Answer 8

1. Nephritis
2. Nephrosis
3. Allergic reactions
4. Urticaria, angioedema
5. Other causes of hypoalbuminemia

Question 9

Complications of nephritis

Answer 9

1. ARF
2. Pulmonary edema
3. Hypertensive encephalopathy

Question 10

Complications of neprhotic

Answer 10

1. Hypovolemia
2. Ascites
3. Pulmonary effusions
4. Peritonitis->infection
5. Thrombosis