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Y5 Paediatrics > Kidney > Flashcards

Kidney Flashcards

1
Q

What is GFR like in infants?

A

LOW

Reaches normal levels at age of 1 or 2

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2
Q

What are three key radiological investigations for the kidney/urinary tract?

A

USS
DMSA
MCUG

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3
Q

What is a DMSA scan

A

Dimercaptosuccinic acid scan

Static scan of the renal cortex
Detects functional defects e.g. scars
It is very sensitive so wait 2 months to not diagnose false scars

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4
Q

What is a MCUG

A

Micturating Cystourethrogram

Contrast induced into bladder through urethral catheter
visualises bladder and urethral anatomuy

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5
Q

What defects can an MCUG detect?

A

vescicoureteric defect

urethral obstruction

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6
Q

What is renal agenesis

A

absence of both kidneys

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7
Q

What is Potter syndrome?

A

oligohydramnnios due to renal agenesis (as amniotic fluid is mainly derived from foetal urine)

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8
Q

what is multi cystic dysplastic kidney

A

SINGLE kidney does not develop properly

Formation of non-functioning structure: large fluid filled cyst, no renal tissue, no connection to bladder

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9
Q

What is PKD

A

BOTH kidneys affected
multiple cysts on both kidneys
maintain SOME function

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10
Q

What is a horseshoe kidney?

A

lower poles of two kidneys fuse at midline

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11
Q

What is a duplex kidney?

A

two ureters insert into the same kidney

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12
Q

What is bladder exstrophy

A

Due to failure of fusion of midline structures

Leads to exposed bladder mucosa

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13
Q

What is prune belly syndrome?

A

Absence of anterior abdominal wall muscles

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14
Q

Where could obstruction to urine flow occur?

A

Pelvi-ureteric junction
Vescico-ureteric junction
Bladder neck
Posterior urethra

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15
Q

What is a posterior urethral valve

A

An obstructing membrane in the posterior male urethra

Causes outlet obstruction

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16
Q

What are negative consequences of a posterior urethral valve in the foetus

A 
Renal failure (oligohydramnios) 
Rest failure / pulmonary hypoplasia (due to insufficient lung development )
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17
Q

What is postnatal tx for congenital renal abnormalities?

A

Prophylactic antibiotics (prevent UTIs)
USS (after few weeks)
US/MCUG if required

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18
Q

What are sx of UTI in infant?

A 
fever 
vomiting 
lethargy/irritability 
poor feeding/faltering growth 
jaundice 
septicaemia 
offensive urine 
febrile seizure
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19
Q

What are sx of UTI in children

A 
Urinary: dysuria, freq, urgency 
Cloudy/offensive urine 
Eneuresis
Abdo pain, loin tenderness 
Vomiting, diaghrroea 
Fever without rigors
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20
Q

How do you collect sample for ix in UTI

A

Clean catch
adhesive plastic bag
urethral catheter
Suprapubic aspiration

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21
Q

What further investigations can you do for UTI

A

urine dip

MC&S

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22
Q

What are commonest organisms for UTI

A

E coli
Klebsiella
Proteus

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23
Q

What are other factors that contribute to incomplete bladder emptying > UTI?

A 
infrequent voiding 
vulvitis 
obstruction from loaded rectum from constipation
neuropathic bladder
vescicoureteric reflux
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24
Q

What is vescicoureteric reflux?

A

abnormality of vescicoureteric junction - ureters are displaced laterally and inter directly into bladder

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25
Q

Why does vescicoureteric reflux occur?

A

familial / with bladder pathology

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26
Q

What are investigations of rVUR

A

USS

MCUG if obstruction is suspected

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27
Q

What outcomes of urine dip require antibiotics?

A

nitrites +, LE+

nitrites +, LE-

28
Q

What do you do if nitrite-, LE + occurs?

A

do not start antibiotics unless good clinical evidence

29
Q

What features indicate pyelo?

A

bacteriuria + fever >38 / + loin tenderness

30
Q

what is daytime enuresis?

A

lack of bladder control during the day in a child that is old enough to be continent (3-5 yo)

31
Q

What are causes of daytime eneuresis?

A 
lack of attention to bladder sensation (developmental problem) 
detrusor instability 
bladder neck stiffness 
neuropathic bladder 
UTI 
constipation

ectopic ureter

32
Q

How do you investigate daytime enuresis

A

MC&S
USS
urodynamic studies
MRI (if need to exclude spinal defect>)

33
Q

Once you exclude neuro cause, what do you do for child with daytime enuresis?

A

star chart
bladder training
pelvic floor exercise

34
Q

What is the main cause of secondary enuresis

A

emotional upset

35
Q

What are other causes of secondary eneuresis

A

UTI

polyuria

36
Q

What are benign causes of proteinuria

A 
Orthostatic proteinuria (standing upright all day) 
Transient proteinuria (during febrile illness / after exercising)
37
Q

What are other causes of proteinuria?

A 
Glomerular abnormalities 
increased GFR
Reduced renal mass in CKS 
HTN 
Tubular proteinuria
38
Q

What is nephrotic syndrome TRIAD PHO

A

proteinuria
hypoalbuminaemia
oedema

39
Q

What are clinical features of nephrotic syndrome

A

periorbital oedema (first sign)
oedema (leg, scrotum, vulva)
ascites
breathlessness

40
Q

What is management of nephrotic syndrome

A

PO corticosteroids

41
Q

What are complications of nephrotic syndrome

A
  • hypovolaemia
  • thrombosis
  • infection
  • high cholesterol
42
Q

what are features of glomerular haematuria

A

brown urine
presence of deformed red cells (as they pass through glomerulus)
casts

43
Q

what are features of lower urinary tract haematuria

A

red
at beginning / end of stream
NOT accompanied by proteinuria
unusual in children

44
Q

what are causes of glomerular haematuria

A

glomerulonephritis (acute/chronic)
IgA nephropathy
Familial nephritis

45
Q

causes of non glomerular haematuria

A 
infection 
sickle cell disease 
bleeding disorder 
renal vein thrombosis 
trauma
46
Q

What are investigations for haematuria

A 
MC&S
Protein, calcium excretion 
USS 
U&E, creat, calcium, phosphate, albumin 
FBC, platelets, coagulation screen, sickle cell screen
47
Q

What does acute nephritis present as

A

HTN
oedema
haematuria, proteinuria

48
Q

causes of acute nephritis

A

post infectious
vasculitis
IgA nephropathy
Goodpastruses

49
Q

What is henoch Schonein purpura caused by

A

UNKNOWN

50
Q

What are features of henoch Schonein purpur

A

PAGAP

purpuric rash 
arthlagia 
abdo pain 
periarticular oedema 
glomerulonephritis
51
Q

What is rash like in henoch Schonein purpura

A

symmetrical
over buttock and extensor surfaces
trunk is spared

52
Q

What is arthralgia (joint pain) like in henoch Schonein purpura

A

knees and ankles

with periarticular oedem

53
Q

what is abdominal pain like in henoch Schonein purpur

A

tx with corticosteroids

causes haematemesis, malaena

54
Q

what is management for henoch Schonein purpura

A

most resolve spontaneously in 4 weeks

joint pain relief with paracetamol/ibuprofen

55
Q

What is the most common cause of familial nephritis

A

Alport syndrome (X linked recessive(

56
Q

What autoantibody is present in SLE

A

anti-dsDNA

57
Q

What is complement levels like in SLE

A

LOW

58
Q

what is HTN defined as in children

A

above 95th percentile for height, age, sex

59
Q

What are causes of unilateral palpable kidney

A 
multi cystic kidney 
compensatory hypertrophy 
obstructed hydronephrosis 
Wilms tumour 
Renal vein thrombosis
60
Q

What are causes of bilateral palpable kidney

A

PKD
tuberous sclerosis
renal vein thrombosis

61
Q

What is falconi syndrome

A

loss of excess molecules from proximal tubule (amino acids, glucose, ophsophate, bicarb, sodium, calcium, K+)

62
Q

How do you manage AKI

A

STOP AKI

Sepsis - perform septic screen
Toxins - identify and stop nephrotoxic drugs
Optimise volume status and BP
Prevent harm - treat reversible causes e.g. UTI

63
Q

How do you manage UTI in infants <6 weeks

A

IV ampicillin + gent / cefotaxime

ADMIT TO HOSPITAL

64
Q

What are two markers of post-strep nephritis

A

anti-streptolysin O titre

anti-DNAase B titre

65
Q

what are causes of HTN in chilòdren

A

Renal: renal parenchymal disaease, renal artery stenosis, PKD

Aortic coarctation

Catecholamine excess (phaeo, neuroblastoma)

Endocrine (CAH, Cushings, steroids, hyperthyroid)

66
Q

Which form of inheritance has a worse prognosis for PKD

A

Autosomal RECESSIVE has worse prognosis

Y5 Paediatrics (30 decks)

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