Kidney and renal tract problems

Question 1

What is AKI?

Answer 1

Abrupt loss of kidney function, resulting in retention of urea and other nitrogenous waste products and in dysregulation of extracellular volume and electrolytes

Question 2

What are the types of causes of AKI?

Answer 2

Pre-renal
Perfusion
Intrinsic
Post renal

Question 3

What are the intrinsic causes of AKI?

Answer 3

Glomerular disease
--haemolytic uraemia syndrome. 
--GN
Tubular injury
--acute tubular necrosis
Interstitial nephritis- 
--NSAID
--autoimmune

Question 4

What is the post renal cause of AKI?

Answer 4

Obstruction

Question 5

What are the features of AKI?

Answer 5

Anuria/oliguria <0.5ml/kg/hr for >8 hours
Hypertension with fluid overload
Rapid rise in plasma creatinine >1/5x age reference or known baseline

Question 6

What is the warning score in AKI?

Answer 6

1= 1.5-2x reference level
2= 2-3x reference level
3= >3x reference level

Question 7

What is the management of AKI?

Answer 7

Prevention
Monitor- urine output, PEWs, BP, weight
Hydratin
Minimise drugs

Question 8

What is haemolytic uraemia syndrome?

Answer 8

Microangiopathic haemolytic anaemia
Thrombocytopenia
AKI

Question 9

When does haemolytic uraemia syndrome usually occur?

Answer 9

Following verotixin producing E. coli infection

Can be pneumococcal, drugs

Question 10

What is the management of haemolytic uraemia syndrome?

Answer 10

Monitor kidney functions
Maintain- fluids, renal replacement therapy if necessary
Minimise drugs- no antibiotics

Question 11

What are the long term consequences of haemolytic uraemia syndrome?

Answer 11

Hypertension
Proteinuria
Evolution to CKD

Question 12

What are the common UTI causative organisms in kids?

Answer 12

E. coli 85%

Klebsiella, proteus

Question 13

What is the presentation of UTIs in neonates?

Answer 13

Fever
Vomiting
Lethargy
Irritability

Question 14

What is the presentation of UTI in preverbal children?

Answer 14

Fever, vomiting, poor feeding, lethargy

Abdo/loin pain and tenderness

Question 15

What is the presentation of UTI in verbal children?

Answer 15

Frequency, dysuria
Abdo/lin pain/tenderness
Fever, malaise, vomiting

Question 16

What investigations are done for UTI?

Answer 16

Dipstick
Microscopy- pyuria >10
Urine culture

Question 17

When should UTIs be further investigated?

Answer 17

<6 months
Septic presentation
Recurrent
Upper tract symptoms

Question 18

What further investigations can be done for UTI?

Answer 18

US
DMSA- for scarring and function
Micturating cystourethrogram- dynamic

Question 19

What is the treatment of lower tract UTIs?

Answer 19

3 days oral antibiotic

>3 months, trimethoprim

Question 20

What is the treatment of upper tract UTIs?

Answer 20

7-10 days antibiotics
Oral- >3 months= trimethoprim, co-amoxiclav or cephalosporin
IV= cephalosporin or co-amoxiclav

Question 21

What is the prevention of UTIs?

Answer 21

Correct voiding dysfunction

Fluids, hygiene, avoid constipation

Question 22

What is the grading of vesicoureteric reflux?

Answer 22

1= ureter
2= ureter, pelvis, calyces
3= dilation of ureter
4= Pelvic dilatation, tortuous ureter, obliteration of fornices
5= gross dilatation and tortuosity

Question 23

What are the causes of CKD?

Answer 23

Congenital- reflux nephropathy, dysplasia, syndromes
Hereditary- cystic kidney disease
Glomerulonephritis

Question 24

What is the normal GFR?

Answer 24

90-120

Question 25

What are the stages of CKD re GFR?

Answer 25

``` 2= 60-89 3= 30-59 4= 15-29 5= end stage renal disease ```

Question 26

AT what GFR does CKD normally becomes symptomatic?

Answer 26

60

Question 27

What factors affect progression of CKD?

Answer 27

Late referral Hypertension Proteinuria Recurrent UTIs

Question 28

What is the management of CKD?

Answer 28

Low K and phosphate diet | Avoid hypercalcaemia

Question 29

Wha are the causes of cystic renal disease?

Answer 29

Developmental Genetic Acquired

Question 30

What are the congenital causes of developmental cystic renal disease?

Answer 30

Dysplasia | Multicystic dysplastic

Question 31

What is multi cystic dysplastic kidney?

Answer 31

Sporadic Ureteric atresia and non functioning kidney Hypertrophy of contracleteral kidney

Question 32

What does autosomal recessive renal cystic disease cause problems with?

Answer 32

Renal collecting ducts

Question 33

What are the features of autosomal recessive cystic renal disease?

Answer 33

Antenatally large bright kidneys Oligohydramnios Severe resp distress Severe- decreased amniotic fluid, pulmonary hypoplasia, foetal compression, bilateral renal genesis, polycystic kidney disease

Question 34

What does autosomal dominant cystic renal disease cause?

Answer 34

Damage to all nephron segments, liver, pancreatitis, brain | Severe hypertension

Question 35

What causes syndromic cystic renal disease?

Answer 35

Juvenile familial neohronophthisis- tubular cysts, polyuria, normotensive

Question 36

What causes acquired renal cystic disease?

Answer 36

Cancer