Kidney and renal tract problems Flashcards
What is AKI?
Abrupt loss of kidney function, resulting in retention of urea and other nitrogenous waste products and in dysregulation of extracellular volume and electrolytes
What are the types of causes of AKI?
Pre-renal
Perfusion
Intrinsic
Post renal
What are the intrinsic causes of AKI?
Glomerular disease --haemolytic uraemia syndrome. --GN Tubular injury --acute tubular necrosis Interstitial nephritis- --NSAID --autoimmune
What is the post renal cause of AKI?
Obstruction
What are the features of AKI?
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
What is the warning score in AKI?
1= 1.5-2x reference level 2= 2-3x reference level 3= >3x reference level
What is the management of AKI?
Prevention
Monitor- urine output, PEWs, BP, weight
Hydratin
Minimise drugs
What is haemolytic uraemia syndrome?
Microangiopathic haemolytic anaemia
Thrombocytopenia
AKI
When does haemolytic uraemia syndrome usually occur?
Following verotixin producing E. coli infection
Can be pneumococcal, drugs
What is the management of haemolytic uraemia syndrome?
Monitor kidney functions
Maintain- fluids, renal replacement therapy if necessary
Minimise drugs- no antibiotics
What are the long term consequences of haemolytic uraemia syndrome?
Hypertension
Proteinuria
Evolution to CKD
What are the common UTI causative organisms in kids?
E. coli 85%
Klebsiella, proteus
What is the presentation of UTIs in neonates?
Fever
Vomiting
Lethargy
Irritability
What is the presentation of UTI in preverbal children?
Fever, vomiting, poor feeding, lethargy
Abdo/loin pain and tenderness
What is the presentation of UTI in verbal children?
Frequency, dysuria
Abdo/lin pain/tenderness
Fever, malaise, vomiting
What investigations are done for UTI?
Dipstick
Microscopy- pyuria >10
Urine culture
When should UTIs be further investigated?
<6 months
Septic presentation
Recurrent
Upper tract symptoms
What further investigations can be done for UTI?
US
DMSA- for scarring and function
Micturating cystourethrogram- dynamic
What is the treatment of lower tract UTIs?
3 days oral antibiotic
>3 months, trimethoprim
What is the treatment of upper tract UTIs?
7-10 days antibiotics
Oral- >3 months= trimethoprim, co-amoxiclav or cephalosporin
IV= cephalosporin or co-amoxiclav
What is the prevention of UTIs?
Correct voiding dysfunction
Fluids, hygiene, avoid constipation
What is the grading of vesicoureteric reflux?
1= ureter 2= ureter, pelvis, calyces 3= dilation of ureter 4= Pelvic dilatation, tortuous ureter, obliteration of fornices 5= gross dilatation and tortuosity
What are the causes of CKD?
Congenital- reflux nephropathy, dysplasia, syndromes
Hereditary- cystic kidney disease
Glomerulonephritis
What is the normal GFR?
90-120
What are the stages of CKD re GFR?
2= 60-89 3= 30-59 4= 15-29 5= end stage renal disease
AT what GFR does CKD normally becomes symptomatic?
60
What factors affect progression of CKD?
Late referral
Hypertension
Proteinuria
Recurrent UTIs
What is the management of CKD?
Low K and phosphate diet
Avoid hypercalcaemia
Wha are the causes of cystic renal disease?
Developmental
Genetic
Acquired
What are the congenital causes of developmental cystic renal disease?
Dysplasia
Multicystic dysplastic
What is multi cystic dysplastic kidney?
Sporadic
Ureteric atresia and non functioning kidney
Hypertrophy of contracleteral kidney
What does autosomal recessive renal cystic disease cause problems with?
Renal collecting ducts
What are the features of autosomal recessive cystic renal disease?
Antenatally large bright kidneys
Oligohydramnios
Severe resp distress
Severe- decreased amniotic fluid, pulmonary hypoplasia, foetal compression, bilateral renal genesis, polycystic kidney disease
What does autosomal dominant cystic renal disease cause?
Damage to all nephron segments, liver, pancreatitis, brain
Severe hypertension
What causes syndromic cystic renal disease?
Juvenile familial neohronophthisis- tubular cysts, polyuria, normotensive
What causes acquired renal cystic disease?
Cancer
