Kids and Kidneys

Question 1

In children, what are the most common causes of secondary hypertension? What features would make you admit a child with hypertension?

Answer 1

• Endocrine - hormone secreting tumours
• Renal - congenital/acquired (parenchymal) disease
• Vascular - coarctation, RAS, renal artery thrombosis
• Medications
• Features of end-organ damage e.g. CCF, headache, visual disturbance, oedema

Question 2

In paediatric renal disease, what is the usefulness of proteinuria levels?

Answer 2

Predicts prognosis (except in minimal change disease)

Question 3

What are the features of nephrotic syndrome? What are the most common paediatric causes? What are some complications?

Answer 3

• Oedema, hypoalbuminaemia (<25g/L), proteinuria, hypercholesterolaemia
• Minimal change disease, glomerulonephridities (SLE etc.)
• Infection, thrombosis, dehydration, effusions

Question 4

What are the features of nephritic syndrome? What are the most common causes?

Answer 4

• Results from acute inflammation and impaired filtration
  
  • Hypertension, haematuria, proteinuria, raised creatinine, oliguria
• Any glomerulonephritides
  
  • Post-Strep GN (2-4 weeks post-infection)
  • IgA, SLE, HSP

Question 5

What investigations might you consider in a child with nephritic syndrome to elucidate a cause?

Answer 5

• MSU for MCS, protein:creatinine ratio
• ANA, dsDNA, C3, C4 levels (SLE)
• ANCA (vasculitis)
• ASOT (post-Strep)
• Anti-GBM (Goodpasture’s)
• HBV/HCV serology (associated with membranoproliferative GN)

Question 6

What causes haemolytic-uraemic-syndrome? What are some presenting features?

Answer 6

• Haemolytic anaemia (non-immune), thrombocytopaenia, AKI (+/- bloody diarrhoea)
• Caused by Shiga toxin (e.g. EHEC) or other pathogens, genetics

Question 7

How would you manage a child with haemolytic uraemia syndrome?

Answer 7

• Supportive +/- blood transfusion/dialysis if required
• No steroids
• No antibiotics (can cause increase Shiga toxin release and worsen course)

Question 8

What causes Henoch-Scholein purpura? What are the classic presenting features? How is it treated?

Answer 8

• Immune-mediated small vessel vasculitis with IgA deposition
• Presentation
  
  • Palpable purpuric rash over gravity-dependent/pressure areas - mostly lower extremities, buttocks
  • Arthralgia/arthritis
  • Abdominal pain
  • Renal disease
• Treatment
  
  • Antiinflammatories for pain. Steroids if non-responsive to this
  • Longer-term follow-up for development of renal complications

Question 9

What are the most common causes of chronic kidney disease in children?

Answer 9

• Reflux nephropathy
• Posterior urethral valve
• Renal hypo/dysplasia