Kids and Kidneys

Question 1

How does kidney disease present in children?

Answer 1

Late

Question 2

How do you tell if the blood pressure cuff is the right size?

Answer 2

Largest cuff that fits between the shoulder and elbow

Question 3

What is normal BP in children?

Answer 3

Less than 90th percentile

Question 4

What are the cut offs for hypertension?

Answer 4

90-95th or more than 120/80 - pre-HTN
More than 95th - stage 1
More than 99th - stage 2

Question 5

What are the causes of HTN?

Answer 5

White coat HT
Organic
- Renal, cardiac, endocrine
Lifestyle/familial

Question 6

What are the most common causes of organic HTN?

Answer 6

Renal - cyst, reflux

Question 7

Who do you measure BP in?

Answer 7

Children with chronic disease

Question 8

What are the symptoms of malignant HT?

Answer 8

Headache
Blurred vision
Nausea
Vomiting
- Medical emergency due to raised ICP and risk of encephalopathy

Question 9

How do you treat malignant HT?

Answer 9

Bring it down slowly

Question 10

How do you treat malignant HT?

Answer 10

Bring it down slowly

Question 11

What are the main causes of haematuria?

Answer 11

Artefact
Transient 
UTI
Medical Renal disease
- Hypercalciuria
- Thin basement membrane disease 
- Alport syndrome
- Glomerulonephritis
- Coagulopathy 

Urological disease

• Calculi - 1-2% of children
• Tumour
• Stricture
• Trauma

Question 12

What is thin membrane disease?

Answer 12

Recessive collagen type 4 disorder

Generally benign, causes haematuria during illness

Question 13

How do you investigate proteinuria?

Answer 13

Spot collection

- Early morning, albumin creatinine ratio

Question 14

What are the causes of proteinuria?

Answer 14

Artefact
Transient
Benign orthostatic proteinuria
UTI
Renal disease 
- Acute or chronic kidney disease

Question 15

What are the features of nephrotic syndrome?

Answer 15

Oedema
Hypoalbuminaemia
Proteinuria
Hypercholesterolaemia
Prothrombic

Question 16

Why do you get prothrombic in nephrotic syndrome?

Answer 16

Concentrated blood

Loss of anticoagulant factors

Question 17

What is minimal change disease?

Answer 17

GN

In 2-10 yo, atopic, triggered by infection and immune mediated, 90% response to steroids, relapse occur in 2/3

Question 18

How is minimal change disease managed?

Answer 18

Steroids - take 1 week to work
Penicillin to prevent spontaneous bacterial peritonitis
Aspirin - prothrombic state

Question 19

What are the features of nephritic syndrome?

Answer 19

HT
Haematuria - heavy and macroscopic 
Proteinuria
Renal impairment
Oliguria

Question 20

What are some acute complications of nephritic syndrome?

Answer 20

K derangement

Question 21

What are the causes of nephritic syndrome?

Answer 21

GN of any sort - SLE, IgA

Post-strep GN important

Question 22

What is the most important test in post-strep GN?

Answer 22

Complement levels - C3 and C4 will be low in Post-strep GN

Question 23

How is nephritic syndrome treated?

Answer 23

Diuretics - Frusemide

Question 24

What is HUS? How does it present?

Answer 24

Haemolytic uraemic syndrome

Bloody diarrhoea illness one week previous
Reduced urine output 
Also
- CNS
- Pancreatitis

Question 25

What is the pathophysiology of HUS?

Answer 25

Thrombotic microangiopathy

Mechanical not immune mediated

Question 26

What is the classic Ix finding in HUS?

Answer 26

RBC fragments on blood film

Question 27

How does HSP present?

Answer 27

Not unwell
Lower limb purpura
GI - abdo pain
Joint - arthralgia

Question 28

What is the long term risk in HSP?

Answer 28

IgA nephropathy

Question 29

How do you Mx HSP?

Answer 29

Steroids for GI and joint symptoms

Monitor for six months for kidney involvement