Kids and Kidneys Flashcards
How does kidney disease present in children?
Late
How do you tell if the blood pressure cuff is the right size?
Largest cuff that fits between the shoulder and elbow
What is normal BP in children?
Less than 90th percentile
What are the cut offs for hypertension?
90-95th or more than 120/80 - pre-HTN
More than 95th - stage 1
More than 99th - stage 2
What are the causes of HTN?
White coat HT
Organic
- Renal, cardiac, endocrine
Lifestyle/familial
What are the most common causes of organic HTN?
Renal - cyst, reflux
Who do you measure BP in?
Children with chronic disease
What are the symptoms of malignant HT?
Headache Blurred vision Nausea Vomiting - Medical emergency due to raised ICP and risk of encephalopathy
How do you treat malignant HT?
Bring it down slowly
How do you treat malignant HT?
Bring it down slowly
What are the main causes of haematuria?
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
What is thin membrane disease?
Recessive collagen type 4 disorder
Generally benign, causes haematuria during illness
How do you investigate proteinuria?
Spot collection
- Early morning, albumin creatinine ratio
What are the causes of proteinuria?
Artefact Transient Benign orthostatic proteinuria UTI Renal disease - Acute or chronic kidney disease
What are the features of nephrotic syndrome?
Oedema Hypoalbuminaemia Proteinuria Hypercholesterolaemia Prothrombic
Why do you get prothrombic in nephrotic syndrome?
Concentrated blood
Loss of anticoagulant factors
What is minimal change disease?
GN
In 2-10 yo, atopic, triggered by infection and immune mediated, 90% response to steroids, relapse occur in 2/3
How is minimal change disease managed?
Steroids - take 1 week to work
Penicillin to prevent spontaneous bacterial peritonitis
Aspirin - prothrombic state
What are the features of nephritic syndrome?
HT Haematuria - heavy and macroscopic Proteinuria Renal impairment Oliguria
What are some acute complications of nephritic syndrome?
K derangement
What are the causes of nephritic syndrome?
GN of any sort - SLE, IgA
Post-strep GN important
What is the most important test in post-strep GN?
Complement levels - C3 and C4 will be low in Post-strep GN
How is nephritic syndrome treated?
Diuretics - Frusemide
What is HUS? How does it present?
Haemolytic uraemic syndrome
Bloody diarrhoea illness one week previous Reduced urine output Also - CNS - Pancreatitis
What is the pathophysiology of HUS?
Thrombotic microangiopathy
Mechanical not immune mediated
What is the classic Ix finding in HUS?
RBC fragments on blood film
How does HSP present?
Not unwell
Lower limb purpura
GI - abdo pain
Joint - arthralgia
What is the long term risk in HSP?
IgA nephropathy
How do you Mx HSP?
Steroids for GI and joint symptoms
Monitor for six months for kidney involvement
