Met / Endo / Renal Flashcards
How is T1DM diagnosed?
Random BSL >11.1 in the absence of an acute illness
Fasting BSL >7
OGTT >11.1 at 2hrs post glucose
C-peptide: Low or undetectable C-peptide level indicates absence of insulin secretion from pancreatic beta cells
What are the presenting symptoms of T1DM?
Usually short history of acute symptoms Weight loss Polyuria Polydipsia Polyphagia Weakness/fatigue Irritability
How does DKA present?
Vomiting Abdominal pain Change in LOC Dehydration Ketone breath Hyperventilation (Kussmaul breathing)
What are the different types of short/intermediate/long acting insulins?
Rapid acting: 15mins, lasts 1-5hrs (Novorapid, Humalog)
Short acting: 30-60mins, up to 8hrs (Actrapid, Humalin)
Intermediate acting: 1-2hrs, peaks at 2-4hrs, lasts 16-35hrs (Insulatard)
Long acting: steady state in 3-4days (Levemir, lantus)
Biphasic
What is congenital adrenal hyperplasia? What are the symptoms?
Defect in pathway that synthesises cortisol from cholesterol (21 a-hydroxylase)
- Causes failure to thrive
- Deficiency in aldosterone (excretion of sodium in urine (natiuresis) –> salt wasting (vomiting) and dehydration)
- Partial deficiency in cortisol (hypoglycaemia, hypotension, shock)
- EXCESS androgens (ambiguous genitalia, precocious puberty, menstrual irregularity, infertility)
How is VUR diagnosed?
Identified prenatally on U/S - HYDRONEPHROSIS
After birth:
- Ultrasound of bladder, ureters, kidneys
- MCUG - only do if U/S abnormal
* Can only grade VUR using MCUG - DMSA scan - ONLY do if MCUG abnormal
- Evaluates renal structure and morphology, can assess for scarring (large radiation exposure)
- Inject radioactive dye into vein which reaches kidneys 2-4hrs later
Under what conditions would you perform a renal U/S KUB?
If <6mo
If recurrent UTI
If atypical presentation without response to treatment
What are the complications of VUR?
Increased pressure on the kidneys –> reflux nephropathy and scarring, HTN, chronic renal failure
What are the grades of VUR?
1 - reflux into non-dilated ureter
2 - reflux into renal pelvix and calyces without dilation
3 - reflux with mild/moderate dilation, minimal fornice blunting
4 - reflux with moderate ureteral tortuosity and dilation of pelvis and calyces
5 - reflux with gross dilation of ureter, pelvis, calyces, loss of papillary impressions, ureteral tortuosity
>4 = scarring
What is the management for VUR?
- Resolves spontaneously (10% each year)
○ Unlikely if severe - Prophylactic Abx - NO longer indicative
- Surgery if recurrent UTIs or grade 4-5 VUR
- Investigate siblings if strongly genetic
What are some other congenital renal abnormalities?
Complete bilateral agenesis
Abnormalities of ascent and rotation
Duplex kidney (2 ureters)
Horseshoe kidney
Autosomal recessive polycystic kidney disease
VUR
Posterior urethral valves - more common in boys
What are the 4 features of nephritic syndrome?
- Haematuria
- Proteinuria
- Hypertension
- Fluid overload
- Due to damage to epithelium
What are the 4 features of nephrotic syndrome?
- Proteinuria
- Oedema
- Hyperlipidaemia
- Hypoalbuminaemia
- Due to damage to glomerular basement membrane and podocytes
What are some common causes of nephritic syndrome in children?
Post-strep glomerulonephritis
IgA nephropathy
Goodpastures syndrome
What are some common causes of nephrotic syndrome in children?
**Minimal change disease ○ Steroid sensitive (90%) ○ Steroid resistant (10%) Rare ○ Focal segmental glomerulosclerosis ○ Membranoproliferative glomerulonephritis
Describe minimal change disease - definition, clinical features, treatment
Kidney disease causing nephrotic syndrome
○ Causes damage to glomerular basement membrane and podocytes without visible changes on light microscopy
Unknown cause: leads to excessive protein loss in urine
Clinical features: oedema often around eyes/face –> progresses to extremities and abdo
Treatment: steroids, monitor fluid balance
Describe IgA nephropathy - definition, cause, clinical features, treatment
Form of glomerulonephritis caused by mesangial (glomerular) deposits of of IgA immune complexes causing chronic inflammation and consequent scarring, commonest cause of glomerulonephritis worldwide
Cause: Develops 1-2 days after URTI
Clinical features: recurrent macroscopic haematuria, oedema
Treatment: manage HTN, proteinuria, and oedema
**HSP is considered to be a systemic form of IgA nephropathy
Describe post-strep glomerulonephritis - cause, clinical features, investigations, treatment
Caused by strep antigen immune complexes deposited in glomeruli basement membrane –> inflammation –> podocyte damage
- Type 3 hypersensitivity reaction
- Group A beta-haemolytic strep
Cause: develops 1-2 weeks after strep throat or impetigo
Clinical features: discoloured/smoky urine (haematuria), fluid overload (oedema, HTN)
Investigations: U/A (blood, protein), EUC (elevated BUN, Cr), MCS (red cells and casts), throat swab, renal biopsy
Treatment:
- Supportive care
- Bed rest for 2-3 weeks
- Treat acute renal insufficiency and HTN
- Monitor water/salt intake
- Abx to prevent spread (ben pen)
What is Goodpasture syndrome and how does it present?
Abnormal production of anti-GBM antibodies –> attack the glomerular (and alveolar) basement membrane
Clinical features: malaise, weight loss, fatigue, fever, joint aches and pains
- Can also have lung involvement
Treatment: immunosuppressants (corticosteroids and cyclophosphamide) + plasmapheresis (antibodies are removed from the blood)
What are the different methods of acquiring a urine specimen from a child?
Clean catch
Supra-pubic aspirate
In/out catheter
Bag/pad sample
What is the appropriate treatment for UTI in a child?
- Antibiotics promptly
○ Prevent serious illness and renal scarring
○ Cystitis: oral trimethoprim, cephalexin
○ Pyelonephritis: oral ciprofloxacin or IV gentamycin - High fluid intake
- Regular unhurried voiding
- Good perineal hygiene
What are the education points that need to be considered for a parent following UTI?
- Don’t take long baths
- Hygiene
- Clean under foreskin
- Wipe
