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PAEDIATRICS > Met / Endo / Renal > Flashcards

Met / Endo / Renal Flashcards

1
Q

How is T1DM diagnosed?

A

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

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2
Q

What are the presenting symptoms of T1DM?

A 
Usually short history of acute symptoms
Weight loss
Polyuria
Polydipsia
Polyphagia
Weakness/fatigue
Irritability
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3
Q

How does DKA present?

A 
Vomiting
Abdominal pain
Change in LOC
Dehydration
Ketone breath
Hyperventilation (Kussmaul breathing)
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4
Q

What are the different types of short/intermediate/long acting insulins?

A

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

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5
Q

What is congenital adrenal hyperplasia? What are the symptoms?

A

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)
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6
Q

How is VUR diagnosed?

A

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
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7
Q

Under what conditions would you perform a renal U/S KUB?

A

If <6mo
If recurrent UTI
If atypical presentation without response to treatment

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8
Q

What are the complications of VUR?

A

Increased pressure on the kidneys –> reflux nephropathy and scarring, HTN, chronic renal failure

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9
Q

What are the grades of VUR?

A

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

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10
Q

What is the management for VUR?

A
  • 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
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11
Q

What are some other congenital renal abnormalities?

A

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

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12
Q

What are the 4 features of nephritic syndrome?

A
  1. Haematuria
  2. Proteinuria
  3. Hypertension
  4. Fluid overload
  • Due to damage to epithelium
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13
Q

What are the 4 features of nephrotic syndrome?

A
  1. Proteinuria
  2. Oedema
  3. Hyperlipidaemia
  4. Hypoalbuminaemia
  • Due to damage to glomerular basement membrane and podocytes
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14
Q

What are some common causes of nephritic syndrome in children?

A

Post-strep glomerulonephritis
IgA nephropathy
Goodpastures syndrome

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15
Q

What are some common causes of nephrotic syndrome in children?

A 
**Minimal change disease
	○ Steroid sensitive (90%)
	○ Steroid resistant (10%)
Rare
	○ Focal segmental glomerulosclerosis
	○ Membranoproliferative glomerulonephritis
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16
Q

Describe minimal change disease - definition, clinical features, treatment

A

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

17
Q

Describe IgA nephropathy - definition, cause, clinical features, treatment

A

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

18
Q

Describe post-strep glomerulonephritis - cause, clinical features, investigations, treatment

A

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)

19
Q

What is Goodpasture syndrome and how does it present?

A

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)

20
Q

What are the different methods of acquiring a urine specimen from a child?

A

Clean catch
Supra-pubic aspirate
In/out catheter
Bag/pad sample

21
Q

What is the appropriate treatment for UTI in a child?

A
  • 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
22
Q

What are the education points that need to be considered for a parent following UTI?

A
  • Don’t take long baths
  • Hygiene
  • Clean under foreskin
  • Wipe

PAEDIATRICS (9 decks)

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