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Paediatrics > Nephritic syndrome > Flashcards

Nephritic syndrome Flashcards

1
Q

Microscopic heamaturia - how many times do you need to pick this up before you Investigate?

A

> trace on 3 occasions

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2
Q

false positives of heamaturia include?

A

Haemaglobinuria, myoglobinuria

stix positive + microscopy negative

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3
Q

Associated proteinuria =?

A

glomerular disease

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4
Q

causes of haematuria? - systemic

A

clotting disorders

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5
Q

most common cause of renal frank haematuria ?

A

Glomerulonephritis

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6
Q

2 types of renal tumour?

A

Wilm’s - nephroblastoma

  • Cysts
  • sarcomas
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7
Q

common causes of haematuria? (5)

A 
Malignancies - sarcomas
Stones
UTI
Trauma
Urethritis
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8
Q

how may it present? - case

A 
10 years old
7 day history of sore throat, pyrexia and vomiting
Abdominal/lumbar pain, no radiation
GP treated as UTI
Day 7 of illness “red” urine
Some urgency, frequency but no dysuria
Hypertension
BP 130 /85
Water handling problem
Raised JVP
Peripheral oedema
Pallor
Abdomen – non tender, no organomegaly

Urine
Frank
dipstix Blood 3+, protein 3+
Red cells on microscopy

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9
Q

how to approach a diagnosis of nephritic syndrome?

A
  • blood tests - raised creatinine
  • electrolytes - hyponatraemia and hyperkalaemia
  • FBC - Mild anaemia, no haemolysis
  • Albumin low
  • urine work up to exclude UTI
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10
Q

Clinical features of glomerulonephritis

A 
Haematuria and proteinuria
Reduced GFR
Oliguria 
Fluid overload
Raised JVP
oedema
Hypertension
Worsening renal failure = Rapidly Progressive GN

= cause of AKI

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11
Q

Endothelial cell injuries include?

A
  • post infectious glomerulonephritis (PIGN),

- Haemolytic Uraemic Syndrome, - Membranoproliferative - - Glomerulonephritis (MPGN), Lupus, ANCA vasculitis

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12
Q

investigations for nephritic syndrome?

A
  • Renal USS
  • infectious/sore throat - swab for group A strep
  • immunology work up complement C3 AND C4
  • ANA and ANCA
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13
Q

Features of Acute Post-Infectious Glomerulonphritis

  • cause?
    site?
A

age 3-5

  • group a strep - beta hemolytic

throat infection , skin

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14
Q

Pathogenesis of nephritic syndrome?

A
  • Antigen “Mimicry”

- Ab-Ag complexes

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15
Q

How to diagnose Acute Post-Infectious Glomerulonphritis?

differentials (4)

A

Bacterial culture
positive ASOT
low C3 normalises

  • lupus, MPGN, HSP / IgA nephropathy,
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16
Q

Treating Acute Post-Infectious Glomerulonphritis?

A
  • Antibiotic - penicillin
  • Support renal functions
  • Electrolyte / acid base
    Overload / hypertension
    Diuretics
17
Q

IgA often presents after a?

A

URTI

- Older children and adults

18
Q

Clinical signs of IgA Nephropathy? (3)

A
  • Recurrent macroscopic haematuria
  • Chronic microscopic haematuria
  • Varying degree of proteinuria
19
Q

Step 1 in IgA nephropathy pathogenesis

A

increased levels of Gd-IgA1

20
Q

Step 2 in IgA nephropathy pathogenesis

A

production of anti-IgA1 antibodies

IgA or IgG

21
Q

Step 3 in IgA nephropathy pathogenesis

A

IMMUNE COMPLEXES FORM

- FORM IN SITU

22
Q

Step 4 in IgA nephropathy pathogenesis

A

complexes in the mesangium cause local immune activation and injury

23
Q

what is caused/ what conditions are a result of antigens deposited in the kidneys? (6)

A 
complement activation
cytokine release
matrix production 
mesangial proliferation 
glomerular sclerosis 
interstitial fibrosis
24
Q

How to diagnose IgA nephropathy ?

A

clinical pictire

- renal biopsy if needed

25
Q

treatment of IgA nephropathy - mild

A

ACEI - for proteinuria and hypertension

26
Q

treatment of IgA nephropathy - severe?

A

immunosuppresion (KDIGO)

27
Q

IgA related vasculitis - clinical feature

  • what do you need to diagnose?
A

Mandatory palpable purpura

  • Abdominal pain
    2. Renal involvement
    3. Arthritis or arthralgia
    4. Biopsy - IgA depostition
28
Q

what vessels does IgA vasculitis affect

A

arterioles
capillaries
venules

29
Q

Cause of IgA vasculitis ?

A

Viral URTI in 70%

Streptococcus, drugs

30
Q

what cells are injured in IgA conditions?

A

Mesangial

31
Q

Treatments of IgA Vasculitis?

A

analgesia -Joints, gut

antacids, Glucocorticoid therapy - gut symptoms

severe - immunospression

Paediatrics (49 decks)

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