Nephro-urology Flashcards
What condition is low C3 associated with?
Acute post-streptococcoal glomerulonephritis
What imaging would you arrange for <6 month old with a non-atypical UTI?
Renal USS in 6 weeks
MCUG if abnormal
What imaging would you arrange for a >6 month old with an atypical UTI
Renal USS with acute infection
DMSA in at 6 months
Wht imaging would you arrange for <6 month old with a atypical UTI?
Renal USS with acute infection
MCUG when illness resolved
DMSA in 4-6 months
What imaging would you arrange for a >6 month old with a non-atypical UTI
No imaging required if this is first infection
If recurrent USS in 6 weeks. DMSA at 4-6 months.
What investigations would you arrange ? bilateral hydronephrosis
MAG3 or MCUG to ascertain whether the appearances are the result of obstruction or reflux.
Describe posterior urethral valves
abnormal valves attach to the urethral wall leading to obstruction and dilatation of the posterior urethra. Over time the bladder detrusor muscle becomes hypertrophied.
Think if bilateral hydronephrosis
What organism is most commonly impilcated in haemolytic uraemic syndrome?
Shiga toxin-producing Escherichia coli
What are the causes of CKD?
congenital—malformations, obstructive uropathy, renal dysplasia, reflux nephropathy
metabolic—cystinosis, oxalosis, polycystic kidney disease
glomerulonephritis—focal segmental glomerulosclerosis, congenital nephrotic syndrome, IgA nephropathy
Define primary and secondary enuresis
> 5 years and never been dry
5 years, has been dry over 6 months but now wetting.
What are the treatement for nocturnal enuresis ?
Behavioural modifications such as regular bladder emptying, ‘lifting’ the children as parents go to bed and walking them to the toilet and motivational approach with ‘star charts’ for younger children. Enuresis alarms—’bell and pad alarm’
If older, small dose desmopressin
If due to bladder instability, oxybutynin
What organism is most commonly implicated in formation of renal stones?
Proteus species
Describe Alport Syndrome
X-linked dominant mutation (80% of time) of type IV collagen
Kidney failure, deafness, visual problems
What are the laboratory findings of Distal RTA (type I)
Urine pH >5.5, hypokalaemia, metabolic acidosis
How does RTA type one typically present?
Renal colic, renal stones, faltering growth
What are the laboratory findings of Proximal RTA (type II)
Metabolic acidosis, hypokalaemia, Urine pH <5.5
Urine raised bicarb, glucose and amino acids
How does Proximal RTA Type II present?
Fanconi Syndrome
Faltering growth and rickets
What are the lab findings of Bartter Syndrome?
Hypokalaemic metabolic alkalosis,
May also: hyponatremia, hypochloraemia, hypercalciuria and nephrocalcinosis may also be observed
What are the lab findings of RTA type IV?
hyPERkalaemia, mild metabolic acidosis
Barter syndrome lab findings in older child suggests what?
Gitelman syndrome
What supplements do you need to give patients with CKD? and why?
Iron and erythropoietin - broken kidney doesn’t make
Calcium and Vit D supplement - CKD causes herphosphataemia which leads to hypo calcaemia and vit D deficiency. May also need phosphate binders
RTA type 1 is classified as what? and has What lab findings?
Failure to secrete H+ in distal convoluted tubule.
Metabolic acidosis, hyPOkalaemia and urine pH> 5.5
RTA type 2 is classsified as what? What are the lab findings?
Failure to resorb bicarbonate in proximal convoluted tubule.
Metabolic acidosis, hyPOkalaemia and urine pH can be <5.5
What are the types of polycystic kidney disease?
AR - PKHD1, 6p21–12
AD - PKD1 (16p13) or PKD2 (4q21–23)
Describe AR PCKD
a/w with pulmonary hypoplasia due to oligohydramnios
multiple microcysts antenetally
HTN
Kidney failure +/- liver fibrosis and sequelea it (varices) in early childhood
Describe AD PCKD
Macrocysts seen on USS
may be asymptomatic and indeed cystless until 4th decade of life
HTN
a/w cystic liver disease, pancreatic cysts and intracranial aneurysms
