Nephrology Flashcards
Describe the triad of symptoms present in nephrotic syndrome.
generalised oedema, heavy proteinuria (>200mg/mmol) and hypoalbuminaemia (<25g/L).
Describe the pathology of nephrotic syndrome.
Nephrosis is the process of leaking protein from a damaged glomerulus, distinguishing it from nephritis, which is inflammation that can involve any part of the nephron or interstitium. The glomerular basement membrane is made up of specialised epithelial cells (podocytes) which normally fuse together and prevent proteins albumin-sized or larger from being filtered; in nephrotic syndrome, they become flattened and start to allow the leaking of these proteins
What is the most common cause of nephrotic syndrome?
Minimal change disease
Name some causes of nephrotic syndrome.
congenital nephrotic syndromes, focal segmental glomerulosclerosis and mesangiocapillary glomerulonephritis.
What atypical features would prompt discussion with a nephrologist and consideration of renal biopsy?
Age < 1 year or > 12 years Hypertension Impaired renal function Frank haematuria Steroid resistant nephrotic syndrome
Describe the management of nephrotic syndrome.
- High dose steroids
- Low salt diet
- Prophylactic antibiotics
What should you be on high alert for in a nephrotic child complaining of abdominal pain?
Mesenteric ischaemia - Nephrotic children are in a pro-thrombotic state and if thrombosis occurs in this group it carries a significant morbidity and mortality.
Name some common causative organisms of UTI in children
Common causes of UTIs are E.Coli (about 85% or more), Klebsiella species and Staphylococcus saprophyticus
Name some risk factors of developing an UTI.
Age below one year
Female – however in children under 3 months UTIs are more common in boys than girls
Caucasian race
Previous UTI
Voiding dysfunction
Vesicoureteral reflex (VUR) – this is the reflux of urine from the bladder into the ureter (can be unilateral or bilateral), Around 33% of infants and children who have a urinary tract infection have VUR.
Sexual abuse – can cause urinary symptoms but infection is uncommon
Spinal abnormalities
Constipation
Immunosuppression
In non verbal children, describe how they might present with a UTI.
Vomiting Fever Lethargy Poor feeding Failure to thrive
In a verbal child, describe how they might present with a UTI.
Increased frequency
Painful urination
There may also be dysfunctional voiding, changes in continence, abdominal pain and loin tenderness.
Less common symptoms may include vomiting, fever, malaise, haematuria, offensive smelling urine and cloudy urine.
Define recurrent UTI.
Two or more episodes of upper UTI (pyelonephritis)
One episode of upper UTI and one episode of lower UTI
Three episodes of lower UTI
Describe how to manage all infants and children 3 months or older with cystitis/lower UTI.
Treat with oral antibiotics for 3 days. Trimethoprim, Nitrofurantoin, a cephalosporin or Amoxicillin may be suitable. An antibiotic should be chosen according to local guidelines and results of urine culture.
Describe how to manage infants and children 3 months or older with acute pyelonephritis or an upper UTI.
If referral is not appropriate treat with oral antibiotics, ciprofloxacin or co-amoxiclav for 7-10 days
In a 3 year old boy that responds well to antibiotic treatment within 48 hours, what imaging is required?
USS Urgently - A 3 year old boy with a UTI would be classed as an atypical UTI. According to NICE guidance, in this age group an urgent ultrasound KUB would be appropriate.
