Nephrology Flashcards
define urinary tract infections (UTIs)
an infection that occurs anywhere from the kidneys to the urethra
clinical features of UTIs in babies < 3mnths
fever vomiting lethargy irritability poor feeding failure to thrive offensive urine
clinical features of UTIs in babies 3-12 mnths
fever
poor feeding
abdominal pain
vomiting
clinical features of UTIs in children >12mnths
⬆️ frequency
dysuria
abdominal pain (suprapubic)
incontinence
investigations of paeds UTIs
urine dipstick
clean catch MSU for MC&S
if in non-potty trained baby:
urine collection pad
diagnosis of paeds UTIs
+ve leukocytes and nitrites on urine dip
+ve urine culture
management of UTIs in babies < 3mnths WITH fever
IV antibiotics (ceftriaxone) full septic screen (e.g. bloods + blood culture + lactate)
management of UTIs in children > 3mnths with lower UTIs
oral antibiotic (e.g. nitrofuranotoin)
management of UTIs in children > 3mnths with upper UTIs
oral antibiotic (e.g. cephalosporin)
define acute pyelonephritis
infection of kidney tissue that can lead to scarring and affect kidney function
when to suspect acute pyelonephritis in paeds
temperature >38
loin pain or tenderness
investigations for recurrent paediatric UTIs
babies <6mnths:
abdominal US
children:
abdominal US after 6wks
DMSA scan after 4-6mnths
signs of atypical UTIs
poor urine flow abdominal or bladder mass raised creatinine septicaemia failure to respond to anitbiotics in 48hrs infection with non E.coli
investigations for atypical UTIs
abdominal US
define vesicoureteric reflex (VUR)
an abnormal flow of urine from the bladder into the upper urinary tract within young children
classification of VUR
Grade I: into ureters only
Grade II: into pelvis without dilatation
Grade III: into pelvis with mild dilatation
Grade IV: into pelvis with moderate dilatation
Grade V: through calyces - refer to surgeon
clinical features of VUR
pain on passing urine
recurrent UTIs
investigations for VUR
MCUG scan
DMSA test 4-6mnths following
urine dipstick
management of VUR
prescribe antibiotic prophylaxis
define minimal change disease
a common cause of nephrotic syndrome in children characterised by minimal histological changes in the kidney structures
clinical features of minimal change disease
peripheral oedema (e.g. facial swelling)
dyspnoea
abdominal pain
nausea + vomiting
risk factors of minimal change disease
Hodgkin’s lymphoma
leukemia
recent viral illness
investigations in minimal change disease
urinalysis
24hr urine protein
bloods (FBC, U+Es, LFTs, RFTs)
management in minimal change disease
fluid restriction and reduced salt intake
corticosteroids (e.g. prednisolone)
human albumin and furosemide
indications for renal biopsy in minimal change disease
unresponsive to steroids
haematuria
<1 yrs or >12yrs
define haemolytic uraemia syndrome (HUS)
a syndrome arising due to thrombosis within the microvasculature due to shiga toxin
common causes of HUS
E.coli (O157:H7) and shigella
risk factors of HUS
children < 5yrs adults >75yrs genetic predisp recent farm visits undercooked meat
clinical features of HUS
bloody diarrhoea vomiting abdominal pain low-grade pyrexia oliguria/anuria haematuria
signs of HUS
pale or jaundiced
bruising
abdominal tenderness
investigations of HUS
urine dipstick
bloods (FBC, U+Es, LFTs and clotting factor)
stool culture
management of HUS
IV fluids + analgesia
antihypertensives
referral to paeds for renal dialysis
cardinal rule in management of HUS
NO administration of antibiotics as can trigger verotoxin expression and release
describe the triad of HUS
microangiopathic haemolytic anaemia
thrombocytopenia
AKI
describe the classic presentation of minimal change disease
peri-orbital oedema
proteinuria
hyperalbuminaemia
