nephrology Flashcards
HUS TRIAD what is usualy the history
THROMBcytopenia
haemolytic anaemia- microangipathic
kidney failure
diarrhea for a bout a week and then when its dissolves child is pale
history of child with hUS
parents would say that child has been having diarrhoea (bloody or non bloody) before symptoms began or had contact with farm annals
normal urine output
1-3ml/kg
<1 year = 2 - so if mcc says infant !
toddler =1.5
older children =1
1.
treatment of upper uti in babies
no symptoatic bacyteriua
cephalosporins or co-amoxi for 7-10 days
postive mb in urine but no symptoms common in girls who bed wed
Abs for post strep grammarian arthritis
nephritic syndrome and neutrophils
protein too
low c3
cells seen in HUS
tx for lower uti
schistocytes
nitrofurointin, cephalosportins for 3 days
What can cause post strep a
skin infection or a throat infection
Difference between IGA and toe streptococcus
Both wIll present with a similar history but POST STREP it’s more chronic weeks where is IG A is more acute
and also the antibodies
IG A - will have iG a depostis
pst strep - IG G
WHAT I S TTUBULAR CASTSIN URINE INDICATIVE OF
TUBULAR NECROSIS
CLASSIC SIGN OF IG A
MACROSPCI HEMATURIA
TARGET AUDIENCE FOR IG A
YOUNG MEN -2-3 DAYS AFTER A RESPI INFECTION
TX HUS
DO NOT GIVE TRANSFUSION OF BLOOD OR PLATELTES will make it worse, we just treat symptomatically, either fluid restriction to not overwhelm or hydration, depends on the degree of damage
tea and coke sign of
nephritic
ARF IN KIDS
less than 0.5/kg/hour, we can commonly see this in gastroenteritis
SODIUM LEVELS
in pre-renal it tends to be low (because kindeys are trying to hold on to as much water as possible) and in renal it tends to be high as the kidneys lose their ability to conserve and re-absorb sodium
RENAL >20
PRE- RENAL <10 or some say 20?
which conditions are associated with low c3
post strep and lupus!1
Glomerular versus extra glomerular
glomerular : no clots, coke and tea, rbc casts, protein cast
posterior urthral valves
whats important to remember
associated with respiratory problems can lead to potters syndrome hypertrophic bladder bilateral hydronephrosis vesicle uretral reflux key hole sign on ultrasound dont use a baloon catheter, catheritiesaton can be difficult and lead to bladder spasm
potter syndrome
whcih condtions are only found in boys
oligohydromious
Potter phenotype refers to a typical facial appearance that occurs in a newborn when there is no amniotic fluid.
typcically can die from respiratory issues
fetal compression : dysmorphic features suquashed face/limbs
posterior uretheral valve
urtheral atresia
urtheral hypoplasiia
b2 microglobulin
use b2 microlgllbulin, its found on most nucleated cells and shed to be excreted. Small traces are found in blood and urine, because the tubules reabsorb the b2 was filtered so if there is a tubular problem then levels in urine increase and since the glomeruli are responsible for the filtering process, if they are not working then levels in blood increase. B2 is also a tumour marker for certain malignant silk eleukemia, mm,
AKI CONSTELLATION
hyperkalemia
hypnatremia
hypocalcemi
hyperphosphatrema
most serious complications of AKI
LUPUS labs
pulmonary edema
hyperkalemia
metabolic acidosis
low c3! ANA, (RF in 30%) anticardilipin antibodies
hemorrhagic cystitis
bed wetting
adenovirus
more common in boys, upper age limit is 5, a lot will have a history of bed wetting
primary
secondary: used to be dry now nt so have to test for all the diabtees and do an palpation to check for large bladder
tx - restroct fluids before bed
waking child up to pee after a few hours
TCA- imiprimine
frailly syndrome
dilated calyx
hydronephrosis
tumour
heamtauriai
ectopic uretrs
hydronephrosis - no where for urine to go
dribbling - gilrs
VUR - especially boys
commonly associated with a fupelex kidney
normal proteinuria
<30 per 24
zicroalbuminemia
30 - 3000
normal urinary creatinine ratio
<20 mg /mmol ( early morning)
non pathological causes of proteinuria
orthostatic
febrile illness
exercise
UTI
labs for nephrotic
hemoconcentration hyperlipdemia >200mg protein creatinine ratio >200 low antibodies album <2.5 g
why is there dyspnea in proteinuria patients
pleural effusions and abdominal distention
if MCD is resistant what to use
when to consider biposy in PSGN
cyclosporin A
low c3 >3 month
urine findinngs >year
congenital nephrotic syndrome
complications of PSGC
first 3 months of life, , AR, high mortality with severe proteinuria
Electrolyte abnormalties casued by hypekalemia, hypocalcemia and hyperphospahatmeica hypetenisve encepalopathy, seziures, HEART FAILURE
tx of congenital nephrotic syndrome
unilateral nephrectomy followed by dialysis
tx for hyperphospahtemia
calcium carbonate /phosophate binders
triad of HSP
MOST common symptom of pSGN
abdo pain
purpura (Ccan be necrotic too so black)
arthritis
EDEMA!
where is the rash found in HSP
whats the main pathophys of hSP
dx
extensor surfaces
but
legs
IGA DEPOSTIS
kawasaki disease- rash
juavenille arthritis- has a salmon pink rash and joint pain
always wanna rule out septic but obvs no rash
rF- gives joint pain and skin manifestations
ABDO PAIN- acute abdomen
diagnosis of HSP and which joints usulaly affected
urine- hematuria/prtoeineria
history of recent URTI
skin biopsy of lesiosn
hypertension
knee and ankle
what is the most common vasculitis in chilhood
HSP
tx HSP
most common orgnaism in girls uti
pain relief and CS but only if there is systemic involvement
e.coli, kleb then proetus
type of hematuria in HSP
microscopic
types of hUS
most common uti organisims in boys
classic: history of food posioning assoc with bacteria like e.coli, slamonella, shigela
complement deficiency:
50% e.coli 50% proteus
key differential for HUS and why?
TTP
- microangipathic hemolysis
- thrombocytopenia
investigations in hus
urine- heamturia + non nephrotic protein
blood: shistocytes + reticulcytes + anemia + plt
GFR + BUN
signs of hemolysis : low haptoglobin! reticulocuytes
stool cuture: e.coli
tx of non classic hus
eculizamab
what are the condtions that have microangiopathic hemolysis
what is the pentad of TTP
- HUS
- TTP
- exact the same as HUS + fever+ nerological signs, headache, seizure
ADAMST3 is for what
TTP IT WILL BE LOWW!
subepithelial humps are seen in
POST STREP
