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Year 3- Paediatrics > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Five functions of the kidney?

A
  1. Waste handling
  2. Water handling
  3. Salt balance
  4. Acid base control
  5. Endocrine - erythropoietin for RBC, renin for BP, PTH for bone health
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2
Q

If urine is frothy, what is it high in>?

A

Protein

->like how egg whites froth when making a pavlova because high in protein

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3
Q

If there is increasing proteinuria, is it likely to be nephritic or nephrotic syndrome?

A

Nephrotic

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4
Q

If there is increasing haematuria, is it likely to be nephritic or nephrotic syndrome?

A

Nephritic syndrome

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5
Q

Which cells of the kidney are affected in minimal change disease?

A

Podocytes

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6
Q

Which cells of the kidney are affected in Haemolytic Uraemic Syndrome?

A

Endothelial cell

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7
Q

Which cells of the kidney are affected in IgA nephropathy?

A

Mesangial cell

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8
Q

Three ways to assess proteinuria?

A

Urine dipstick- easiest
Protein Creatinine ratio-practical
24hr urine collection - gold standard

->urine dips can be falsely negative as children drink large volumes and can dilute their urine

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9
Q

Three symptoms of nephrotic syndrome?

A

Proteinuria
Hypalbuminaemia
Oedema

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10
Q

Is there any haematuria in minimal change disease?

A

Can be- 50% have microscopic haematuria

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11
Q

Most common nephrotic syndrome in children?

A

Minimal change disease

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12
Q

Treatment for minimal change disease?

A

Prednisolone for 8wks

->type of glucocorticoid steroid

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13
Q

Common side effects from high dose, prolonged treatment of glucocorticoids in children?

A

Behaviour changes
Sleep disturbance
Mood changes

Increased infection risk- check varicella status, pneumococcal vaccine, start antibiotic prophylaxis

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14
Q

Frank haematuria always need investigation in children.
Microscopic haematuria needs to be traced on two or three occasions before investigating.

However, if there is microscopic haematuria, it requires investigation if there is what other finding in the urine?

A

Proteinuria

->associated proteinuria with haematuria = glomerular disease

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15
Q

List some of the lower UT causes of haematuria.

A

Urethritis
Trauma
UTI
Stones
Malignancies- sarcoma (rare)

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16
Q

List some of the upper UT causes of haematuria.

A

Cysts
Glomerulonephritis
Tumour- Wilm’s, nephroblastoma

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17
Q

Systemic cause of haematuria?

A

Clotting disorders

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18
Q

Nephritic syndrome is a clinical definition for what?

A

Glomerulonephritis

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19
Q

If a patient has post-infectious glomerulonephritis or haemolytic uraemic syndrome, which type of cell has been damaged?

A

Endothelial cell

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20
Q

If a patient has IgA nephropathy, which type of cell has been damaged?

A

Mesangial cell

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21
Q

What is the usually cause of acute post-infectious glomerulonephritis?

A

Group A strep

->note that post-infectious glomerulonephritis is a type of nephritic syndrome

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22
Q

How long after a throat infection can acute post-infectious glomerulonephritis occur?

A

7-10 days

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23
Q

How long after a skin infection can acute post-infectious glomerulonephritis

A

2-4 weeks

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24
Q

How is a diagnosis of acute post-infectious glomerulonephritis made?

A

Bacterial culture
Positive ASOT

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25
Management of acute post-infectious glomerulonephritis?
Antibiotics Support renal function If fluid overload or hypertension, consider a diuretic
26
When does IgA nephropathy commonly occur?
1-2 days after URTI
27
Who tends to get IgA nephropathy?
Older children and adults ->most common type of glomerulonephritis
28
Clinical findings of IgA nephropathy?
Recurrent macroscopic haematuria +/- chronic microscopic haematuria Varying degrees of proteinuria
29
Diagnosis of IgA nephropathy?
Usually a clinical pictures, can be confirmed with a biopsy
30
Treatment of IgA nephropathy?
Mild disease- ACEi for the persistent proteinuria or hypertension Moderate to severe- immunosuppression
31
At what age does Henoch Schonlein Purpura (HSP) IgA related vasculitis tend to occur?
5-15yrs
32
What are the symptoms required to make a clinical diagnosis of HSP IgA related vasculitis?
Palpable purpura (raised, different to flat in pneumococcal septicaemia). One of: Abdominal pain Renal involvement Arthritis or arthralgia Biopsy- IgA deposition
33
What can IgA vasculitis be triggered by, and how long after the trigger do the symptoms occur? I think IgA vasculitis is the same as HSP IgA related vasculitis idk why it needed that complicated name
1-3 days post trigger Trigger is usually viral URTI, but could be streptococcus or drugs
34
Treatment of IgA vasculitis / HSP IgA related vasculitis ?
Symptomatic- for joints Moderate to severe- glucocorticoid, immunosuppression ->long term, hypertension and proteinuria screening
35
If you don't respond to steroids in paediatrics, what is the most likely diagnosis?
FSGS- Focal segmental glomerulosclerosis
36
AKI?
Acute kidney injury Abrupt loss of kidney function Can result in retention of urea and other waste products. Dysregulation of extracellular volume and electrolytes.
37
Symptoms of AKI in paediatrics?
Anuria/oliguria (less or no peeing) Hypertension with fluid overload Rapid rise in plasma creatinine
38
Okay to check you were reading... What is raised in plasma in AKI in children?
Creatinine ->rises rapidly
39
How much is creatinine increased in AKI?
> 1.5x normal or previous baseline
40
How much is the urine output in children with an AKI?
<0.5 ml/kg for 8hrs
41
Management of AKI?
3 Ms Monitor: PEWS, urine output, weight Maintain good hydration, electrolytes and acid-base balance Minimise drugs
42
Give an example of a pre-renal cause of AKI.
Perfusion problem e.g. gastroenteritis, liver disease, haemorrhage.
43
List some intrinsic renal causes of AKI.
Glomerular disease- haemolytic uraemic syndrome, glomerulonephritis Tubular injury Interstitial- NSAID, autoimmune
44
Common features of haemolytic uraemic syndrome?
Anaemia- low haemoglobin Thrombocytopenia- low platelets AKI
45
When does HUS tend to occur?
After bloody diarrhoea, caused by entero-haemorrhagic E.Coli (E.Coli O157) ->can be caused from pneumococcal infection or drugs too
46
Recap- where can transmission of E.Coli O157 occur from?
Farm animals Contaminated meat or veg
47
How long after bloody diarrhoea, usually caused by E.Coli O157, can HUS occur?
Up to 14 days after ->bloody diarrhoea is a medical emergency in children
48
Which toxin is produced by E.Coli O157?
Shiga toxin
49
Which other organs can be affected in severe HUS?
Brain Lungs Heart Pancreas
50
Okayyy so triad of HUS?
Microangiopathic haemolytic anaemia Thrombocytopenia AKI
51
If a patient has bloody diarrhoea, what can be done to reduce risks of HUS?
Intravascular volume expansion using saline
52
Management of HUS?
Again, 3Ms Monitor: fluid balance, electrolytes, waste hormones Maintain- IV normal saline and fluid, renal replacement therapy Minimise: no antibiotics or NSAIDs
53
What % of your kidney function do you have to lose before creatinine starts to become abnormal?
40%
54
Test for UTI?
Bacteria culture from MSSU
55
How do neonates present with UTI?
Fever, vomiting, lethargy, smelly urine
56
How do older children present with UTI?
Similar to adults- frequency, dysuria, abdominal pain, fever
57
When are dipstick urine tests not reliable for diagnosis of paediatric UTI?
If child is <2 yrs ->this is because they drink a lot of fluids which can dilute urine
58
Gold-standard investigation for UTI?
Bacteria culture of MSSU
59
What is the most common causative microorganism of a UTI?
E.Coli
60
What is vesicoureteral reflux?
Condition in which urine flows backward from the bladder to one or both ureters and sometimes to the kidneys
61
Investigations for vesicoureteral reflux?
Ultrasound DMSA- isotope scan Micturating cysto-urethrogram- gold standard ->gold standard requires bladder to be catheterised and child put to sleep so not pleasant for children
62
Treatment of lower UTI?
3 day oral antibiotics
63
Treatment of upper UTI/pyelonephritis?
10 day oral antibiotic
64
List some of the factors affecting progression of CKD.
Later referral Hypertension Proteinuria High intake of protein, phosphate and salt Bone health Recurrent UTIs
65
What is a good way of measuring BP in children under five if not with a sphigmanomter?
Doppler ultrasound
66
In metabolic bone disease, what role does the kidney have?
Kidneys normally excretes phosphate. If kidneys are damaged, can't secrete phosphate so it's elevated. This increases PTH. Kidneys also activated vitamin D3 so if damaged, less vitamin D = poor bone health
67
Principles of managing metabolic bone disease?
Low phosphate diet Phosphate binders Active vitamin D ->if ongoing poor growth, GH
68

Year 3- Paediatrics (27 decks)

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