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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
Q

Management of acute post-infectious glomerulonephritis?

A

Antibiotics

Support renal function

If fluid overload or hypertension, consider a diuretic

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26
Q

When does IgA nephropathy commonly occur?

A

1-2 days after URTI

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27
Q

Who tends to get IgA nephropathy?

A

Older children and adults

->most common type of glomerulonephritis

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28
Q

Clinical findings of IgA nephropathy?

A

Recurrent macroscopic haematuria

+/- chronic microscopic haematuria

Varying degrees of proteinuria

29
Q

Diagnosis of IgA nephropathy?

A

Usually a clinical pictures, can be confirmed with a biopsy

30
Q

Treatment of IgA nephropathy?

A

Mild disease- ACEi for the persistent proteinuria or hypertension

Moderate to severe- immunosuppression

31
Q

At what age does Henoch Schonlein Purpura (HSP) IgA related vasculitis tend to occur?

32
Q

What are the symptoms required to make a clinical diagnosis of HSP IgA related vasculitis?

A

Palpable purpura (raised, different to flat in pneumococcal septicaemia).

One of:
Abdominal pain
Renal involvement
Arthritis or arthralgia
Biopsy- IgA deposition

33
Q

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

A

1-3 days post trigger

Trigger is usually viral URTI, but could be streptococcus or drugs

34
Q

Treatment of IgA vasculitis / HSP IgA related vasculitis ?

A

Symptomatic- for joints
Moderate to severe- glucocorticoid, immunosuppression

->long term, hypertension and proteinuria screening

35
Q

If you don’t respond to steroids in paediatrics, what is the most likely diagnosis?

A

FSGS- Focal segmental glomerulosclerosis

36
Q

AKI?

A

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
Q

Symptoms of AKI in paediatrics?

A

Anuria/oliguria (less or no peeing)
Hypertension with fluid overload
Rapid rise in plasma creatinine

38
Q

Okay to check you were reading…

What is raised in plasma in AKI in children?

A

Creatinine

->rises rapidly

39
Q

How much is creatinine increased in AKI?

A

> 1.5x normal or previous baseline

40
Q

How much is the urine output in children with an AKI?

A

<0.5 ml/kg for 8hrs

41
Q

Management of AKI?

A

3 Ms

Monitor: PEWS, urine output, weight

Maintain good hydration, electrolytes and acid-base balance

Minimise drugs

42
Q

Give an example of a pre-renal cause of AKI.

A

Perfusion problem e.g. gastroenteritis, liver disease, haemorrhage.

43
Q

List some intrinsic renal causes of AKI.

A

Glomerular disease- haemolytic uraemic syndrome, glomerulonephritis
Tubular injury
Interstitial- NSAID, autoimmune

44
Q

Common features of haemolytic uraemic syndrome?

A

Anaemia- low haemoglobin
Thrombocytopenia- low platelets
AKI

45
Q

When does HUS tend to occur?

A

After bloody diarrhoea, caused by entero-haemorrhagic E.Coli (E.Coli O157)

->can be caused from pneumococcal infection or drugs too

46
Q

Recap- where can transmission of E.Coli O157 occur from?

A

Farm animals
Contaminated meat or veg

47
Q

How long after bloody diarrhoea, usually caused by E.Coli O157, can HUS occur?

A

Up to 14 days after

->bloody diarrhoea is a medical emergency in children

48
Q

Which toxin is produced by E.Coli O157?

A

Shiga toxin

49
Q

Which other organs can be affected in severe HUS?

A

Brain
Lungs
Heart
Pancreas

50
Q

Okayyy so triad of HUS?

A

Microangiopathic haemolytic anaemia
Thrombocytopenia
AKI

51
Q

If a patient has bloody diarrhoea, what can be done to reduce risks of HUS?

A

Intravascular volume expansion using saline

52
Q

Management of HUS?

A

Again, 3Ms

Monitor: fluid balance, electrolytes, waste hormones

Maintain- IV normal saline and fluid, renal replacement therapy

Minimise: no antibiotics or NSAIDs

53
Q

What % of your kidney function do you have to lose before creatinine starts to become abnormal?

54
Q

Test for UTI?

A

Bacteria culture from MSSU

55
Q

How do neonates present with UTI?

A

Fever, vomiting, lethargy, smelly urine

56
Q

How do older children present with UTI?

A

Similar to adults- frequency, dysuria, abdominal pain, fever

57
Q

When are dipstick urine tests not reliable for diagnosis of paediatric UTI?

A

If child is <2 yrs

->this is because they drink a lot of fluids which can dilute urine

58
Q

Gold-standard investigation for UTI?

A

Bacteria culture of MSSU

59
Q

What is the most common causative microorganism of a UTI?

60
Q

What is vesicoureteral reflux?

A

Condition in which urine flows backward from the bladder to one or both ureters and sometimes to the kidneys

61
Q

Investigations for vesicoureteral reflux?

A

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
Q

Treatment of lower UTI?

A

3 day oral antibiotics

63
Q

Treatment of upper UTI/pyelonephritis?

A

10 day oral antibiotic

64
Q

List some of the factors affecting progression of CKD.

A

Later referral
Hypertension
Proteinuria
High intake of protein, phosphate and salt
Bone health
Recurrent UTIs

65
Q

What is a good way of measuring BP in children under five if not with a sphigmanomter?

A

Doppler ultrasound

66
Q

In metabolic bone disease, what role does the kidney have?

A

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
Q

Principles of managing metabolic bone disease?

A

Low phosphate diet
Phosphate binders
Active vitamin D

->if ongoing poor growth, GH

Year 3- Paediatrics (24 decks)

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