Nephrology 3 Flashcards
How are infants with UUTI age >3 months treated?
o Consider referral to a paediatric specialist
o Treat with oral antibiotics for 7-10 days- the use of antibiotics with low resistance patterns is recommended, i.e. cephalosporin and co-amoxiclav
o If oral antibiotics cannot be used, treat with IV antibiotics, such as cefotaxime or ceftriaxone for 2-4 days followed by oral antibiotics for a total duration of 10 days
How are infants with LUTI age >3 months treated?
o Treat with oral antibiotics for 3 days i.e. trimethoprim, nitrofurantoin, cephalosporin or amoxicillin
o The parents or carers should be advised to bring the infant or child for reassessment if the infant or child is still unwell after 24-48 hours- if an alternative diagnosis is not made, a urine sample should be sent for culture to identify the presence of bacteria and determine antibiotic sensitivity if urine culture has not already been carried out
o Antibiotic prophylaxis should not be routinely recommended in infants and children following first- time UTI.
What are the causes of vulvovaginitis?
o Infection- bacterial or fungal o Specific irritants o Poor hygiene o Sexual abuse Rarely associated with threadworm infection
What is the management for vulvovaginitis?
hygiene, the avoidance of bubble bath and scented soaps and the use of loose-fitting cotton underwear
• Swabs should be taken to identify any pathogens, which can then be specifically treated-
salt baths may be helpful
• Oestrogen cream applied sparingly to the vulva may relieve the problem in resistant cases by increasing vaginal resistance to infection as prepubertal tissues tend to be atrophic
What is AKI?
sudden reduction in glomerular filtration rate resulting in an increase in blood concentration of urea & creatinine and disturbed fluid & electrolyte haemostasis
oliguria (<0.5 ml/kg per hour)
How can AKI be classified?
Prerenal (most common): hypovolaemia, burns, sepsis, haemorrhage, nephritic syndrome
Renal: HUS, vasculitis, embolus, renal vein thrombosis, ATN, glomerulonephritis, pyelonephritis
Postrenal: obstruction, congenital- posterior urethral valves, blocked urinary catheter
How is prerenal failure managed?
suggested by hypovolaemia- the fractional excretion of sodium is very low as the body tries to retain fluid
• The hypovolaemia needs to be urgently corrected with fluid replacement and circulatory support if acute tubular necrosis is to be avoided
How is renal failure managed?
• If there is circulatory overload- restriction of fluid intake and challenge with a diuretic may increase urine output sufficiently to allow gradual correction of sodium and water balance
• A high-calorie, normal protein feed will decrease catabolism, uraemia and hyperkalaemia
• Emergency management of metabolic acidosis, hyperkalaemia and hyperphosphataemia
a renal biopsy should be performed to identify rapidly progressive glomerulonephritis,as this may need immediate treatment with immunosuppression
What are the commonest causes of renal failure in children in the UK?
HUS
ATN- usually in the setting of multisystem failure in the ICU or following cardiac surgery
How is post renal failure managed?
- This requires assessment of the site of obstruction and relief by nephrostomy or bladder catheterisation
- Surgery can be performed once fluid volume and electrolyte abnormalities have been corrected
What are the causes of CKD?
o Structural malformation- 40% o Glomerulonephritis- 25% o Hereditary nephropathies- 20% o Systemic disease- 10% o Miscellanoeus/unknown- 5%
What are the stages of CKD?
o Stage 1: normal GFR>90 mL/min per 1.73m2 and persistent albuminuria
o Stage 2: GFR 60-89 mL/min per 1.73m2 and persistent albuminuria
o Stage 3: GFR 30-59 mL/min per 1.73m2
o Stage 4: GFR 15-30 mL/min per 1.73m2
o Stage 5: GFR <15 mL/min per 1.73m2 or end stage renal disease
What are the clinical features of CKD?
o Anorexia or lethargy o Polydipsia and polyuria o Failure to thrive/grow o Bone deformities o Hypertension o Acute-on-chronic renal failure o Proteinuria o Normochromic, normocytic anaemia
What are the diet recommendations in kidney disease?
- Anorexia and vomiting are common- improving nutrition using calorie supplements and nasogastric or gastrostomy feeding is often necessary to optimise growth
- Protein intake should be sufficient to maintain growth and a normal albumin, whilst preventing the accumulation of toxic metabolic by products
How is renal osteodystrophy prevented?
- Phosphate retention and hypocalcaemia due to decreased activation of vitamin D leads to secondary hyperparathyroidism, which results in osteitis fibrosis and osteomalacia
- Phosphate restriction be decreasing the dietary intake of milk products, calcium carbonate as a phosphate binder and activated vitamin D supplements help to prevent renal osteodystrophy
