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Nephrology Flashcards

MCD // Post infective GN // IgA + HSP // HUS // CKD // UTI

1
Q

What are the functions of the kidney?

A
  1. Waste handling - urea/creatine
  2. Water handling
  3. Salt balance - sodium, potassium, calcium, phosphate
  4. Acid base control - bicarb
  5. Endocrine
    • red cells / blood pressure / bone health
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2
Q

How do patients present?

A

Haematuria or Proteinuria

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3
Q

What does proteinuria signify?

A

Kidney damage

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4
Q

What is nephrotic syndrome?

A
  • Nephrotic range of proteinuria
  • Causes albumin to drop (Hypoalbuminaemia)
  • Oedema
  • [protein is like a magnet to water - less protein in blood, less water]
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5
Q

SSx of proteinuria?

A
  • Frothy urine
  • Periorbital oedema, pitting oedema legs, ascites, small pleaural effusions
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6
Q

How can we test for proteinuria?

A
  1. Dipstix
    • >3+ is abnormal
  2. Protein creatinine ratio (this will confirm suspicions)
    • Early morning is best
  3. 24hr urine collection
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7
Q

Minimal Change disease (MCD)

  • Nephrotic syndrome

What are typical features?

A
  • Age (2-5yrs)
  • Normal blood pressure
  • Resolving microscopic haematuria
  • Normal renal function
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8
Q

MCD

What are atypical features?

When would we biopsy?

A
  • Suggestions of autoimmune disease
  • Abnormal renal function
  • Steroid resistance
  • Only biopsy if there is suggestion of atypical features!
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9
Q

Rx for MCD?

main side effect in kids

A
  • Prednisolone 8 weeks
  • Difficult behavior
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10
Q

Outcomes of MCD?

A
  • •Remission
    • –95% in 2-4 weeks
  • •Relapse
    • –80%
      • •50% frequent
  • •80% long term remission
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11
Q

What is a steroid resistant nephrotic syndrome?

A
  • Acquired
    • Focal Segmental Glomeruloscerosis (FSGS)
  • Congenital
    • NPHS1 – nephrin
    • NPHS 2 – podocin
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12
Q

What are the two different types of haematuria?

How do we test?

A

Microscopic and Macroscopic

Do a urine dipstix

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13
Q

What is persistant haematuria and proteinuria a sign of?

A

glomerular disease

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14
Q

What is nephritic syndrome?

A
  • Clinical diagnosis
    • describes glomerulonephritis
  • Haem + proteinuria
  • Reduced GFR
    • fluid overload: raised JVP, oedema
    • Hypertension
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15
Q

Main two causes of glomerulonephritis (nephritic)?

A
  • Post infective GN
  • IgA nephropathy
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16
Q

Who is affected by post infective GN and what is it caused by?

A
  • Age of onset: 2-5
  • Cause: Usually Group A Strep
    • normally throat or skin
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17
Q

Disease progression of post infective GN?

Ix?

A

Self limiting

  • positive ASOT
  • low C3 normalises
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18
Q

Rx for post infective GN?

A
  • Antibiotic – penicillin
  • Support renal functions
  • Overload / hypertension
    • Diuretics
19
Q

What is the most common nephritic syndrome? (glomerulonephritis)

A

IgA nephropathy

20
Q

IgA nephropathy

Who gets it?

When does it present?

What is seen on urine?

A
  • Older kids and adults
  • 1-2 days after URTI
  • Urine
    • Recurrent macroscopic haematuria
    • ± chronic microscopic haematuria
    • Varying degree of proteinuria
21
Q

What is the pathogenesis of IgA nephropathy?

A
  1. Increased levels of circulating Gd-IgA1
  2. Production of anti-IgA1 antibodies
  3. Immune complexes form in circulation
  4. Immune complexes form in situ
  5. Immune complexes in the mesangium cause local immune activation & injury
22
Q

Ix for IgA nephropathy?

A
  • Clinical picture
    • Negative autoimmune workup
    • Normal compliment
  • Confirmation Biopsy
23
Q

Rx for IgA?

A

Mild: ACEi

Severe: Immunosuppresion

24
Q

What is HSP?

A

Basically it is the same disease of IgA nephropathy except it is effecting the vessels (vasculitis).

aka Henoch Schonlein Pupura

25
How can we identify **HSP**?
* **Mandatory palpable purpura** * Plus one of 4 * Abdo pain, renal involvement, Arthritis, biopsy
26
What are prodromal features of **HSP**?
* 1-3 days post trigger * Viral URTI in 70% * Streptococcus, drugs
27
Rx for **HSP**?
* Immmunosuppresion * Trial in moderate to severe renal disease * Long term * Hypertension and proteinuria screening
28
What is **AKI**?
* Serum creatinine: \> 1.5x age specific reference creatinine (or previous baseline if known) * Urine output\<0.5 ml/kg for \> 8hours * AKI 1: Measured creatinine \>1.5-2x reference creatinine/ULRI * AKI 2: Measured creatinine 2-3x reference creatinine/ULRI * AKI 3: Serum creatinine \>3x reference creatinine/ULRI
29
How do we prevent **AKI**?
3 Ms * **Monitor** * Urine Output, PEWs, BP, weight * **Maintain** * good hydration * **Minimise** * drugs
30
Intrinsic causes of **AKI**?
* Glomerular problem: **HUS** * Tubular injury * Interstitial nephritis
31
What is **HUS**?
**Haemolytic-Uraemic Syndrome** * Occurs post diarrhoea * Entero-Haemorrhagic E.coli (EHEC)
32
Bloody diarrhoea is a medical emergency in children Rx?
* Assess for **HUS** risk (15% will develop)
33
Triad of features of **HUS**:
* Microangiopathic haemolytic anaemia * Thrombocytopenia * Acute renal failure / AKI
34
Rx for **HUS**?
* IV normal saline and fluid
35
What are main causes of **CKD**?
* Congenital Anomalies of the Kidney and Urinary Tract (CAKUT): reflux nephropathy, dysplasia
36
What factors can increase progression in **CKD**?
* Hypertension * Proteinuria
37
**CKD** How do we assess BP in kiddo?
Doppler – gold standard for under age 5years
38
at what eGFR does CKD become symptomatic?
* \<60
39
**UTI** How does it present in neonates, pre-verbal kids and verbal kids?
* Neonates: vomiting, lethargy, fever, irratability * Pre-verbal: Abdo pain, lethary, irratability * Verbal: Abdo pain, frequency and dysuria
40
**UTI** How do we urgently obtain a urine sample from a kid?
* Catheter samples or suprapubic aspiration (USS)
41
**UTI** How do we make a diagnosis?
* **Dipstix** * Leucocyte esterase activity, nitrites * unreliable \< 2 yrs of age * **Microscopy** * Pyuria \>10 WBC per cubic mm * Bacturia * **Culture** \> 105 Colony forming units * E.coli
42
Complications of **UTI**?
Scarring
43
**UTI** Rx?
* Oral – From 3 months of age - Trimethorim, Co-amoxiclav, cephalosporin * IV - 3rd generation Cephalosporin or Co-amoxiclav, IV Aminoglycosides effective (good renal excretion) * Prophylaxis – abnormal urinary tract / VUR grade 3 and above
44
What imaging can we use for kidneys?
* **ultrasound** for structure * **DMSA** (isotope) for scarring * **MAG3** scan for dynamic

Paediatrics (32 decks)

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