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Paeds > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Differential for offensive smelling urine

A

Dehydration most likely

UTI

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2
Q

Presentation of UTI

A 
Fever
Poor feeding
Vomiting
Crying
Frequency
Offensive smelling urine
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3
Q

How to obtain a urine sample

A

Sterile pot
Non absorbent pad in nappy - specimen will be contaminated
Bag over genitalia

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4
Q

Investigations for suspected UTI

A

Dipstick

If at least 1 of either leu or nit are positive on dipstick do urine microscopy, culture and sensitivity

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5
Q

Treatment of UTI

A

5-7 days antibiotics
IV piperacillin and tazobactum if febrile then switch to oral cefalexin
Prophylactic trimethoprim

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6
Q

Benefits of prophylactic trimethoprim in children

A

Lowers risk of UTI if abnormal urinary tract

Prevents renal scarring

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7
Q

Grades of hydronephrosis

A

1: slightly enlarged major calyces
2: enlarged major calyces and renal pelvis within renal border
3: enlarged minor calyces, major calyces and renal pelvis outside of renal border
4: grade 3 with loss of renal parenchyma

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8
Q

What is the process of a micturating cystourethrogram

A

Catheterise
Fill the bladder with contrast
Take X-ray images during micturation

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9
Q

Grades of vesicoureteric reflux

A

1: reflux into ureter
2: reflux into ureter and renal pelvis without hydronephrosis
3: reflux into the ureter and renal pelvis with mild hydronephrosis
4: moderate hydronephrosis with twisting of the ureter
5. Severe hydronephrosis with twisting of the ureter and loss of renal parenchyma

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10
Q

What does a micturating cystourethrogram detect

A

Abnormal urinary tract e.g vesicoureteric reflux

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11
Q

Risks associated with vesicoureteric reflux

A

Recurrent UTI
Renal scarring
Hypertension

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12
Q

How is vesicoureteric reflux often detected

A

Fetal anomaly scan - ask in history of UTI about fetal scans

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13
Q

Management of vesicoureteric reflux

A

DMSA isotope scan 6 months after UTI - detects renal scarring
Education of parents/carers to get prompt treatment of UTI
Prophylactic trimethoprim until continent
Follow up clinics
If still present when developed continence, consider cystoscopic deflux

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14
Q

Triad of symptoms in nephrotic syndrome

A

Oedema
Proteinuria
Oliguria
(Hypercholesterolaemia)

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15
Q

Fluid management of nephrotic syndrome with generalised oedema

A

IV albumin as normal saline/hartmanns/dextrose will go straight to extravascular compartment

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16
Q

Management of nephrotic syndrome

A

Check immunity to chicken pox as immunocompromised - prophylactic aciclovir
Fluids/albumin
Oral prednisolone
Home monitoring of proteinuria

17
Q

Dose of prednisolone or nephrotic syndrome

A

First 4 weeks: 60mg/sq m

Next 4 weeks: 40mg/sq m on alternate days

18
Q

Definition of remission of nephrotic syndrome

A

Urine protein neg/trace for 3 consecutive days

19
Q

Definition of relapse in nephrotic syndrome

A

Urine protein + or more for 3 consecutive days

20
Q

Definition of frequent relapse in nephrotic syndrome

A

2 or more relapses in 6 months
OR
4 or more relapses in 1 year

21
Q

Definition of steroid dependence in nephrotic syndrome

A

Child relapses whilst on steroids or within 2 weeks of stopping steroids

22
Q

Describe the most common pathophysiology of nephrotic syndrome in children

A

Minimal change glomerulonephritis

Electron microscopy shows widened filtration slits

23
Q

Presentation of nephritic syndrome

A 
Haematuria
Generalised oedema
Poor feeding
Reduced urine output 
Recent strep infection?
24
Q

Investigations for nephritic syndrome

A

BO
Urine dipstick - protein and blood
Renal USS
Blood test - C3 + 4, ASOT

25
Q

What is ASOT

A

Antistreptolysin O test

for post strep glomerulonephritis

26
Q

Management of nephritic syndrome

A

Furosemide

Assess AKI risk using RIFLE criteria

27
Q

Causes to nephritic syndrome

A 
Post infectious glomerulonephritis 
Henoch-Schonlein purpura nephritis
SLE nephritis
ANCA vasculitis
IgA nephropathy
Anti glomerular basement membrane disease
Membranoproliferative glomerulonephritis
28
Q

Calculation for correction of % dehydration

A

Fluids (ml) = % dehydration x 10 x weight (kg)

29
Q

Maintenance fluids for children

A

First 10kg: 100ml/kg
Second 10kg: 50ml/kg
Subsequent kg: 20ml/kg

30
Q

Causes of paediatric hydronephrosis

A

Posterior urethral valves
Ureteric kinks
Vesicoureteric reflux

31
Q

Management of posterior urethral valves

A

Immediate surgery after birth to relieve obstruction
DMSA scan to assess renal damage
Follow up for ESRD - urine dipstick, US kidneys and bladder, BP

Paeds (27 decks)

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