Nephrology Flashcards
Differential for offensive smelling urine
Dehydration most likely
UTI
Presentation of UTI
Fever Poor feeding Vomiting Crying Frequency Offensive smelling urine
How to obtain a urine sample
Sterile pot
Non absorbent pad in nappy - specimen will be contaminated
Bag over genitalia
Investigations for suspected UTI
Dipstick
If at least 1 of either leu or nit are positive on dipstick do urine microscopy, culture and sensitivity
Treatment of UTI
5-7 days antibiotics
IV piperacillin and tazobactum if febrile then switch to oral cefalexin
Prophylactic trimethoprim
Benefits of prophylactic trimethoprim in children
Lowers risk of UTI if abnormal urinary tract
Prevents renal scarring
Grades of hydronephrosis
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
What is the process of a micturating cystourethrogram
Catheterise
Fill the bladder with contrast
Take X-ray images during micturation
Grades of vesicoureteric reflux
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
What does a micturating cystourethrogram detect
Abnormal urinary tract e.g vesicoureteric reflux
Risks associated with vesicoureteric reflux
Recurrent UTI
Renal scarring
Hypertension
How is vesicoureteric reflux often detected
Fetal anomaly scan - ask in history of UTI about fetal scans
Management of vesicoureteric reflux
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
Triad of symptoms in nephrotic syndrome
Oedema
Proteinuria
Oliguria
(Hypercholesterolaemia)
Fluid management of nephrotic syndrome with generalised oedema
IV albumin as normal saline/hartmanns/dextrose will go straight to extravascular compartment
Management of nephrotic syndrome
Check immunity to chicken pox as immunocompromised - prophylactic aciclovir
Fluids/albumin
Oral prednisolone
Home monitoring of proteinuria
Dose of prednisolone or nephrotic syndrome
First 4 weeks: 60mg/sq m
Next 4 weeks: 40mg/sq m on alternate days
Definition of remission of nephrotic syndrome
Urine protein neg/trace for 3 consecutive days
Definition of relapse in nephrotic syndrome
Urine protein + or more for 3 consecutive days
Definition of frequent relapse in nephrotic syndrome
2 or more relapses in 6 months
OR
4 or more relapses in 1 year
Definition of steroid dependence in nephrotic syndrome
Child relapses whilst on steroids or within 2 weeks of stopping steroids
Describe the most common pathophysiology of nephrotic syndrome in children
Minimal change glomerulonephritis
Electron microscopy shows widened filtration slits
Presentation of nephritic syndrome
Haematuria Generalised oedema Poor feeding Reduced urine output Recent strep infection?
Investigations for nephritic syndrome
BO
Urine dipstick - protein and blood
Renal USS
Blood test - C3 + 4, ASOT
What is ASOT
Antistreptolysin O test
for post strep glomerulonephritis
Management of nephritic syndrome
Furosemide
Assess AKI risk using RIFLE criteria
Causes to nephritic syndrome
Post infectious glomerulonephritis Henoch-Schonlein purpura nephritis SLE nephritis ANCA vasculitis IgA nephropathy Anti glomerular basement membrane disease Membranoproliferative glomerulonephritis
Calculation for correction of % dehydration
Fluids (ml) = % dehydration x 10 x weight (kg)
Maintenance fluids for children
First 10kg: 100ml/kg
Second 10kg: 50ml/kg
Subsequent kg: 20ml/kg
Causes of paediatric hydronephrosis
Posterior urethral valves
Ureteric kinks
Vesicoureteric reflux
Management of posterior urethral valves
Immediate surgery after birth to relieve obstruction
DMSA scan to assess renal damage
Follow up for ESRD - urine dipstick, US kidneys and bladder, BP
