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Paediatrics > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Paediatric most common cause for proteinuria/ haematuria

A

Glomerular disease

  • Nephrotic syndrome
  • nephritic syndrome
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2
Q

Paediatric most common cause for acute kidney injury

A

Haemolytic uraemic syndrome

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3
Q

Paediatric most common cause for chronic kidney disease

A 
Developmental anomalies (CAKUT)
-reflux nephropathy
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4
Q

5 kidney functions

A 
Waste handling (urea and creatinine)
Water handling 
Salt balance (Na, K, Ca, P)
Acid base control (bicarbonate)
Endocrine (red cells/ blood pressure/ bone health)
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5
Q

What makes up the glomerular filtration barrier

A

Endothelial cells:

  • Fenestrated
  • Vulnerable to immune mediated injury

GBM:

  • 2 proteins - Type IV collagen (COL4) and laminin
  • Synthesis from podocytes and endothelial cells
  • Mesangial cells playing a role in turnover

Podocyte:

  • Proteins
    • Podocin, nephrin

Mesangial cells:

  • Glomerular structural support
  • Embedded in GBM
  • Regulates blood flow of the glomerular capillaries
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6
Q

What makes up the EM glomerular filtration barrier

A

Fenestrated endothelial cell,
Glomerular basement membrane,
Podocyte with “slit diaphragms”

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7
Q

Clinical indication of glomerulopathy

A

Blood and protein

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8
Q

What does proteinuria normally signify?

A

Glomerular injury

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9
Q

Clinical symptoms of nephritic syndrome (PHARAOH)

A 
Proteinuria
Haematuria
Azotaemia
Red blood cell casts
Oliguria
Hypertension

Intravascular overload

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10
Q

Clinical symptoms of nephrotic syndrome

A

Proteinuria
Hypoalbuminaemia
Oedema

Hyperlipidaemia

Intravascular depletion

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11
Q

In acquired glomerulopathy what components are affected

A

Epithelial cells (podocyte)

  • Minimal Change Disease
  • FSGS
  • Lupus

Basement membrane

  • Post infectious glomerulonephritis
  • Membranous glomeruopathy
  • MPGN (Membranoproliferative glomerulonephritis)

Endothelial cell

  • PIGN
  • HUS
  • MPGN
  • Lupus
  • ANCA vasculitis

Mesangial cell

  • Henoch-Schonlein purpura
  • IgA nephropathy
  • Lupus
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12
Q

Congenital glomerulopathy layers involved

A

Podocyte cytoskeletal integrity
(congeital nephrotic syndrome)
-Proteins- Podocin, nephrin

Basement membrane proteins

  • Alport syndrome (XL)
  • Thin basement membrane disease

Endothelial/ microvascular integrity
-Complement regulatory protein

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13
Q

Testing for proteinuria

A

Dipstix (>2 usually abnormal)
Protein creatinine ratio (nephrotic range >250mg/mmol)
24hr urine collection (nephrotic range >1g/m2/24hrs)

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14
Q

Nephrotic syndrome treatment

A

Prednisolone 8 weeks

Second line immunosuppression

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15
Q

Who does nephrotic syndrome clinically present?

A 
pale, 
periorbital oedema,
pitting oedema legs,
ascites, 
small pleural effusions,
hypotension, 
frothy urine
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16
Q

Common cause of nephrotic presentation in children?

A

Minimal change disease,

Focal segmental glomerulosclerosis

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17
Q

Minimal change disease typical features

A

age 2-5
normal BP
resolving microscopic haematuria
normal renal function

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18
Q

Atypical features of MCD

What would you consider doing if someone presented with these?

A

Suggestions of autoimmune disease,
abnormal renal function,
steroid resistance

-Consider renal biopsy

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19
Q

Main side effects noticied by parents in children with glucocorticoid treatment

A

behaviour change,
mood change,
sleep disturbance

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20
Q

Glucocorticoid treatment, what must the dr think about before

A

hypertension,
pneumococcal vaccination,
antibiotic prophylaxis

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21
Q

what is on the spectrum for idiopathic nephrotic syndrome in childhood

A 
non relapsing,
infrequently relapsing, 
frequently relapsing, 
steroid dependent,
Steroid resistant (Focal segmental glomerulosclerosis)
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22
Q

Pathology behind steroid resistant nephrotic syndrome

A

Interaction between lymphocytes (t and B cells) and podocytes

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23
Q

Acquired cause of steroid resistant nephrotic syndrome

A

Focal Segmental Glomeruloscerosis

causes podocyte loss and progressive inflammation and sclerosis

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24
Q

Congenital causes of steroid resistant nephrotic syndrome

A

NPHS1-nephrin loss
NPHS2- podocin loss
infant presentation

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25
Q

What does persistent haematuria and proteinuria suggest

A

glomerular disease

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26
Q

Causes of haematuria

A

systemic:
-clotting disorders

Renal:

  • Glomerulonephritis
  • Tumour (Wilm’s nephroblastoma)
  • Cysts

Malignancies:
-Sarcomas

Stones

UTI

Trauma

Urethritis

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27
Q

What investigations to use in nephritic syndrome and their results

A 
Creatinine (increased)
Electrolytes- hyponatraemia hyperkalaemia
FBC- anaemia, no haemolysis
Albumin (slightly low)
UTI (negative)
28
Q

Presentation of nephritic syndrome

A 
haematuria
proteinuria
reduced GFR
-oliguria
-fluid overload (raised JVP and oedema)
- Hypertension
-Worsening renal failure (=rapidly progressing)
29
Q

Case:
7 day history of sore throat
+ nephritic syndrome

Typical cause

A

Acute Post-Infectious Glomerulonephritis

30
Q

Acute Post-Infectious Glomerulonephritis common cause and from what site?

A

Group A strep
Beta haemolytic

Site- throat 7-10 days
Skin 2-4 weeks

31
Q

Investigations for Acute Post-Infectious Glomerulonephritis as cause for nephritic syndrome

A 
Renal USS
ASOT 
Throat swab 
ANCA
Complement levels
?Biopsy
32
Q

Treatment for Acute Post-Infectious Glomerulonephritis

A

Antibiotics
Electrolytes
Diuretics

33
Q

Second most common cause of nepritis in children

A

Henoch Schonlein Purpura (IgA related vasculitis)

34
Q

What is Henoch Schonlein Purpura

A

Non streptococcal post infectious glomerulonephritis

Also known as IgA vasculitis

35
Q

What needs to be present for clinical diagnosis of Henoch Schonlein Purpura

A

-Mandatory palpable purpura
-One of 4: (BARA)
Abdominal pain
Renal involvement
Arthritis or arthralgia
Biopsy- IgA deposition

36
Q

IgA vasculitis triggers and duration of symptoms

A

1-3 days post trigger presents:

  • viral URTI
  • streococcus or
  • drugs

Duration:
4-6 weeks
1/3 relapse

37
Q

Clinical presentation of IgA nephropathy

A

recurrent macroscopic haematuria
+/- Chronic microscopic haematuria
Varying degree of proteinuria

38
Q

How to diagnosis IgA nephropathy

A

Autoimmune workup (negative)
Compliement (normal)
Biopsy

39
Q

Treatment for IgA nephropathy

A

mild- ACEi

moderate-severe- Immunosuppression

40
Q

Causes of nephritic syndrome in children

A

Post infectious glomerulonephritis
IgA nephropathy
Henoch-Schonlein purpura

41
Q

Causes of nephrotic syndrome in children

A

FSGS

minimal change

42
Q

Acute Kidney Injury definition

A

Abrupt loss of kidney function
Resulting in:
-the retention of urea and other nitrogenous waste products
And
-Dysregulation of extracellular volume and electrolytes

43
Q

Acute renal failure presentation

A

Anuria/oliguria (<0.5ml/kg for >8 hours)
Hypertension with fluid overload
Rapid rise in plasma creatinine (>1.5x age specific reference)

44
Q

Interpretation of AKI warning score

A

AK1- creatinine >1.5-2x reference
AK2- creatinine 2-3x reference creatinine
AK3- creatinine >3x reference creatinine

45
Q

AKI management

A 
Prevention
2Ms
-Monitor (Paediatric early warning scores (BP), urine output, weight)
-Maintain (Good hydration)
-Minimise (drugs)
46
Q

Causes of AKI

prerenal, intrinsic renal and post-renal

A

Pre-renal:
-Perfusion problem

Intrinsic renal:

  • Glomerular diease- HUS, Glomerulonephritis
  • Tubular injury- Acute tubular necrosis (consequence of hypoperfusion or drugs)
  • Interstitial nephritis- NSAID, autoimmune, drugs

Post-renal:
-Obstructive uropathies

47
Q

Causes of Haemolytic-uraemic syndrome

A

Entero-haemorrhaic E.coli
Pneumoccal infection
drugs
Atypical HUS

48
Q

Period of risk of HUS after Ecoli o157:H7 serotype

A

up to 14 days after onset of diarrhoea

49
Q

Triad of Haemolytic-uraemic syndrome

A

Microangiopathic haemolytic anaemia
Thrombocytopenia
AKI/ Acute renal failure

50
Q

HUS management

A 
Monitor:
-5 kidney functions
Maintain:
-IV normal saline and fluid
Minimise:
-No antibiotics/NSAIDs
51
Q

AKI long term complications

A

BP (hypertension)
Proteinuria
Evolution to CKD

52
Q

Chronic kidney disease causes in paediatrics

A

Congenital anomalies of the kidney and urinary tract

  • Reflux nephropathy
  • Dysplasia
  • Obstructive uropathy

hereditary conditions:

  • Cystic kidney disease
  • Cystinosis

Glomerulonephritis

53
Q

What conditions can be associated with CAKUT

A

turner
trisomy 21
Branchio-oto-renal
Prune belly syndrome

54
Q

At what GFR do you begin to see symptoms

A

<60

55
Q

Presentation of CKD

A 
Waste handling:
-Uraemic- loss of appetitie, weight loss, itch 
Water:
-Polyuria
Salt balance:
-lethargy
Endocrine
-renal rickets
Bladder dysfunction
56
Q

UTI definition

A

Clinical signs plus

  • Bacteria culture from midstream urine
  • Any growths on suprapubic aspiration or catheter
57
Q

What urine sample techniques to use for different age groups

A

clean catch urine or midstream urine

sick infants- catheter sample or suprapubic aspiration

58
Q

what is vesico-ureteric reflux

A

e flow of urine travels backwards from the bladder, up the ureters

59
Q

Grades of vesico-ureteric reflux

A

grade 1: reflux limited to the ureter
grade 2: reflux up to renal pelvis
grade 3: mild dilatation of ureter
grade 4 :tortuous ureter with moderate dilatation
grade 5: tortuous ureter with severe dilatation of ureter and pelvicalyceal system

60
Q

Who to investigate when it comes to children and UTI

A

If:
upper tract symptoms
<6 months
Recurrent UTIs

61
Q

Investigations to conduct if worried about UTIs

A

Ultrasound
DMSA (isotope scan)
Micturating cysto-urethrogram MAG 3 scan

62
Q

Treatment for children with UTIs

A

Lower tract- 3 days oral antibiotics

Upper tract/ pyelonephritis- 7-10 days

63
Q

Factors affecting progression of CKD

A 
late referral
Hypertension
Proteinuria
High intake of protein, phosphate and salt
Bone heath 
Acidosis
Recurrent UTIs
64
Q

How to measure childs BP

A

sphigmanomter

oscillomerty

65
Q

Blood pressure chart children definition of hypertension

A

> or equal to 95th percentile

66
Q

Metabolic bone disease treatment principles

A

low phospate diet
oral phosphate binders
active vitamin D

Paediatrics (17 decks)

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