Nephrology Flashcards
What is nephrotic syndrome?
Heavy proteinuria
What is nephritic syndrome?
Haematuria
What are the 5 kidney functions?
Waste handling Water handling Salt balance Acid base control Endocrine - adrenal
What are the 3 filtration layers of the glomerulus?
Endothelium - fenestrated
Glomerular basement membrane
Podocytes
What makes urine frothy?
Protein
What does proteinuria signify?
Glomerular injury
What glomerulopathy do you get as a result of podocyte dysfuction?
Minimal change disease
What glomerulopathy do you get as a result of basement membrane dysfunction?
Post infectious glomerular nephritis
What glomerulopathy do you get as a result of mesangial cell dysfunction?
IgA nephropathy
What level of proteinuria on dipstix is too high?
> 3+
What is the normal protein creatinine ratio?
<20mg/mmol
What is the gold standard for identifying extent of proteinuria?
24hr urine collection
What may be seen on examination with nephrotic syndrome?
Pale
Inflated weight
Oedematous
Frothy urine
What are typical deatures of nephrotic syndrome?
Age 1-10
Normal blood pressure
No frank haematuria
Normal renal fuction
What are atypical features of nephrotic syndrome leading to consideration of biopsy?
Suggestions of autoimmune disease
Abnormal renal function
Steroid resistance
How is nephrotic syndrome treated?
Prednisolone 8 weeks
What is risk of corticosteroid administration?
Iatrogenic Cushings
What do parents notice with high dose glucocorticoids?
Behaviour
Sleep disturbance
Mood instability
What percentage of children with nephrotic syndrome respond to treatment?
90%
Whatis the general outcome of nephrotic syndrome?
95% remission in 2-4 weeks
80% relapse
What acquired nephrotic syndrome will be steroid resistant?
Focal segmental glomerulosclerosis
Should frank haematuria always be investigated?
Yes
What are causes of haematuria?
Systemic - clotting disorders Renal - glomerulonphritis Nephroblastoma Cysts UTI Stones Urethritis
How is nephritic syndrome diagnosed?
Haematuria and proteinuria
Reduced GFR - Oliguria, Fluid overload, Hypertension, progressive renal failure
What is the most common glomerular area affected in nephritic syndrome?
Endothelial cells
What is the most common bacterial cause of post infectious glomerulonephritis?
Group A strep - throat 7-10 days after infection or skin 2-4 weeks after
How is post infectious glomerulonephritis diagnosed?
Bacterial culture
Positive Anti streptolysin O titre
Low complement normalises
How is post infectious glomerulonephritis treated?
Antibiotics
Electrolyte/acid base maintenance
Diuretics for fluid overload
How is IgA related vasculitis diagnosed?
Mandatory palpable purpura One of 4 of: Abdominal pain Renal involvement Arthritis or arthralgia Biopsy
How long does an episode of IgA vasculitis last?
4-6 weeks
How is IgA vasculitis treated?
Treat symptoms - joints and gut, ACEi to reduce proteinuria
Corticosteroids for gut involvement
Imunosuppression
Hypertension and proteinuria screening
What causes IgA nephropathy?
Non strep post infectious glomerulonephritis - 1-2 days after URTI
What are urine features of IgA nephropathy?
Recurrent macroscopic haematuria
Chronic microscopic haematuria
Varying degree of proteinuria
Does treating strep prevent post infectious glomerulonephrtis?
No
What are clinical features of AKI?
Serum creatinine >1.5x age specific reference creatinine
Urine output <0.5ml/kg for 8 hours
What is grade 1 AKI?
Measured creatinine >1.5-2x reference creatinine
What is grade 2 AKI?
Measured creatinine >2-3x reference creatinine
What is grade 3 AKI?
Measured creatinine >3x referenced creatinine
How is AKI managed?
3Ms;
Monitor - PEWS etc
Maintain - hydration
Minimise - drugs
What re intrinsic causes of AKI?
Haemolytic uraemic syndrome Glomerulonephritis Acute tubular necrosis Drugs Autoimmune
What drugs cause AKI?
NSAIDs
What causes acute tubular necrosis?
Hypoperfusion
What is the main post renal cause of AKI?
Obstructive uropathies
What causes haemolytic uraemic syndrome?
E.Coli producing verotoxin or shigatoxin
Pneumococcal infection
How does HUS present?
E.coli O157 infection
Bloody diarrhoea
What is the triad of HUS?
Microangiopathic haemolyic anemia
Thrombocytopenia
AKI
What is the most important part of managing HUS?
Maintenance - maintain hydration and salt
What are consequences of AKI?
Blood pressure
Proteinuria
Evolution to CKD
What is the most common cause of CKD in children?
Congenital Anomalies of the Kidney and Urinary Tract (CAKUT)
What are risk factors for CAKUT?
Turner
Trisomy 21
Branchio-oto-renal
Prune belly syndrome
What is used to stage CKD?
GFR
How does uraemia present?
Loss of appetite
Weight loss
Itch
How does salt/acid base imbalance present?
Lethargy - hyperkalaemic
How do neonates with UTI present?
Fever
Vomiting
Lethargy
Irritability
How do pre-verbal children present with UTI?
Fever Abdo pain/tenderness Vomiting Poor feeding Lethargy Irritability
How do verbal children present with UTI?
Abdominal/loin pain or tenderness
Fever
Malaise
Vomiting
What tests can be used for UTI diagnosis?
Dipstix - leukocyte esterase activity, nitrites
Microscopy - pyuria, bacturia
Culture >10^5 of the same organism
What does a high grade of vesico-ureteric reflux mean?
Increased risk of AKI
What can happen as a result of UTI?
Scarring
What 3 factors lead to scarring?
UTI
Vulnerable kidney
Vesico-ureteric reflux
What kidney investigations can be done?
USS - structure
DMSA isotope scan - scarring and function
How is lower tract UTI treated?
3 days oral antibiotic
How is upper tract UTI treated?
Antibiotics 7-10 days
Fluids, hygiene, constipation
What are the 2 main factors affecting CKD?
Hypertension
Proteinuria
What is the gold standard for blood pressure measurement?
Sphigmamometer
How is CKD managed?
Minimise weight loss - keep well nourished
Low potassium diet, avoid hyper calcaemia, reduce phosphate
What happens to phosphate in kidney damage?
Increases
