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Paediatrics > Nephrology > Flashcards

Nephrology Flashcards

1
Q

What is nephrotic syndrome?

A

Heavy proteinuria

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2
Q

What is nephritic syndrome?

A

Haematuria

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3
Q

What are the 5 kidney functions?

A 
Waste handling
Water handling
Salt balance
Acid base control
Endocrine - adrenal
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4
Q

What are the 3 filtration layers of the glomerulus?

A

Endothelium - fenestrated
Glomerular basement membrane
Podocytes

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5
Q

What makes urine frothy?

A

Protein

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6
Q

What does proteinuria signify?

A

Glomerular injury

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7
Q

What glomerulopathy do you get as a result of podocyte dysfuction?

A

Minimal change disease

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8
Q

What glomerulopathy do you get as a result of basement membrane dysfunction?

A

Post infectious glomerular nephritis

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9
Q

What glomerulopathy do you get as a result of mesangial cell dysfunction?

A

IgA nephropathy

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10
Q

What level of proteinuria on dipstix is too high?

A

> 3+

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11
Q

What is the normal protein creatinine ratio?

A

<20mg/mmol

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12
Q

What is the gold standard for identifying extent of proteinuria?

A

24hr urine collection

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13
Q

What may be seen on examination with nephrotic syndrome?

A

Pale
Inflated weight
Oedematous
Frothy urine

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14
Q

What are typical deatures of nephrotic syndrome?

A

Age 1-10
Normal blood pressure
No frank haematuria
Normal renal fuction

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15
Q

What are atypical features of nephrotic syndrome leading to consideration of biopsy?

A

Suggestions of autoimmune disease
Abnormal renal function
Steroid resistance

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16
Q

How is nephrotic syndrome treated?

A

Prednisolone 8 weeks

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17
Q

What is risk of corticosteroid administration?

A

Iatrogenic Cushings

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18
Q

What do parents notice with high dose glucocorticoids?

A

Behaviour
Sleep disturbance
Mood instability

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19
Q

What percentage of children with nephrotic syndrome respond to treatment?

A

90%

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20
Q

Whatis the general outcome of nephrotic syndrome?

A

95% remission in 2-4 weeks

80% relapse

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21
Q

What acquired nephrotic syndrome will be steroid resistant?

A

Focal segmental glomerulosclerosis

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22
Q

Should frank haematuria always be investigated?

A

Yes

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23
Q

What are causes of haematuria?

A 
Systemic - clotting disorders
Renal - glomerulonphritis
Nephroblastoma
Cysts
UTI
Stones
Urethritis
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24
Q

How is nephritic syndrome diagnosed?

A

Haematuria and proteinuria

Reduced GFR - Oliguria, Fluid overload, Hypertension, progressive renal failure

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25
Q

What is the most common glomerular area affected in nephritic syndrome?

A

Endothelial cells

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26
Q

What is the most common bacterial cause of post infectious glomerulonephritis?

A

Group A strep - throat 7-10 days after infection or skin 2-4 weeks after

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27
Q

How is post infectious glomerulonephritis diagnosed?

A

Bacterial culture
Positive Anti streptolysin O titre
Low complement normalises

28
Q

How is post infectious glomerulonephritis treated?

A

Antibiotics
Electrolyte/acid base maintenance
Diuretics for fluid overload

29
Q

How is IgA related vasculitis diagnosed?

A 
Mandatory palpable purpura
One of 4 of:
Abdominal pain
Renal involvement
Arthritis or arthralgia
Biopsy
30
Q

How long does an episode of IgA vasculitis last?

A

4-6 weeks

31
Q

How is IgA vasculitis treated?

A

Treat symptoms - joints and gut, ACEi to reduce proteinuria
Corticosteroids for gut involvement
Imunosuppression
Hypertension and proteinuria screening

32
Q

What causes IgA nephropathy?

A

Non strep post infectious glomerulonephritis - 1-2 days after URTI

33
Q

What are urine features of IgA nephropathy?

A

Recurrent macroscopic haematuria
Chronic microscopic haematuria
Varying degree of proteinuria

34
Q

Does treating strep prevent post infectious glomerulonephrtis?

A

No

35
Q

What are clinical features of AKI?

A

Serum creatinine >1.5x age specific reference creatinine

Urine output <0.5ml/kg for 8 hours

36
Q

What is grade 1 AKI?

A

Measured creatinine >1.5-2x reference creatinine

37
Q

What is grade 2 AKI?

A

Measured creatinine >2-3x reference creatinine

38
Q

What is grade 3 AKI?

A

Measured creatinine >3x referenced creatinine

39
Q

How is AKI managed?

A

3Ms;
Monitor - PEWS etc
Maintain - hydration
Minimise - drugs

40
Q

What re intrinsic causes of AKI?

A 
Haemolytic uraemic syndrome
Glomerulonephritis
Acute tubular necrosis
Drugs
Autoimmune
41
Q

What drugs cause AKI?

A

NSAIDs

42
Q

What causes acute tubular necrosis?

A

Hypoperfusion

43
Q

What is the main post renal cause of AKI?

A

Obstructive uropathies

44
Q

What causes haemolytic uraemic syndrome?

A

E.Coli producing verotoxin or shigatoxin

Pneumococcal infection

45
Q

How does HUS present?

A

E.coli O157 infection

Bloody diarrhoea

46
Q

What is the triad of HUS?

A

Microangiopathic haemolyic anemia
Thrombocytopenia
AKI

47
Q

What is the most important part of managing HUS?

A

Maintenance - maintain hydration and salt

48
Q

What are consequences of AKI?

A

Blood pressure
Proteinuria
Evolution to CKD

49
Q

What is the most common cause of CKD in children?

A

Congenital Anomalies of the Kidney and Urinary Tract (CAKUT)

50
Q

What are risk factors for CAKUT?

A

Turner
Trisomy 21
Branchio-oto-renal
Prune belly syndrome

51
Q

What is used to stage CKD?

A

GFR

52
Q

How does uraemia present?

A

Loss of appetite
Weight loss
Itch

53
Q

How does salt/acid base imbalance present?

A

Lethargy - hyperkalaemic

54
Q

How do neonates with UTI present?

A

Fever
Vomiting
Lethargy
Irritability

55
Q

How do pre-verbal children present with UTI?

A 
Fever
Abdo pain/tenderness
Vomiting 
Poor feeding
Lethargy
Irritability
56
Q

How do verbal children present with UTI?

A

Abdominal/loin pain or tenderness
Fever
Malaise
Vomiting

57
Q

What tests can be used for UTI diagnosis?

A

Dipstix - leukocyte esterase activity, nitrites
Microscopy - pyuria, bacturia
Culture >10^5 of the same organism

58
Q

What does a high grade of vesico-ureteric reflux mean?

A

Increased risk of AKI

59
Q

What can happen as a result of UTI?

A

Scarring

60
Q

What 3 factors lead to scarring?

A

UTI
Vulnerable kidney
Vesico-ureteric reflux

61
Q

What kidney investigations can be done?

A

USS - structure

DMSA isotope scan - scarring and function

62
Q

How is lower tract UTI treated?

A

3 days oral antibiotic

63
Q

How is upper tract UTI treated?

A

Antibiotics 7-10 days

Fluids, hygiene, constipation

64
Q

What are the 2 main factors affecting CKD?

A

Hypertension

Proteinuria

65
Q

What is the gold standard for blood pressure measurement?

A

Sphigmamometer

66
Q

How is CKD managed?

A

Minimise weight loss - keep well nourished

Low potassium diet, avoid hyper calcaemia, reduce phosphate

67
Q

What happens to phosphate in kidney damage?

A

Increases

Paediatrics (25 decks)

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