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Paedriatrics > Nephrology > Flashcards

Nephrology Flashcards

1
Q

What is the average GFR in a neonate?

A

20-30ml/min

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2
Q

By what age does the GFR equal an adult?

A

2yrs

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3
Q

What are the 5 basic kidney functions?

A
  1. Waste handling
  2. Water handling
  3. Salt balance
  4. Acid base control
  5. Endocrine
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4
Q

What are parts of the glomerular filtration barrier?

A

Endothelial cell
Glomerular basement membrane (GBM)
Podocyte
Mesangial cells

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5
Q

What suggests glomerular injury?

A

Proteinuria

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6
Q

What is the underlying cause of: increasing haematuria and intravascular overload?

A

Nephritic syndrome

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7
Q

What is the underlying cause of: increasing proteinuria and intravascular depletion?

A

Nephrotic syndrome

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8
Q

If the epithelial cell (podocyte) is affected in acquired glomerulopathy what is the likely pathology?

A

Minimal Change Disease

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9
Q

If the basement membrane is affected in acquired glomerulopathy what is the likely pathology?

A

Post Infectious Glomerulonephritis (PIGN)

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10
Q

If the endothelial cell is affected in acquired glomerulopathy what is the likely pathology?

A

PIGN, Haemolytic uraemic syndrome (HUS)

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11
Q

If the mesangial cell is affected in acquired glomerulopathy what is the likely pathology?

A

HSP/IgA nephropathy

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12
Q

Which is common and which is rare out of acquired and congenital glomerulopathy?

A

Acquired - common

Congenital - rare

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13
Q

If the podocyte cytoskeleton integrity is affected in congenital glomerulopathy what is the likely pathology?

A

Congenital nephrotic syndrome

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14
Q

Mutations in which proteins can lead to congenital nephrotic syndrome?

A

Podocine

Nephrin

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15
Q

If the basement membrane proteins are affected in congenital glomerulopathy what is the likely pathology?

A

Alport syndrome

Thin basement membrane disease

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16
Q

If the endothelial/microvascular integrity is affected in congenital glomerulopathy where is the likely pathology?

A

Complement regulatory proteins (MPGN)

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17
Q

How can you check for proteinuria?

A

Dipstix
Protein Creatinine Ratio
24hr urine collection

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18
Q

What is the gold standard for checking proteinuria?

A

24hr urine collection

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19
Q

When is a dipstix usually abnormal?

A

> 3+

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20
Q

What does a dipstix do?

A

Measures concentration of protein

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21
Q

When is it best to measure protein creatinine ratio?

A

Early morning urine

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22
Q

When is the Protein Creatinine ratio in the nephrotic range?

A

> 250mg/mmol

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23
Q

What is the normal protein creatinine ratio?

A

Pr:CR ratio <20mg/mmol

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24
Q

What are common symptoms of nephrotic syndrome?

A

Nephrotic range proteinuria
Hypoalbuminaemia
Oedema

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25
Q

What is a typical presentation of nephrotic syndrome?

A 
Swollen face (worse in mornings)
Exam: pale, looked well, inflated weight, periorbital oedema, pitting oedema legs, ascites, small pleural effusions, frothy urine
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26
Q

What three things diagnose nephrotic syndrome?

A

Oedema
Proteinuria
Low albumin (bloods)

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27
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal change disease

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28
Q

What are typical features of nephrotic syndrome?

A

Normal BP
No frank haematuria
Normal renal function
Typically age 1-10

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29
Q

What are atypical features of nephrotic syndrome?

A

Suggestions of autoimmune disease
Abnormal renal function
Steroid resistance

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30
Q

What is the treatment for nephrotic syndrome if typical features?

A

Prednisolone 8wks

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31
Q

What are the typical side effects from high dose glucocorticoids that parents notice?

A

Behaviour
Mood lability
Sleep disturbance

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32
Q

What do doctors need to consider in terms of side effects from high dose glucocorticoids in children?

A

Infection risk

Hypertension

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33
Q

What percentage of children with nephrotic syndrome should react to steroids?

A

90%

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34
Q

What percentage of nephrotic syndrome in children relapse?

A

80%

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35
Q

What is an acquired nephrotic syndrome that can be steroid resistant?

A

Focal Segmental Glomerulosclerosis (FSGS)

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36
Q

What are congenital nephrotic syndromes that can be steroid resistant?

A

NPHS1 - nephrin

NPHS2 - podocin

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37
Q

If there is haematuria and associated proteinuria what would you assume?

A

Glomerular disease

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38
Q

What are some causes of haematuria?

A 
Systemic: clotting disorder
Renal: glomerulonephritis
Tumour/malignancies
Cysts
UTI
Stones
Trauma
Urethritis
39
Q

If there is frank haematuria, is it more likely nephrotic or nephritic?

A

Nephritic

40
Q

What is the usual cause of acute post-infectious glomerulonephritis?

A

Group A strep

41
Q

How would you diagnose acute post-infectious glomerulonephritis?

A

Bacterial culture
Positive ASOT
Low C3 complement level normalises

42
Q

What is the treatment for post-infectious glomerulonephritis?

A

Antibiotic
Support renal function
Diuretics for overload/hypertension

43
Q

What is the outcome for post-infective glomerulonephritis usually?

A

Self-limiting

44
Q

How would you make clinical diagnosis of Henoch Schonlein Purpura (IgA related vasculitis)?

A 
Mandatory palpable purpura
One of 4:
- Abdo pain
- Renal involvement
- Arthritis or arthralgia
- Biopsy: IgA deposition
45
Q

What is the most common childhood vasculitis?

A

IgA vasculitis

46
Q

When does IgA vasculitis usually occur?

A

1-3 post-trigger e.g. virus

47
Q

How long does IgA vasculitis usually last?

A

4-6wks

48
Q

What is the treatment for IgA vasculitis?

A

Symptomatic
Glucocorticoid therapy
Immunosuppression

49
Q

What is the most common glomerulonephritis?

A

IgA nephropathy

50
Q

How does IgA nephropathy present clinically?

A

Recurrent macroscopic haematuria
+/- chronic microscopic haematuria
Varying degrees of proteinuria

51
Q

How is IgA nephropathy diagnosed?

A

Clinically

Confirmation renal biopsy

52
Q

What biopsy is done in IgA nephropathy for confirmation?

A

Renal biopsy

53
Q

What is the treatment for mild IgA nephropathy?

A

Proteinuria with ACEi

54
Q

What is the treatment for moderate to severe IgA nephropathy?

A

Immunosuppression

55
Q

What is the outcome for those with IgA nephropathy?

A

25% ESRF by 10yrs

56
Q

What diseases are likely if it is nephritic syndrome?

A

Post-infectious GN

HSP/IgA

57
Q

What diseases are likely if it is nephrotic syndrome?

A

FSGS

Minimal change disease

58
Q

What is FSGS?

A

Focal segmental glomerulosclerosis

59
Q

What signs happen in acute renal failure?

A

Anuria/oliguria
Hypertension with fluid overload
Rapid rise plasma creatinine

60
Q

What is AKI?

A

Abrupt loss kidney function, retention of urea and other nitrogenous waste products and dysregulation of extracellular volume and electrolytes

61
Q

What is the serum creatinine in AKI?

A

> 1.5x age specific reference creatinine

62
Q

What is the urine output in AKI?

A

<0.5ml/kg for >8hrs

63
Q

What are the 3 AKI warning scores?

A

AKI 1: creatinine >1.5-2x ref
AKI 2: creatinine 2-3x ref
AKI 3: serum creatinine >3x ref

64
Q

What are the 3 M’s of AKI management?

A

Monitor: PEWS, urine output, weight
Maintain: good hydration
Minimise: drugs

65
Q

What are the main causes of AKI?

A

Pre-renal
Perfusion problem
Post-renal

66
Q

What are intrinsic renal problems that can cause AKI?

A

Glomerular disease: HUS (haemolytic uremic syndrome) , glomerulonephritis
Tubular injury: acute tubular necrosis (ATN)
Interstitial nephritis

67
Q

What are causes of acute tubular necrosis (ATN)?

A

Hypoperfusion

Drugs

68
Q

What are causes of interstitial nephritis?

A

NSAID
Autoimmune
Drugs

69
Q

What are post-renal causes of AKI?

A

Obstructive uropathies

70
Q

When does HUS typically occur?

A

Post-diarrhoea

71
Q

What typically causes HUS?

A

Entero-haemorrhagic e.coli

72
Q

When is the period of risk of HUS?

A

Up to 14days after onset of diarrhoea

73
Q

What is HUS a triad of?

A

Microangiopathic haemolytic anaemia
Thrombocytopenia
AKI/ARF

74
Q

What are the 3 M’s of HUS?

A

Monitor: 5 kidney functions
Maintain: IV, renal replacement therapy
Minimise: no antibiotics/NSAIDs

75
Q

What are the long term consequences of AKI?

A

BP
Proteinuria monitoring
Evolution to CKD

76
Q

What are examples of congenital anomalies of the kidney and urinary tract (CAKUT)?

A

Reflux nephropathy
Dysplasia
Obstructive uropathy

77
Q

What are causes of CKD in paediatrics?

A

CAKUT
Hereditary conditions
GN

78
Q

What may CAKUT be associated with?

A

Turner
Trisomy 21
Branchio-oto-renal
Prune Belly syndrome

79
Q

At what GFR would you start to see signs and symptoms in CKD?

A

<60

80
Q

How would you diagnose UTI?

A

Clinical signs +

  • bacteria culture from MSSU
  • grow on suprapubic aspiration/catheter
81
Q

What are the clinical findings in younger paediatric patients for a UTI?

A

More systemic symptoms: fever, vomiting, lethargy, irritability

82
Q

What are the clinical findings in older paediatric patients for a UTI?

A

More lower tract symptoms: frequency, dysuria

83
Q

What can you use to diagnose UTI?

A

Dipstix
Microscopy
Culture

84
Q

What is a concerning diagnosis with recurrent UTI?

A

Vescico-ureteric reflux

Renal scarring

85
Q

What are the different grades of vescico-ureteric reflux?

A

Grade 1-5

86
Q

What investigations can be done for UTI?

A

US
DMSA (isotope scan)
Micturating cysto-urethrogram (MCUG)
MAG 3 scan

87
Q

What is the treatment for lower tract UTI?

A

3 days oral antibiotic

88
Q

What is the treatment for upper tract UTI/pyelonephritis?

A

Antibiotics 7-10 days
Prevention
Fluids, hygiene

89
Q

What are factors affecting progression of CKD?

A 
Late referral
Hypertension
Proteinuria
High intake protein, phosphate, salt
Bone health
Acidosis
Recurrent UTIs
90
Q

What is the gold standard for BP?

A

Spigmanometer

91
Q

What happens to phosphate in kidney disease?

A

High phosphate as kidneys normally excrete phosphate

High phosphate -> increase PTH

92
Q

What does a high PTH cause?

A

Metabolic bone disease

93
Q

What is the treatment to prevent metabolic bone disease in kidney failure?

A

Low phosphate diet
Oral phosphate binders
Vitamin D

94
Q

What is CVS in renal failure?

A

Accelerated atherosclerosis

Paedriatrics (19 decks)

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