Nephrology Flashcards
Features of bed wetting - Enuresis
Day and night time continence usually achieved by 3 or 4.
Enuresis = involuntary discharge of urine by day or night or both, in a child aged 5 years or older, in absence of congenital or acquired defects or nervous system or urinary tract.
Primary - child never achieved continence
Secondary - Child been dry for at least 6 months before
Often occurs at night due to deep sleep = nocturnal enuresis.
Day time = diurnal enuresis.
More common in girls.
Causes of bed wetting?
Primary - normal variation on development, small bladder, failure to wake up to sensation of needing to urinate, psychological distress, secondary to another condition.
Secondary - UTI, constipation, diabetes, new psychosocial problems such as stress in family or school life/abuse.
Management of enuresis?
Look for possible underlying cause/triggers to treat.
Advise on fluid intake, diet and toileting behaviour.
Reward systems.
Enuresis alarm first-line for children under age of 7 - need to be used for at least 3 months.
Desmopressin used first-line in children >7 years of age, particularly if short-term control needed or enuresis alarm ineffective.
Oxybutinin (anticholinergic), reduces contractility of bladder, and helpful with urge incontinence with children who have diurnal enuresis.
Causes of haematuria?
Idiopathic Trauma UTI Bleeding disorders - ITP, HSP Nephritic syndrome Kidney stones Wilms tumour Hydronephritis Renal vein thrombosis Haemolytic uraemic syndrome (bloody diarrhoea)
Investigations of haematuria?
Microscopic haematuria with normal BP and kidney function -> check urine over several months. If continues -
- Renal USS
- Urinalysis for protein, calcium, creatinine
- Blood (U&Es)
Microscopic haematuria, with proteinuria/HTN/abnormal bloods/FMH of kidney disease -
- Kidney biopsy.
Management of haematuria?
Surveillance if child is otherwise healthy.
Manage underlying cause.
What is haemolytic uraemic syndrome?
Similar condition of TTP
- arteriolar thrombi are predominantly formed in kidneys.
Causes and features of haemolytic uraemic syndrome?
Toxin produced by E. coli causes acute renal failure Ciclosporin SLE HIV Pregnancy Tumours The pill
Triad of: haemolytic anaemia, thrombocytopenia, AKI.
E. coli can cause brief gastroenteritis with bloody diarrhoea. After 5 days of diarrhoea: - Reduced urine output - Haematuria Abdominal pain - Lethargy and irritability - Confusion
Investigations of haemolytic uraemic syndrome?
FBC - anaemia, thrombocytopenia, fragmented blood film
U&E (AKI)
Stool culture
Management of haemolytic uraemic syndrome?
Urgent referral to paediatric renal unit for renal dialysis if required.
Supportive treatment - fluids, blood transfusion, dialysis.
Self-limiting and 80% make full recovery.
Does not respond to plasma exchange as it is not brought about by the deficiency in VWF-cleaving protease.
Causes of nephritic syndrome?
Reduction in kidney function
Haematuria
Proteinuria
Features of nephritic syndrome?
Haematuria
HTN
Azotemia (increased blood urea nitrogen and creatinine) - reduced kidney function
Proteinuria
Blurred vision
Oliguria
Oedema
Causes of nephritic syndrome in children?
Often post-strep glomerulonephritis
IgA nephropathy
Haemolytic uraemic syndrome (GI infection produces toxins causing haemoylsis of RBCs).
Henoch-Shonlein purpura (purple spots on skin, joint pain, GI problems, glomerulonephritis).
Features and management of post-streptococcal glomerulonephritis?
Occurs 1-3 weeks post beta-haemolytic strep infection (eg tonsillitis).
Immune complexes from strep antigens along with ab’s and complement proteins from person’s immune system get stuck in glomeruli causing inflammation.
Management is supportive and patients usually make full recovery (80%). Some can have progressive worsening renal function.
Features and management of IgA nephropathy?
Related to HSP (IgA vasculitis)
IgA deposits in nephrons causes inflammation and nephritic syndrome.
Histology shows IgA deposits and glomerular mesangial proliferation.
Often presents with haematuria a few days after URTI.
Management - supportive treatment (antihypertensives, etc)
Investigations of nephritic syndrome?
Blood pressure (high) Urine dip - protein and blood Urinalysis Blood U&Es Complement levels are low Test for streptococcus (ASOT) Kidney biopsy
Management of nephritic syndrome?
Bed rest Low potassium/salt/fluid diet (due to fluid overload) Strict fluid input/output chart Regular weight checks (twice daily) Consider antihypertensives Consider anti-inflammatory medication Consider antibiotic for streptococcus
What is Henoch-Schonlein Purpura?
IgA mediated small vessel vasculitis.
Usually seen in children following an infection.
