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Yr4 - Paeds > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Define nephrotic syndrome

A 
Glomerular disorder
Presents with triad of
- generalised oedema
- heavy proteinuria > 200mg/mmol
- hypoalbuminemia
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2
Q

Epidemiology of nephrotic syndrome

A

Uncommon - 2 in 100,000 children per year

  • higher incidence in UK Asian populations
  • twice as common in boys
  • most common in early childhood - median age of 4 years
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3
Q

Pathophysiology of nephrotic syndrome

A 
Leaking protein from damaged glomerulus
- podocytes become flattened
Most commonly caused by minimal change disease in children 
- congenital nephrotic syndromes
- focal segmental glomerulosclerosis
- mesangiocapillary glomerulonephritis
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4
Q

Clinical features of nephrotic syndrome

A 
Oedema
Proteinuria
Hypoalbuminemia
Atypical features - discussion with nephrologist
- < 1 of > 12 years old
- hypertension
- impaired renal function
- frank haematuria
- steroid resistant nephrotic syndrome
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5
Q

Ddx for nephrotic syndrome

A

Heart failure - heart murmur, SOB, cyanosis or hepatomegaly
Allergic reaction - facial oedema
Malnutrition

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6
Q

Ix for nephrotic syndrome

A

Confirm diagnosis and rule out atypical features

  • urine dip
  • urinary protein:creatinine ratio
  • U+Es
  • FBC
  • serum albumin
  • varicella zoster serology
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7
Q

Management of nephrotic syndrome

A

High dose steroids
- usually react well but may relapse
- may require low-dose maintenance steroids
Low salt diet
- to prevent worsening oedema
Prophylactic antibiotics
= leak immunoglobulins through kidneys so higher risk of infection

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8
Q

Complications of nephrotic syndrome

A

Fluid management
- can be intravascularly depleted even though peripherally oedematous
Infection
Varicella Zoster
- may require VZV immunoglobulin or IV acyclovir
Thrombosis
- prothrombotic state

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9
Q

Pathophysiology of UTIs

A

Most commonly

  • E.Coli
  • Klebsiella species
  • Staphylococcus saprophyticus
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10
Q

Risk factors for UTIs

A 
Age below one year
Female - more common in boys under 3 months
Caucasian race
Previous UTI
Voiding dysfunction
Vesicoureteral reflex
Sexual abuse
Spinal abnormalities
Constipation
Immunosuppression
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11
Q

Clinical features of UTI

A 
Preverbal infants
- vomiting
- fever
- lethargy
- poor feeding
- failure to thrive
Children who can verbalise
- increased frequency
- painful urination
Examination
- increased temp, HR, RR and cap refill time
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12
Q

DDx of UTI

A 
Vulvovaginitis or vaginal foreign body
- vaginal discharge with normal urine dip
Kawasaki disease
- rash, mucositis, swelling of extremities
Voiding dysfunction
- urine withholding behaviours
Sepsis with no UTI source
Threadworms
- perianal itching
Meningitis
- photophobia, neck stiffness and rash
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13
Q

Ix for UTI

A 
Microscopy and culture
- clean catch urine sample
- urine collection pad
Urine dipstick
- leukocyte esterase and nitrites
Consider USS for recurrent UTIs
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14
Q

Atypical features of UTI

A 
Poor urine flow
Abdo or bladder mass
Raised creatinine
Sepsis
Failure to respond to treatment in 24 hours
Non-E.coli organism
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15
Q

Definition of recurrent UTIs

A

2 or more episodes of pyelonephritis
One episode of upper UTI and one episode of lower UTI
3x episodes of lower UTI

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16
Q

Management of UTIs

A 
All infants and children 3months + with cystitis/lower UTI
- oral abx for 3 days
- cefalexin
All those with upper UTI
- referral to paediatric specialist
- oral cefalexin or IV cefuroxime
Children over 12
- nitrofurantoin
17
Q

Complications of UTI

A

Renal scarring/damage
Hypertension
Renal insufficiency and failure

18
Q

Risk factors for recurrent UTIs

A

Younger children - aged less than 6 months
Female
VUR grade 3-5
Voiding abnormalities

19
Q

Define renal agenesis

A

Total absence of one or both kidneys

20
Q

Define multicystic dysplastic kidney

A

Renal cortex replaced with multiple cysts leaving no functioning cortex

21
Q

Define horseshoe kidney

A

Fusion of inferior poles of the 2 kidneys across the midline

- both function independently

22
Q

Define dulplex kidney

A

A single kidney has 2 separate pelvicalyceal systems

23
Q

Define posterior urethral valves

A

Urethral obstruction from a valve-like fold of tissue

24
Q

Define autosomal dominant polycystic kidney disease

A

Multiple progressive cyst formation within the kidneys

25
Q

Define pelviuretieric junction obstruction

A

Inadequate canalisation of the pelviureteric junction

- leads to obstruction

26
Q

NICE guidelines for USS imaging in children < 6 months

A 
USS during acute infection
- only if atypical UTI - septic, abdominal mass, raised creatinine, failure to respond to abx, non-E.coli
USS within 6 weeks
- responds well to treatment in 48 hrs
DMSA 4-6 months following
- atypical UTI
- recurrent UTI
MCUG 
- atypical
- recurrent
27
Q

Define reflux nephropathy

A

Renal damage due to retrograde flow of urine from the bladder to upper renal tract

  • incompetence at vesicoureteric junction
  • secondary to obstrcution
  • neurogenic bladder
28
Q

Risk factors for reflux nephropathy

A

Fhx
Recurrent UTIs
Anatomical renal tract abnormality

29
Q

Clinical features for reflux nephropathy

A

Asymptomatic or recurrent UTIs

30
Q

Mx of reflux nephropathy

A

Mild
- observation and advice on identifying features of infection
Moderate
- antibiotic prophylaxis to prevent further damage to the kidneys due to infection
Severe
- surgical repair

31
Q

Features of nephritic syndrome

A

Proteinuria
Haematuria
Renal failure

32
Q

Pathophysiology of nephritic syndrome

A

Inflammation due to glomerulonephritis
Leads to leaky glomerulus
- proteinuria
- haematuria + red cell casts
Increased cellularity reducing glomerular blood flow and filtration
- reduced renal function - rise in creatinine and urea
- salt and water retention -> systemic hypertension, oedema and oliguria

33
Q

Causes of nephritic syndrome

A

Post-streptococcal glomerulonephritis

IgA nephropathy

34
Q

Mx of nephritic syndrome

A 
Manage primary aetiology
- PSGN - supportive
- IgA nephropathy - ACEi
Monitor U+Es eGFR - consider dialysis in acute renal failure
Antihypertensives
Restrict fluid and salt intake
35
Q

Define enuresis

A

Involuntary loss of urine beyond the developmental age of 5

  • typically nocturnal
  • primary or secondary
36
Q

Causes of enuresis

A 
Primary
- delayed development of the bladder sphincter
- neurogenic bladder
- dysfunctional voiding
- reflux nephropathy
Secondary
- DM or DI
- emotional stress
- UTI
- CKD
- constipation
37
Q

Mx of enuresis

A

Positive reinforcement techniques
Enuresis alarms
Evening fluid restriction
Psychological support

Yr4 - Paeds (16 decks)

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