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Paediatrics > Nephrology > Flashcards

Nephrology Flashcards

1
Q

What effect can UTIs have long term for children?

A

Hypertension, scarring on kidney, renal failure

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2
Q

Why investigate UTIs further?

A

Determine any renal scars or damage
Prevent high BP
Prevent chronic renal failure

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3
Q

What does investigation aim to find out?

A

If there are any renal tract abnormalities
If there is any vesico-uteric reflux
If there are any bladder emptying issues
If there are any obstructions

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4
Q

How should UTIs be investigated?

A

clean catch sample, 2 samples

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5
Q

Gold standard method to investigate urinary tracts?

A

USS

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6
Q

What is a DMSA and what does it investigate?

A

injection of isotope into your vein then can see if there are any corticol losses or scaring

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7
Q

MCUG? how is it performed and what information does it provide?

A

Micturating cystourethrogram - Cather passed into bladder through the urethra, cystograffin, looking for reflux

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8
Q

If babies suffer recurrent UTIs or reflux what is suggested?

A

Prophylactic low dose antibiotics

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9
Q

Define reflux nephropathy?

A

Someone who has sustained scarring to their kidney due to vesico-ureteric reflux

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10
Q

Intrarenal reflux of infected urine occurs where in the kidney?

A

Inside the individual papillae of the kidney itself

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11
Q

What can become superimposed on the renal damage that occurs in reflux nephropathy?

A

Glomerulosclerosis

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12
Q

Apart from a DMSA, what renogram can be used to check for obstruction that uses isotope scanning?

A

MAG3 renogram

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13
Q

What is the triad that define nephrotic syndrome?

A

+++proteinuria
hypoproteinaemia (less than 25g/dL)
oedema - facial

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14
Q

What is the triad in nephritic syndrome?

A

oliguria, hypertension, impaired renal function

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15
Q

On clinical examination of a patient with nephrotic syndrome what will you find?

A 
hypovolaemic
prolonged CPT
GI symptoms - vomiting, diarrhoea
Raised haematocrit
Urinary sodium less than 10mmol/L
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16
Q

Nephritis screening blood tests?

A 
FBC
U&E
C3/4
ASOT
ANA
ANCA
Ig
Autoantibodies
Hep B
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17
Q

What was the biggest killer in nephrotic syndrome and how is this prophylactically treated now?

A

Peritonitis due to pseudomonas infection

Given Penicillin V 1-6 years 125mg BD and over 6 250mg BD

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18
Q

How do you manage a child with nephrotic syndrome?

A 
Admit to hospital
IO chart
fluid restriction
BP
Fluid status assessment regularly 
Penicillin V prophylaxis
19
Q

How do you treat someone presenting with their first episode of nephrotic syndrome?

A

Prednisolone 60mg/m2 based on ideal weight for age
Maximum 60mg dose OD for 4 weeks
Remission
Taper dose over the next 8 weeks

20
Q

SE of prednisolone?

A 
Behaviour disturb
weight gain
cushinoid appearance
osteoporosis 
Diabetes
Infection
Hypertension
Need steroid card
21
Q

Complications caused by nephrotic syndrome?

A 
Thrombosis
Hypovolaemia 
AKI
dehydration
Infection
Hyperlipidaemia
Malnutrition
22
Q

How do you define remission and relapse of nephrotic syndrome?

A 
Remission = proteinuria trace for 3 days
Relapse = proteinuria 3+++ for 3 days (dont need oedema)
23
Q

When is albumin infusion indicated in nephrotic and what rate is it given?

A

When significantly hypovolaemic given as 5mls/kg 20% human albumin solution over 4 hours then furosemide 1mg/kg halfway, monitor BP

24
Q

During the first relapse of nephrotic syndrome what is the management?

A

Prednisolone 60mg/m2 on expected weight for age
4 weeks
Tapering dose over preceeding 8 weeks
Penicillin V if oedema present

25
Q

What happens after subsequent relapses?

A

Minimum dose of prednisolone for relapse and debate staying on low dose steroids

26
Q

What makes nephrotic syndrome classified as complicated?

A

Steroid resistance
Multiple relapses either shortly after finishing pred or whilst taking it
Age under 12 months or over 10 at initial presentation
Macroscopic haematuria
Nephritic - persistent hypertension, renal impair

27
Q

Which type of nephrotic syndrome will the patient grow out of eventually?

A

Minimal change nephrotic syndrome

28
Q

What is a common second line treatment for nephrotic syndrome?

A

Cyclophosphamide 2mg/kg for 12 weeks then taper

29
Q

SE that must be monitored in cyclophosphamide treatment?

A

FBC - neutropenia!!
Renal function
LFT
Weekly check for 4 weeks then every 2 weeks

30
Q

SE of cyclophosphamide?

A 
Neutropenia
Infection
Deranged LFTs
Alopecia
Infertility 
Haemorrhagic cystitis
31
Q

Third line agent for nephrotic syndrome? What does it inhibit? What needs to be monitored whilst taking?

A

Cyclosporin 2-5mg/kg/day for 1-2 years
Calcineurin inhibitor
FBC, U&E every 6-8 weeks

32
Q

Side effects of cyclosporin?

A 
Hirtuism
Acne
Gum hypertrophy
Renal impairment 
Hypertension
Immunosuppression
33
Q

If a patient has been on cyclosporin for 2 years what do they need?

A

Renal biopsy for damage

34
Q

What drugs can transplant patients take instead of Cyclophosphamide and Cyclosporin?

A

Tacrolimus

Mycophenolate mofetil

35
Q

Before starting a child on steroids what is it important to check they are immune to?

A

VZV - Ig if they arent as more likely to suffer systemic infection

36
Q

Common triad of symptoms of UTI in those under 3 months?

A

Vomiting
Lethargy
Off feeds

37
Q

How are nitrites on dipstick formed in UTI?

A

bacteria convert nitrates into nitrites

38
Q

FH needs to be asked in UTI?

A

Vesicoureteric reflux

Renal disease

39
Q

oral treatment for UTI vs IV?

A 
Oral = trimethoprim
IV = co-amoxiclav
40
Q

Microscopy vs culture vs sensitivities?

A 
Microscopy = initial look at sample, over 10 level of WCC indicates UTI
Culture = isolate organism responsible 
Sensitivities = see what antibiotic to use
41
Q

What organism causes 80% of UTIs in children?

A

E.coli

42
Q

How common is UTI reoccurence in children?

A

50% within 1 year

43
Q

What 2 low dose antibiotics can be used as prophylaxis against UTIs?

A

Trimethoprim

Cefalexin

44
Q

Anatomical abnormality assocaited to vesicoureteric reflux?

A

Laterally displaced ureters inserting directly into bladder

Paediatrics (20 decks)

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