Nephrology Flashcards
What effect can UTIs have long term for children?
Hypertension, scarring on kidney, renal failure
Why investigate UTIs further?
Determine any renal scars or damage
Prevent high BP
Prevent chronic renal failure
What does investigation aim to find out?
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
How should UTIs be investigated?
clean catch sample, 2 samples
Gold standard method to investigate urinary tracts?
USS
What is a DMSA and what does it investigate?
injection of isotope into your vein then can see if there are any corticol losses or scaring
MCUG? how is it performed and what information does it provide?
Micturating cystourethrogram - Cather passed into bladder through the urethra, cystograffin, looking for reflux
If babies suffer recurrent UTIs or reflux what is suggested?
Prophylactic low dose antibiotics
Define reflux nephropathy?
Someone who has sustained scarring to their kidney due to vesico-ureteric reflux
Intrarenal reflux of infected urine occurs where in the kidney?
Inside the individual papillae of the kidney itself
What can become superimposed on the renal damage that occurs in reflux nephropathy?
Glomerulosclerosis
Apart from a DMSA, what renogram can be used to check for obstruction that uses isotope scanning?
MAG3 renogram
What is the triad that define nephrotic syndrome?
+++proteinuria
hypoproteinaemia (less than 25g/dL)
oedema - facial
What is the triad in nephritic syndrome?
oliguria, hypertension, impaired renal function
On clinical examination of a patient with nephrotic syndrome what will you find?
hypovolaemic prolonged CPT GI symptoms - vomiting, diarrhoea Raised haematocrit Urinary sodium less than 10mmol/L
Nephritis screening blood tests?
FBC U&E C3/4 ASOT ANA ANCA Ig Autoantibodies Hep B
What was the biggest killer in nephrotic syndrome and how is this prophylactically treated now?
Peritonitis due to pseudomonas infection
Given Penicillin V 1-6 years 125mg BD and over 6 250mg BD
How do you manage a child with nephrotic syndrome?
Admit to hospital IO chart fluid restriction BP Fluid status assessment regularly Penicillin V prophylaxis
How do you treat someone presenting with their first episode of nephrotic syndrome?
Prednisolone 60mg/m2 based on ideal weight for age
Maximum 60mg dose OD for 4 weeks
Remission
Taper dose over the next 8 weeks
SE of prednisolone?
Behaviour disturb weight gain cushinoid appearance osteoporosis Diabetes Infection Hypertension Need steroid card
Complications caused by nephrotic syndrome?
Thrombosis Hypovolaemia AKI dehydration Infection Hyperlipidaemia Malnutrition
How do you define remission and relapse of nephrotic syndrome?
Remission = proteinuria trace for 3 days Relapse = proteinuria 3+++ for 3 days (dont need oedema)
When is albumin infusion indicated in nephrotic and what rate is it given?
When significantly hypovolaemic given as 5mls/kg 20% human albumin solution over 4 hours then furosemide 1mg/kg halfway, monitor BP
During the first relapse of nephrotic syndrome what is the management?
Prednisolone 60mg/m2 on expected weight for age
4 weeks
Tapering dose over preceeding 8 weeks
Penicillin V if oedema present
What happens after subsequent relapses?
Minimum dose of prednisolone for relapse and debate staying on low dose steroids
What makes nephrotic syndrome classified as complicated?
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
Which type of nephrotic syndrome will the patient grow out of eventually?
Minimal change nephrotic syndrome
What is a common second line treatment for nephrotic syndrome?
Cyclophosphamide 2mg/kg for 12 weeks then taper
SE that must be monitored in cyclophosphamide treatment?
FBC - neutropenia!!
Renal function
LFT
Weekly check for 4 weeks then every 2 weeks
SE of cyclophosphamide?
Neutropenia Infection Deranged LFTs Alopecia Infertility Haemorrhagic cystitis
Third line agent for nephrotic syndrome? What does it inhibit? What needs to be monitored whilst taking?
Cyclosporin 2-5mg/kg/day for 1-2 years
Calcineurin inhibitor
FBC, U&E every 6-8 weeks
Side effects of cyclosporin?
Hirtuism Acne Gum hypertrophy Renal impairment Hypertension Immunosuppression
If a patient has been on cyclosporin for 2 years what do they need?
Renal biopsy for damage
What drugs can transplant patients take instead of Cyclophosphamide and Cyclosporin?
Tacrolimus
Mycophenolate mofetil
Before starting a child on steroids what is it important to check they are immune to?
VZV - Ig if they arent as more likely to suffer systemic infection
Common triad of symptoms of UTI in those under 3 months?
Vomiting
Lethargy
Off feeds
How are nitrites on dipstick formed in UTI?
bacteria convert nitrates into nitrites
FH needs to be asked in UTI?
Vesicoureteric reflux
Renal disease
oral treatment for UTI vs IV?
Oral = trimethoprim IV = co-amoxiclav
Microscopy vs culture vs sensitivities?
Microscopy = initial look at sample, over 10 level of WCC indicates UTI Culture = isolate organism responsible Sensitivities = see what antibiotic to use
What organism causes 80% of UTIs in children?
E.coli
How common is UTI reoccurence in children?
50% within 1 year
What 2 low dose antibiotics can be used as prophylaxis against UTIs?
Trimethoprim
Cefalexin
Anatomical abnormality assocaited to vesicoureteric reflux?
Laterally displaced ureters inserting directly into bladder
