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
