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Paeds > Nephrology and Genito-urinary > Flashcards

Nephrology and Genito-urinary Flashcards

1
Q

What are the causes of acute nephritis? (4)

A
  • Post­infectious (including streptococcus)
  • Vasculitis (HSP or, rarely, SLE, Wegener granulomatosis, microscopic polyarteritis, polyarteritis nodosa)
  • IgA nephropathy and mesangiocapillary
glomerulonephritis
  • Anti­glomerular basement membrane disease (Goodpasture syndrome) → v rare
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2
Q

Clinical features of acute nephritis?

A

Increased glomerular cellularity restricts glomerular blood flow and therefore filtration decreased
This leads to:
- Decreased urine output and vol overload
- HTN, may cause seizures
- Oedema, characteristically around eyes
- Haematuria and proteinuria

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3
Q

Presenting features of HSP? (5)

A

Rash - buttocks, extensor surfaces of legs/arms, ankles
Joint pain + swelling
Abdo pain
Renal - haematuria (80%), nephotic syndrome (rare)
Often fever

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4
Q

What is HSP?

A
  • Cause unknown
  • Pos genetic predisposition and antigen exposure increase circulating IgA levels and disrupt IgG synthesis
  • IgA and IgG interact to produce complexes that activate complement and are deposited in affected organs, precipitating an inflammatory response with vasculitis
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5
Q

What % with HSP have long-term renal abnormalities?

A

5-10%

- All with renal involvement must be followed for 1y

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6
Q

Management of HSP?

A
  • Usually self limiting
  • No form of therapy has been show to appreciably shorten duration of disease or prevent complications
  • NSAIDS may help joint pain but used with caution in renal insufficiency
  • With nephropathy variety of drugs can be used inc steroids
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7
Q

Causes of acute glomerulonephritis in childhood? (5)

A
  • Post streptococcal (most common)
  • Systemic immune disease – eg SLE
  • Other systemic illnesses – vasculitis, HSP
  • Alport syndrome (familial nephritis)
  • IgA nephropathy
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8
Q

Presentation of acute glomerulonephritis?

A
  • Haematuria
  • Decreased urine output
  • Fatigue
  • Lethargy
  • Headache
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9
Q

Ix for acute glomerulonephritis?

A
  • Electrolytes and creatinine – assess renal function
  • FBC – infection, anaemia
  • Urinalysis – infection, protein, blood
  • Urine culture – infection
  • Complement levels
  • ASO titre
  • Anti-DNAase B
  • Serum IgA measurement
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10
Q

What is nephrotic syndrome? (3)

A

Heavy proteinuria → low plasma albumin + oedema

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11
Q

Most common type of nephrotic syndrome in childhood?

A

Minimal change disease

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12
Q

Clinical signs of nephrotic syndrome?

A
  • Periorbital oedema (esp on waking) → earliest sign
  • Scrotal or vulval, leg + ankle oedema
  • Ascites
  • Breathlessness – due to pleural effusions
  • Abdo distension
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13
Q

Management of nephrotic syndrome?

A

Corticosteroids - prednisolone

  • Every day for 4w
  • Alternate days for 4w

–> If no response - renal biopsy

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14
Q

Complications of nephrotic syndrome? (4)

A

Hypovolaemia
Thrombosis
Infection
Hypercholesterolaemia

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15
Q

Prognosis of steroid-sensitive nephrotic syndrome?

A

1/3 resolve directly
1/3 relapse infrequently
1/3 frequent relapses & steroid-dependent

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16
Q

What atypical features of nephrotic syndrome might prompt consideration of 2nd line treatment +/or biopsy? (5)

A
  • <1 year old or >10 years old
  • Hypertensive
  • Elevated creatinine
  • Macroscopic haematuria
  • Failed to respond to steroids after 4-8w
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17
Q

Commonest organism in UTI?

A

E Coli

18
Q

NICE definition of pyelonephritis?

A

Bacteriuria + fever ≥38°C
OR
Fever <38°C with loin pain/tenderness + bacteriuria

19
Q

NICE definition of cystitis?

A

Bacteriuria but no systemic S or S

20
Q

Sx of UTI in infants?

A
  • Fever
  • Vomiting
  • Lethargy or 
irritability
  • Poor feeding/failure 
to thrive
  • Jaundice
  • Septicaemia
  • Offensive urine
  • Febrile convulsion (>6m)

Non-specific

21
Q

Sx of UTI in older children?

A
  • Dysuria and frequency
  • Abdo pain or loin tenderness
  • Fever with or without rigors (exaggerated shivering)
  • Lethargy and anorexia
  • Vomiting, diarrhea
  • Haematuria
  • Offensive/cloudy urine
  • Febrile convulsion
  • Recurrence of enuresis

More classical sx

22
Q

Features of atypical UTI? (7)

A
  • Seriously ill
  • Poor urine flow
  • Abdo or bladder mass
  • Raised creatinine
  • Septicaemia
  • Failure to respond to suitable abx within 48h
  • Infected with non-E.coli organisms
23
Q

NICE definition of recurrent UTI?

A
  • ≥2 UTIs with acute pyelonephritis/upper UTI
    OR
  • 1 episode of UTI with acute pyelonephritis/upper urinary tract infection plus ≥1 episodes of UTI with cystitis/lower urinary tract infection
    OR
  • ≥3 episodes of UTI with cystitis/lower urinary tract infection
24
Q

What investigations can be done for atypical or recurrent UTIs?

A
  • USS
  • DMSA - assess renal function
  • MCUG - contrast study
25
Q

Treatment of acute pyelonephritis?

Treatment of cystitis?

A

<3m
- IV abx eg cefotaxime, switch to oral

> 3m

  • Usually oral abc e.g. co-amoxiclav
  • Sometimes IV cefotaxime, then oral
  • Total of 7-10d

Cystitis
- Oral abx for 3d

26
Q

Ddx of haematuria? (2 categories)

A

Non-glomerular:

  • Infection → MOST COMMON (seldom only sx)
  • Trauma to genitalia, urinary tract or kidneys
  • Stones
  • Tumours
  • Sickle cell disease
  • Bleeding disorders
  • Renal vein thrombosis
  • Hypercalciuria

Glomerular:

  • Acute GN (usually + proteinuria)
  • Chronic GN (usually + proteinuria)
  • IgA nephropathy
  • Familial nephritis eg Alport syndrome
  • Thin basement membrane disease
27
Q

Diagnostic tests for vesico-ureteric reflux (VUR)? (2)

A
  • USS - can see hydronephrosis

- MCUG - used to see and grade reflux

28
Q

Classification of causes of AKI? (3)

A

Pre-renal
Renal
Post-renal

29
Q

Pre-renal causes of AKI? (7)

A
  • Hypovolaemia
  • Gastroenteritis
  • Burns
  • Sepsis
  • Haemorrhage
  • Nephrotic syndrome
  • Circulatory failure
30
Q

Renal causes of AKI? (11)

A 
Vascular
-	HUS (most common)
-	Vasculitis
-	Embolus
-	Renal vein thrombosis
Tubular
-	Acute tubular necrosis (ATN) (most common)
-	Ischaemic
-	Toxic
-	Obstructive
Glomerular
-	Glomerulonephritis
Interstitial
-	Interstitial nephritis
-	Pyelonephritis
31
Q

Post-renal causes of AKI? (2)

A

Obstruction

  • Congenital eg posterior urethral valves
  • Acquired eg blocked urinary catheter
32
Q

Most common causative organism in HUS?

A

E Coli 0157:H7

→ Acquired through contact with farm animals or eating uncooked beef

33
Q

Triad of abnormalities that occur in HUS?

A
  • Acute renal failure
  • Microangiopathic haemolytic anaemia
  • Thrombocytopenia
34
Q

5 stages of CKD?

A

Stage 1: normal GFR>90 mL/min per 1.73m2 and persistent albuminuria
Stage 2: GFR 60-89 mL/min per 1.73m2 and persistent albuminuria
Stage 3: GFR 30-59 mL/min per 1.73m2
Stage 4: GFR 15-30 mL/min per 1.73m2
Stage 5: GFR <15 mL/min per 1.73m2 or end stage renal disease

35
Q

Clinical features of CKD?

A

Vary with stage, rarely present before GFR <1/3 normal

  • Anorexia or lethargy
  • Polydipsia and polyuria
  • FTT/ faltering growth
  • Bone deformities
  • HTN
  • Acute-on-chronic renal failure
  • Proteinuria
  • Normochromic, normocytic anaemia
36
Q

Causes of CKD? (5)

A
  • Stuctural malformations = 40%
  • Glomerulonephritis = 25%
  • Hereditary nephropathies = 20%
  • Systemic diseases = 10%
  • Miscellaneous/ unknown = 5%
37
Q

Normal systolic BP for

a) 1-5yo
b) 5-10yo

A

a) <110

b) <120

38
Q

Causes of HTN in children?

A

Renal

  • Renal parenchymal disease
  • Renovascular eg renal artery stenosis
  • Polycystic kidney disease (ARPKD + ADPKD)

Coarctation of aorta

Catecholamine XS

  • Phaeochromocytoma
  • Neuroblastoma

Endocrine

  • Congenital adrenal hyperplasia
  • Suching syndrome or corticosteroid therapy
  • Hyperthyroidism

Essential HTN:
- Diagnosis of exclusion

39
Q

How are most urinary tract abnormalities diagnosed?

A

Antenatal USS

40
Q

What is a hypospadia?

A

Urethral opening proximal to normal position on glans in males

41
Q

What is a neuropathic bladder?

A

Bladder does not empty properly due to neurological condition or spinal cord injury

Paeds (15 decks)

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