Nephrology and Genitourinary Flashcards
What causes Henoch-Schonlein purpura?
Antigen exposure post URTI causes increased IgA which disrupts IgG synthesis
IgA and IgG react to form complexes which deposit in affected organs
How does HSP present?
Urticarial –> purpuric rash over buttocks, arms, legs and ankles
Arthralgia - knees and ankles
Periarticular oedema
Colicky stomach pain
Haematemesis and malaena
Haematuria and proteinuria
Ileus, protein losing enteropathy, orchitis
How is HSP managed?
Abdo and testicular USS - obstruction
Barium enema
What are the long term complications of HSP?
Proteinuria may result in nephrotic syndrome
RF: oedema, hypertension and deteriorating renal function
Children are followed up for a year to detect persistent anomalies
What is nephrotic syndrome and what causes it?
Heavy proteinuria –> low plasma albumin and oedema
HSP
SLE
Malaria
Allergens
What are the presenting features of nephrotic syndrome?
Periorbital oedema
Scrotal/vulval, leg and ankle oedema
Ascites
Breathlessness due to pleural effusions and abdo distension
What is steroid sensitive nephrotic syndrome?
85-90% Boys>girls ASIAN Oral corticosteroids make urine free of protein Doesn't progress to renal failure
1/3 resolve
1/3 infrequently relapse
1/3 frequently relapse
What are complications of nephrotic syndrome?
Hypovolaemia - intravascular compartment becomes depleted –> abdo pain and fainting
Thrombosis - hypercoaguable state due to urinary loss of antithrombin
Hypercholesterolaemia
Infection
What is steroid resistant nephrotic syndrome?
Referral to paediatric nephrologist after 4-8 weeks
Diuretics, salt restriction, ACE inhibitors and NSAIDs
What is congenital nephrotic syndrome?
Presents in first 3 months of life
FINNS and INCEST
Hypoalbuminaemia –> mortality
Kidney may need removing
What organisms cause UTIs?
E. coli Klebsiella Proteus Pseudomonas (indicates structural abnormalities) Strep faecalis
What are causes of haematuria?
Infection Trauma Stones Tumours Sickle cell disease Bleeding disorders Renal vein thrombosis Hypercalciuria
Glomerulonephritis
IgA nephropathy
Familial nephritis
Thin basement membrane disease
How does a UTI present in an infant?
Fever Vomiting Lethargy and irritability Poor feeding Jaundice Septicaemia Offensive urine Febrile convulsions
How does a UTI present in a child?
Dysuria and frequency Abdo pain or loin tenderness Fever +/- rigors Lethargy and anorexia Vomiting and diarrhoea Haematuria Febrile convulsions
How are urine dipsticks interpreted?
Nitrates (N) - produced by bacteria Leukocyte esterase (LE) - tests for WBC
N+ve LE+ve = UTI
N+ve LE-ve = start Abx and wait for cultures
N-ve LE+ve = start Abx if clinical picture matches
How are atypical and recurrent UTIs investigated?
USS during acute infection
DMSA after infection
What is vesicoureteric reflux?
RED HAIRED GIRLS
Development anomaly of the junction
Ureters are displaced laterally and enter directly into bladder
Severity ranges from mild to intrarenal reflux and renal scarring
How does an acute kidney injury present in childhood?
Oliguria (less than 0.5ml/kg)
What are the most common causes of AKI in childhood?
Prerenal
- hypovolaemia (burns, sepsis, gastroenteritis, haemorrhage, nephrotic syndrome)
- circulatory failure
Renal (salt and water retention, proteinuria)
- vascular
- tubular
- glomerular
- interstitial
Post renal
- obstruction
How is an AKI managed?
Check fluid balance and circulation
USS for masses or renal obstruction
Prerenal - fluid replacement
Renal - restrict fluid intake, diuretic
Post renal - catheter, surgery
When is dialysis indicated in AKI?
Failure of conservative management Hyperkalaemia Severe hypo/hypernatraemia Pulmonary oedema Severe acidosis
What are the stages of chronic kidney disease?
Stage 1: GFR >90 Stage 2: GFR 60-89 Stage 3: GFR 30-59 Stage 4: GFR 12-29 Stage 5 GFR
What are the presenting features of CKD?
Anorexia/lethargy Polydipsia and polyuria Failure to thrive Bone deformities Hypertension \+ acute renal failure Proteinuria
What are the most common causes of acute glomerulonephritis?
Follows strep throat/skin infection
Vasculitis (SLE, Wegener’s, HSP)
IgA nephropathy
Anti-glomerular basement membrane disease
What happens in glomerulonephritis?
Damaged glomerular cells restricts filtration –>
Decreased urine output and volume overload
Hypertension –> seizures
Oedema
Haematuria and proteinuria
How is the cause of glomerulonephritis diagnosed?
Post-strep
Low C3
Positive ASO and Anti-DNAase B
Otherwise renal biopsy and USS
What causes haemolytic uraemic syndrome?
Secondary to GI infection with E. coli 0157
Prodrome of bloody diarrhoea
Toxins of organism enters GI mucosa and localises to endothelial cells of kidney –> intravascular thrombogenesis
What are the abnormalities which define HUS?
Acute renal failure
Microangiopathic haemolytic anaemia
Thrombocytopenia
What are the risks with non-diarrhoea associated HUS?
May be familial and frequently relapses
High risk of hypertension
Chronic renal failure
Mortality
What are the common causes of HTN in children?
Renal
- renal parenchymal disease
- renal artery stenosis
- polycystic kidneys
- renal tumour
Coarctation of the aorta
Catecholamine excess
- phaechromocytoma (tumour of adrenals)
- neuroblastoma
Endocrine
- CAH
- Cushing’s or corticosteroid treatment
- hyperthyroidism
How does HTN present?
Vomiting Headaches Facial palsy Hypertensive retinopathy Convulsions Cardiac failure Failure to thrive
How is pyelonephritis treated?
Consider referral to paediatric specialist Oral Abx (co-amoxiclav) for 7-10 days IV Abx (ceftriaxone) for 2-4 days then oral
How is cystitis treated?
Oral Abx (trimethoprim, nitrofurantoin) for 3 days
How does urinary tract anomalies present?
Absence of both kidneys –> severe oligohydramnios
Multicystic dysplastic kidney - non functioning kidney
Polycystic kidney disease - both kidneys affected but some function is maintained
Pelvic or horseshoe shaped kidneys - predisposed to infection/obstructs drainage
Duplex system - bifid pelvis -> two ureters
Hydronephrosis - dilation and swelling of kidney due to back pressure
How does the male urethra develop differently in hypospadias?
Occurs in proximal to distal direction under influence of testosterone
Urethral opening lies proximal to normal position
How does IgA nephropathy present?
Similar to HSP but restricted to kidney
Macroscopic haematuria after URTI
How does neuropathic bladder present?
Urinary incontinence - the need to urinate frequently and with urgency
UTI - urine is held in bladder for too long
Kidney injury - high pressure caused by urine backlog
Kidney stones - pain, haematuria, fever
Erectile dysfunction
How is vulvo-vaginitis managed?
Hygiene, avoidance of bubble baths and loose fitting underwear
Oestrogen cream helps atrophic tissue
