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Paediatrics > Nephrology and Genitourinary > Flashcards

Nephrology and Genitourinary Flashcards

1
Q

What causes Henoch-Schonlein purpura?

A

Antigen exposure post URTI causes increased IgA which disrupts IgG synthesis
IgA and IgG react to form complexes which deposit in affected organs

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2
Q

How does HSP present?

A

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

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3
Q

How is HSP managed?

A

Abdo and testicular USS - obstruction

Barium enema

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4
Q

What are the long term complications of HSP?

A

Proteinuria may result in nephrotic syndrome
RF: oedema, hypertension and deteriorating renal function

Children are followed up for a year to detect persistent anomalies

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5
Q

What is nephrotic syndrome and what causes it?

A

Heavy proteinuria –> low plasma albumin and oedema

HSP
SLE
Malaria
Allergens

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6
Q

What are the presenting features of nephrotic syndrome?

A

Periorbital oedema
Scrotal/vulval, leg and ankle oedema
Ascites
Breathlessness due to pleural effusions and abdo distension

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7
Q

What is steroid sensitive nephrotic syndrome?

A 
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

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8
Q

What are complications of nephrotic syndrome?

A

Hypovolaemia - intravascular compartment becomes depleted –> abdo pain and fainting

Thrombosis - hypercoaguable state due to urinary loss of antithrombin

Hypercholesterolaemia

Infection

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9
Q

What is steroid resistant nephrotic syndrome?

A

Referral to paediatric nephrologist after 4-8 weeks

Diuretics, salt restriction, ACE inhibitors and NSAIDs

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10
Q

What is congenital nephrotic syndrome?

A

Presents in first 3 months of life
FINNS and INCEST

Hypoalbuminaemia –> mortality
Kidney may need removing

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11
Q

What organisms cause UTIs?

A 
E. coli
Klebsiella
Proteus
Pseudomonas (indicates structural abnormalities)
Strep faecalis
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12
Q

What are causes of haematuria?

A 
Infection
Trauma
Stones
Tumours
Sickle cell disease
Bleeding disorders
Renal vein thrombosis
Hypercalciuria

Glomerulonephritis
IgA nephropathy
Familial nephritis
Thin basement membrane disease

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13
Q

How does a UTI present in an infant?

A 
Fever
Vomiting
Lethargy and irritability
Poor feeding
Jaundice
Septicaemia
Offensive urine
Febrile convulsions
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14
Q

How does a UTI present in a child?

A 
Dysuria and frequency
Abdo pain or loin tenderness
Fever +/- rigors
Lethargy and anorexia
Vomiting and diarrhoea
Haematuria
Febrile convulsions
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15
Q

How are urine dipsticks interpreted?

A 
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

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16
Q

How are atypical and recurrent UTIs investigated?

A

USS during acute infection

DMSA after infection

17
Q

What is vesicoureteric reflux?

A

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

18
Q

How does an acute kidney injury present in childhood?

A

Oliguria (less than 0.5ml/kg)

19
Q

What are the most common causes of AKI in childhood?

A

Prerenal

  • hypovolaemia (burns, sepsis, gastroenteritis, haemorrhage, nephrotic syndrome)
  • circulatory failure

Renal (salt and water retention, proteinuria)

  • vascular
  • tubular
  • glomerular
  • interstitial

Post renal
- obstruction

20
Q

How is an AKI managed?

A

Check fluid balance and circulation
USS for masses or renal obstruction

Prerenal - fluid replacement

Renal - restrict fluid intake, diuretic

Post renal - catheter, surgery

21
Q

When is dialysis indicated in AKI?

A 
Failure of conservative management
Hyperkalaemia
Severe hypo/hypernatraemia
Pulmonary oedema
Severe acidosis
22
Q

What are the stages of chronic kidney disease?

A 
Stage 1: GFR >90
Stage 2: GFR 60-89
Stage 3: GFR 30-59
Stage 4: GFR 12-29
Stage 5 GFR
23
Q

What are the presenting features of CKD?

A 
Anorexia/lethargy
Polydipsia and polyuria
Failure to thrive
Bone deformities
Hypertension
\+ acute renal failure
Proteinuria
24
Q

What are the most common causes of acute glomerulonephritis?

A

Follows strep throat/skin infection

Vasculitis (SLE, Wegener’s, HSP)

IgA nephropathy

Anti-glomerular basement membrane disease

25
Q

What happens in glomerulonephritis?

A

Damaged glomerular cells restricts filtration –>
Decreased urine output and volume overload
Hypertension –> seizures
Oedema
Haematuria and proteinuria

26
Q

How is the cause of glomerulonephritis diagnosed?

A

Post-strep
Low C3
Positive ASO and Anti-DNAase B

Otherwise renal biopsy and USS

27
Q

What causes haemolytic uraemic syndrome?

A

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

28
Q

What are the abnormalities which define HUS?

A

Acute renal failure
Microangiopathic haemolytic anaemia
Thrombocytopenia

29
Q

What are the risks with non-diarrhoea associated HUS?

A

May be familial and frequently relapses
High risk of hypertension
Chronic renal failure
Mortality

30
Q

What are the common causes of HTN in children?

A

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
31
Q

How does HTN present?

A 
Vomiting
Headaches
Facial palsy
Hypertensive retinopathy
Convulsions
Cardiac failure
Failure to thrive
32
Q

How is pyelonephritis treated?

A 
Consider referral to paediatric specialist
Oral Abx (co-amoxiclav) for 7-10 days
IV Abx (ceftriaxone) for 2-4 days then oral
33
Q

How is cystitis treated?

A

Oral Abx (trimethoprim, nitrofurantoin) for 3 days

34
Q

How does urinary tract anomalies present?

A

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

35
Q

How does the male urethra develop differently in hypospadias?

A

Occurs in proximal to distal direction under influence of testosterone
Urethral opening lies proximal to normal position

36
Q

How does IgA nephropathy present?

A

Similar to HSP but restricted to kidney

Macroscopic haematuria after URTI

37
Q

How does neuropathic bladder present?

A

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

38
Q

How is vulvo-vaginitis managed?

A

Hygiene, avoidance of bubble baths and loose fitting underwear
Oestrogen cream helps atrophic tissue

Paediatrics (14 decks)

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