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CP2 PAEDS > Nephrology and Genitourinary > Flashcards

Nephrology and Genitourinary Flashcards

1
Q

GFR in newborns

A

20ml/min

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2
Q

Ways of assessing renal fct in children (9)

A 
Plasma creatinine concentration 
eGFR
Inulin/EDTA GFR
Creatinine clearance 
Plasma urea conc
USS
DMSA scan 
MCUG 
MAG3
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3
Q

What is the main test of renal fct in children

A

Plasma creatinine [ ]

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4
Q

How is eGFR calculated

A

k x height + creatinine

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5
Q

What incr plasma urea [ ] (2)

A

Renal failure

High protein diet or catabolic state

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6
Q

Is USS of the kidneys used for anatomy or function?

A

Anatomy

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7
Q

What is a DMSA scan and what does it detect

A

Static scan of renal cortex.

Detects functional defect + scars

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8
Q

How long after an UTI must you wait to use a DMSA scan ?

A

> 2 months

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9
Q

What is MCUG used for?

A

Detecting VUR

+ urethral obstruction

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10
Q

Use of MAG3

A

Measure drainage + VUR

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11
Q

What is acute nephritis?

A

Inflammation of the glomerulus/nephrons

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12
Q

Features of acute nephritis (5)

A 
Haematuria 
Mild proteinuria 
Periorbital oedema 
Mild HTN 
Decr renal fct hence oliguria
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13
Q

Causes of acute nephritis (5)

A 
Post infection - strep/sore throat 
Vasculitis - HSP, SLE 
IgA nephropathy 
Familial nephritis 
Goodpastures syndrome
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14
Q

Ix Acute Nephritis (10)

A 
Hx 
Urine dip 
Pr:CR
BP
GFR 
FBC + U/E 
Complement levels 
ASO titre 
ANti-DNAase-B 
Serum IgA
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15
Q

Mx Acute nephritis (5)

A 
Fl restriction + salt restriction 
Diuretics if needed 
Steroids or plasma exchange 
Monitor renal ft for deterioration 
If persistent - ACEi/ARBS to control BP
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16
Q

What is HSP

A

IgA mediated AI HS vasculitis of childhood

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17
Q

Pathophysiology HSP

A

Deposition of IgA + IgG immune complexes –> activate complex –> deposited in skin/organs

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18
Q

What age usually gets HSP

A

3-10y/o

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19
Q

Which gender does HSP affect more?

A

Males

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20
Q

What oftens precedes HSP?

A

UTI

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21
Q

Features HSP (7)

A 
Skin rash - purpuric, palpable, symmetrical, trunks spared 
Fever
Polyarteritis 
Colicky abdo 
GI bleed - haematemesis, melena 
Renal; haematuria, proteinuria 
Glomerulonephritis
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22
Q

Mx HSP

A

Self limiting
Admit to monitor abdo/renal problems
Analgesia
Corticosteroids

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23
Q

How to follow up HSP if proteinuria?

A

At 1/2 weeks
Monthly for 6 months
Again @ 1year

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24
Q

LT complications HSP

A

Renal involvement

Rare - MI, GI bleed etc

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25
Q

What is Nephrotic syndrome

A

Incr permeability of glomeruli to plasma proteins –> proteinuria

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26
Q

Triad nephrotic syndrome

A

Proteinuria (>3.5)
Hypoalbuminaemia (<25)
Oedema

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27
Q

Causes of nephrotic syndrome

A 
Mainly unknown
Minimal change glomerulonephritis 
2' to: 
Systemic disease - HSP,SLE
Allergens
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28
Q

Features Nephrotic syndrome (4)

A

Oedema; periorbital, aascites
Breathlessness
Dizzyness
Abdo pain from odema

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29
Q

Ix nephrotic syndrome (9)

A 
Urinalysis, microscopy, culture
U+E
Incr creatinine 
Decr albumin 
Incr cholesterol 
FBC/ESR
BP 
Urinary Na [  ] 
Hep B/C screen
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30
Q

Complications of nephrotic syndrome (4)

A

Hypovolaemia
Thrombosis
Infection (give vaccine)
Hypercholesterolaemia

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31
Q

What is the most common cause of nephrotic syndrome in childhood?

A

Minimal change nephrotic syndrome

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32
Q

What 2 things is minimal change nephrotic syndrome

A

Hodgkins lymphoma

NSAIDs

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33
Q

Mx steroid sensitive nephrotic syndrome

A 
Corticosteroid therapy 
Oral pred 
60mg/m2 for 4 weeks 
Then reduce to 40mg on alt days for 4w
salt restrict
Monitor fl balance + W
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34
Q

Who is steroid sensitive nephrotic syndrome?

A

1-10y/o

No macroscopic haematuria
Norm BP, complement levels, renal fct

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35
Q

Prognosis steroid sensitive NS?

A

1/3 resolve
1/3 infreq relapse
1/3 freq relapse

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36
Q

Mx steroid resistant NS

A

Diuretics
Salt restricton
ACEi
prophylactic penicillin

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37
Q

What is the most common cause of haematuria

A

UTI

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38
Q

What % girls have UTI before the age of 6

A

1-7%

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39
Q

What % boys have UTI before age of 6

A

1-2%

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40
Q

Main organism –> UTI

A

E..coli

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41
Q

Main organism –> UTI in newborns

A

Group B strep

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42
Q

RF UTI (5)

A 
Renal/urinary tract abnormality 
Incomplete bladder emptying 
Constipation 
VUR
FH of VUR/renal disease
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43
Q

Sx pyelonephritis

A

Bacteruria + fever 38+
or
Bacteruria w/ loin pain

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44
Q

Most common PS UTI infant <3 months (4)

A

Fever
Vomiting
Irritability
Lethargy

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45
Q

most common PS UTI child >3 months - preverbal

A

Fever

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46
Q

Most common PS UTI child >3 months - verbal

A

Frequency

Dysuria

47
Q

4 methods of urine collection

A

Clean catch
Bag urine
Urethral catheter
Suprapubic insertion

48
Q

Atypical UTI features (6)

A 
Serious illness/sepsis 
Poor urine flow 
Abdo mass 
Incr creatinine 
Failure to respond to suitable ABx within 48hrs 
Not ECOLI
49
Q

3 defs of recurrent UTI

A

2+ eps UTI w/ upper UTI
1 ep upper UTI + 1 or > lower UTI
3 eps lower UTI

50
Q

Extra Ix for recurrent/atypical UTI (3)

A

USS
DMSA
MAG3/MCUG

51
Q

Mx UTI <3 months

A

Rx paeds specialist

Tx parenteral ABx

52
Q

Mx UTI >3months

A

Upper UTI - PO co-amx/cephs 7-10days

Lower UTI - PO nitro/trimeth 3 days

53
Q

Preventing recurrence (6(

A 
High fl intake 
Regular voiding 
Double micturition 
Prevent constipation 
Good perineal hygiene 
Probiotics
54
Q

DDx haematuria (7)

A 
UTI *** 
Trauma 
Stones 
Tumour 
Glomerulonephritis 
IgA nephropathy 
Acute  nephritis
55
Q

What % infants w/ febrile UTI’s have VUR

56
Q

What % infants w/ VUR have a 1st degree relative w/ VUR?

57
Q

How to diagnose VUR

58
Q

Causes of vulvo-vaginitis (4)

A

Bacterial/fungal infection
Irritatants
Bad hygiene
Sexual abuse

59
Q

Mx vulvo-vaginitis

A

Advise pt about hygiene
Loose fitting cotton underwear
Take swabs

60
Q

Define AKI

A

Sudden + reversible inability of the kidney to maintain body chemistry + fl balance
Oliguria

61
Q

Pre-renal causes of AKI

A

Hypovolaemia - GI, burns, sepsis, haemorrhage, nephrotic syndrome
Circulatory failure

62
Q

Renal causes of sepsis

A

Vascular
Tubular
Glomerulonephritis
Interstitial - nephritis/pyelonephritis

63
Q

Vascular renal causes of AKI (4)

A

HUS
Vasculitis
Embolus
Renal vv thrombosis

64
Q

Tubular renal causes of AKI (3)

A

ATN
Ischaemia
Obstructive

65
Q

Post-renal causes AKI

A

Urinary obstruction

66
Q

What is the most common cause AKI in children?

A

Pre-renal causes

67
Q

Sx AKI - hypovolaemia

A

D+V
Haemorrhage
Sepsis
Decr oral intake

68
Q

Sx AKI - HUS

A

Bloody diarrhoea

Oliguria

69
Q

Sx AKI - pots infectious glomerulonephritis

A

Hx of infection

70
Q

Sx AKI - Goodpastures

A

Haemoptysis + renal impairment

71
Q

Sx AKI - HSP/SLE

72
Q

Mx pre-renal AKI

A

USS
Monitor circ + fl balance
Fl replacement + circulatory support

73
Q

Mx renal AKI

A 
USS 
Monitor circ + fl balance 
Restrict fl + salt 
Diuretic to incr output 
High-kcal protein 
Renal biopsy if cause not known
74
Q

Mx post-renal AKI

A

USS
Monitor circ + fl balance
Relieve obstruction using nephrostomy
Surgery

75
Q

When is dialysis indicated (6)

A 
Failure of conservative Mx 
Hyperkalaemia 
Severe hyper/hyponatraemia 
Pulm oedema/HTN 
Severe acidosis 
Mutlisystem failure
76
Q

HUS - Triad of abnormalities

A

AKI
Thrombocytopenia
Haemolytic anaemia

77
Q

Common causative organism HUS

A

E.coli 0157

Also can be shigella

78
Q

Where is E.coli 0157 acquired

A

Contact w/ farm animals

Uncooked beef

79
Q

Pathophysiology HUS

A

Toxins enter GI mucosa –> endothelial cells kidneys –> intravascular thrombogenesis –> activate coagulation cascade –> uses up platelets hence thrombocytopenia
Microciruclation –> RBC can’t move through –> haemolytic anaemia

80
Q

Diarrhoea associated HUS prognosis

A

Good if early supportive therapy

81
Q

Atypical HUS

A

No prodrome of diarrhoea

82
Q

Prognosis Atypical HUS

A

High risk HTN/CKD

High mortality

83
Q

Causes of CKD (4)

A

Structural malformation
Glomerulonephritis
Hereditary nephropathy
Systemic disease

84
Q

Features CKD (5)

A 
Anorexia/lethargy
Polydipsia/polyuria 
FTT
Renal osteodystrophy 
HTN
Proteinuria
Unexplained anaemia
85
Q

at what GFR will Sx for CKD start to present?

86
Q

Stage 5 GFR

A

> 90

Norm of incr GFR w/ evidence of renal damage

87
Q

Stage 4 GFR

A

60-89

Slightly decreased w/ evidence of damage

88
Q

Stage 3 GFR

A

30-59

Moderate decrease in GFR w/ or w/o damage

89
Q

Stage 2 GFR

A

15-29

Severe decrease w/ or w/o damage

90
Q

Stage 1 GFR

A

<15

Established renal failure

91
Q

Optimum Mx of end stage CKD

A

Renal transplantation

92
Q

BP for 1-5th centile

93
Q

BP for 6-10 centile

94
Q

CV causes HTN (1)

A

Coarctation of aorta

95
Q

Renal causes HTN (4)

A

Renal parenchymal disease
Renal aa stenosis
Polycystic kidney
Renal tumor

96
Q

Endocrine causes HTN (4)

A

Cushing’s
CAH
Hyperthyroidism
Catecholamine XS - PCC, neuroblastoma

97
Q

How often should children with HTN have their BP monitored?

98
Q

Advice for children w/ HTN (2)

A

Restrict salt intake

Avoid obesity

99
Q

What is renal agenesis?

A

Absence of kidneys

100
Q

PS renal agenesis

A

Oligohydramnios

101
Q

What is a multicystic dysplastic kidney?

A

Non-functioning structure w/ large fl filled cysts
No renal tissue
No connection w/ bladder

102
Q

Pelvic/horseshoe kidney PS

A

Incr infections b/c drainage obstruction

103
Q

What is a duplex system?

A

From bifid pelvis - complete division + 2 uterus for each kidney

104
Q

Posterior urethral valves PS

A

VUR

Obstruction

105
Q

Hydronephrosis PS

A

Incr back P –> dilation + swelling

106
Q

Ix for kidney malformations (5 )

A 
USS 
Examination of baby 
Cystogram 
DMSA 
MAG3
107
Q

What is hypospadias?

A

Urethral opening opening nearer underside of penis.

108
Q

Rate of hypospadias?

109
Q

Mx hypospadias?

A

Surgery before age 2

110
Q

What is neuropathic bladder?

A

Urinary tract dysfunction where bladder doesn’t empty properly due to nn problems

111
Q

What is neuropathic bladder due to?

A

Spinal chord injury

Spina bifida

112
Q

PS neuropathic bladder

A

Daytime freq
Abnormal small voids
Enuresis
UTI - due to stasis

113
Q

Consequences of neurpathic bladder (4)

A

Hydronephrosis
Kidney damage
Renal calculi
Erectile dysfunction

CP2 PAEDS (18 decks)

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