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Paediatrics > Nephrology - CKD > Flashcards

Nephrology - CKD Flashcards

1
Q

Paediatric causes of chronic kidney disease

A
  • Congenital Anomalies of the Kidney and Urinary Tract (CAKUT) - 55%
  • Hereditary conditions - 17%
  • Glomerulonephritis - 10%
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2
Q

Examples of congenital causes of CKD

A
  • Reflux nephropathy
  • Dysplasia
  • Obstructive Uropathy
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3
Q

Examples of hereditary causes of CKD

A
  • Cystic kidney disease
  • Cystinosis
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4
Q

What syndromes may be associated with Congenital Anomalies of the Kidney and Urinary Tract (CAKUT)?

A
  • Turner
  • Trisomy 21
  • Branchio-oto-renal
  • Prune Belly syndrome
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5
Q

Stages of CKD

A
  • Normal = GFR 90-120
  • CKD 2 = GFR 60-89
  • CKD 3 = GFR 30-59
  • CKD 4 = GFR 15-29
  • CKD 5 = ESRD
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6
Q

At what GFR do signs and symptoms start to appear?

A

<60

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7
Q

How does NICE define UTI

A
  • Clinical signs PLUS
    • Bacteria culture from midstream urine
    • Any growth on suprapubic aspiration or catheter
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8
Q

How do neonates most commonly present with UTI?

A
  • Fever
  • Vomiting
  • Lethargy
  • Irritability

(Upper tract symptoms)

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9
Q

How do preverbal children most commonly present with UTIs?

A
  • Fever
  • Abdominal pain
  • Abdominal / loin tendeness
  • Vomiting
  • Poor feeding

(Upper tract symptoms)

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10
Q

How do verbal children most commonly present with UTI?

A
  • Frequency
  • Dysuria

(Lower tract symptoms)

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11
Q

Obtaining urine specimen from children

A
  • Clean catch urine or midstream urine
  • Sick infants
    • catheter samples or suprapubic aspiration (USS)
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12
Q

UTI investigations

A
  • Dipstix
    • Leucocyte esterase activity, nitrites
    • unreliable < 2 yrs of age
  • Microscopy
    • Pyuria >10 WBC per cubic mm
    • Bacturia
  • Culture > 105 Colony forming units
    • E.coli
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13
Q

What is Vescico-Ureteric Reflux

A

Retrograde flow of urine from the bladder to the kidneys

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14
Q

Who should recieve imaging investigations of the renal tract?

A
  • Upper tract symptoms
  • < 6 month
  • Recurrent
  • Septic presentation
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15
Q

What imaging investigations are used in UTI?

A
  • Ultrasound
    • structure
  • DMSA (isotope scan)
    • Scaring / function
  • Micturating cystourethrogram MAG 3 scan
    • dynamic
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16
Q

Treatment of lower urinary tract infection

A
  • 3 days oral antibiotics
    • Trimethoprim, Co-amoxiclav, cephalosporin
17
Q

Treatment of upper urinary tract infections / pyelonephritis

A
  • Antibiotics for 7-10 days
    • Oral if systemically well
      • Trimethoprim, Co-amoxiclav, cephalosporin
    • IV
      • 3rd generation Cephalosporin or Co-amoxiclav
  • Prophylaxis if abnormal urinary tract (VUR grade 3 and above)
18
Q

How can UTIs be prevented?

A
  • fluids
  • hygiene
  • treatment of constipation and voiding dysfunction
19
Q

Factors affecting progression of CKD

A
  • Hypertension
  • Proteinuria
  • High intake of protein, phosphate and salt
20
Q

What is the gold standard for measuring blood pressure under 5 years old?

A

Doppler

21
Q

What factors affect blood pressure?

A
  • sex
  • age
  • height
22
Q

How is hypertension defined in a child?

A
  • 95th centile or higher = hypertension
  • 90th to 95th centile = borderline
23
Q

Why does metabolic bone disease occur in CRD?

A
  • Kidneys excrete phosphate
    • Kidney damage → high levels of phosphate → high levels of PTH
  • Kidneys activate vitamin D
    • Activated vitamin D would normally supress PTH
    • Kidney damage → reduced active vitamin D → high levels of PTH
  • High PTH causes metabolic bone disease and cardiovascular disease
24
Q

Treatment principles for metabolic bone disease

A
  • Low phosphate diet
  • Phosphate binders
  • Active Vitamin D

If ongoing poor growth

  • Growth hormone
25
Q

How does CKD affect cardiovascular risk?

A

It causes accelerated atherosclerosis

Paediatrics (38 decks)

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