Nephrology - CKD Flashcards
Paediatric causes of chronic kidney disease
- Congenital Anomalies of the Kidney and Urinary Tract (CAKUT) - 55%
- Hereditary conditions - 17%
- Glomerulonephritis - 10%
Examples of congenital causes of CKD
- Reflux nephropathy
- Dysplasia
- Obstructive Uropathy
Examples of hereditary causes of CKD
- Cystic kidney disease
- Cystinosis
What syndromes may be associated with Congenital Anomalies of the Kidney and Urinary Tract (CAKUT)?
- Turner
- Trisomy 21
- Branchio-oto-renal
- Prune Belly syndrome
Stages of CKD
- Normal = GFR 90-120
- CKD 2 = GFR 60-89
- CKD 3 = GFR 30-59
- CKD 4 = GFR 15-29
- CKD 5 = ESRD
At what GFR do signs and symptoms start to appear?
<60
How does NICE define UTI
- Clinical signs PLUS
- Bacteria culture from midstream urine
- Any growth on suprapubic aspiration or catheter
How do neonates most commonly present with UTI?
- Fever
- Vomiting
- Lethargy
- Irritability
(Upper tract symptoms)
How do preverbal children most commonly present with UTIs?
- Fever
- Abdominal pain
- Abdominal / loin tendeness
- Vomiting
- Poor feeding
(Upper tract symptoms)
How do verbal children most commonly present with UTI?
- Frequency
- Dysuria
(Lower tract symptoms)
Obtaining urine specimen from children
- Clean catch urine or midstream urine
- Sick infants
- catheter samples or suprapubic aspiration (USS)
UTI investigations
- 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
What is Vescico-Ureteric Reflux
Retrograde flow of urine from the bladder to the kidneys
Who should recieve imaging investigations of the renal tract?
- Upper tract symptoms
- < 6 month
- Recurrent
- Septic presentation
What imaging investigations are used in UTI?
- Ultrasound
- structure
- DMSA (isotope scan)
- Scaring / function
- Micturating cystourethrogram MAG 3 scan
- dynamic
Treatment of lower urinary tract infection
- 3 days oral antibiotics
- Trimethoprim, Co-amoxiclav, cephalosporin
Treatment of upper urinary tract infections / pyelonephritis
- Antibiotics for 7-10 days
- Oral if systemically well
- Trimethoprim, Co-amoxiclav, cephalosporin
- IV
- 3rd generation Cephalosporin or Co-amoxiclav
- Oral if systemically well
- Prophylaxis if abnormal urinary tract (VUR grade 3 and above)
How can UTIs be prevented?
- fluids
- hygiene
- treatment of constipation and voiding dysfunction
Factors affecting progression of CKD
- Hypertension
- Proteinuria
- High intake of protein, phosphate and salt
What is the gold standard for measuring blood pressure under 5 years old?
Doppler
What factors affect blood pressure?
- sex
- age
- height
How is hypertension defined in a child?
- 95th centile or higher = hypertension
- 90th to 95th centile = borderline
Why does metabolic bone disease occur in CRD?
- 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
Treatment principles for metabolic bone disease
- Low phosphate diet
- Phosphate binders
- Active Vitamin D
If ongoing poor growth
- Growth hormone
How does CKD affect cardiovascular risk?
It causes accelerated atherosclerosis
