Nephrology & GU - AKI/CKD/HTN

Question 1

What are the common presenting features of an AKI?

Answer 1

haemorrhage 
fever 
rash 
bloody diarrhoea 
vomiting 
abdo pain 
pale skin 
oedema 
periorbital swelling 
abdo masses

Question 2

What are the common causes of AKI in children?

Answer 2

causes split into prerenal, renal and post renal

commonest cause in children is prerenal and includes hypovolaemia or circulatory failure (burns/sepsis etc)

Question 3

What is the commonest cause of Haemolytic Uraemic Syndrome (HUS)?

Answer 3

Secondary to gastrointestinal infection with E.coli 0157

Question 4

What is the triad of abnormalities which define HUS?

Answer 4

ARF
Haemolytic anaemia
Thrombocytopenia

Question 5

What is the difference between diarrhoea and non-diarrhoea associated HUS?

Answer 5

D+

• bloody diarrhoea
• verotoxin
• epidemic
• 85% make complete recovery
• supportive treatment

D-

• recurrent
• multifactorial
• sporadic
• 70% chronic renal failure
• plasma exchange

Question 6

What are the 5 stage of CKD?

Answer 6

1 - GFR >90 and persistent albuminuria 
2 - GFR 60-89 and persistent albuminuria 
3 - GFR 30-59 
4 - GFR 15-30 
5 - GFR <15 or end stage renal disease

Question 7

What is the most common cause of glomerulonephritis in children?

Answer 7

acute nephritis is usually following a streptococcal sore throat or skin infection 
or vasculitis (HSP)

Question 8

What investigations should be carried out in a patient presenting with acute glomerulonephritis?

Answer 8

U&Es, creatinine, FBC, Urinalysis, Urine culture, Complement levels, ASO titre, Anti DNAase B, Serum IgA measurement
Renal USS can also be performed

Question 9

Why are BP centile in children important?

Answer 9

important as BP gradually increases with age
1-5 year olds should be under 110mmHg
6-10 year olds should be under 120mmHg

Question 10

What are the common causes of HTN?

Important to find cause in children

Answer 10

BP above 95th centile

Renal causes - renal parenchymal disease, renovascular, polycystic kidneys, renal tumour

Coarctation of the aorta

Catecholamine excess - phaeochromocytoma/neuroblastoma

Endocrine - congenital adrenal hyperplasia, cushings syndrome or corticosteroid therapy, hyperthyroidism

Essential HTN - diagnosis of exclusion

Question 11

What is renal pelvic dilation? and its stages?

Answer 11

hydronephrosis caused by vesicoureteric reflux, PUJ obstruction

can be mild (5-10mm) /mod/severe (>15mm)

pyloplasty if >30mm

Question 12

What is a horseshoe kidney?

Answer 12

• 2 renal segments fused across the midline
• usually asymptomatic
• increased risk of UTI due to PUJ obstruction and VUR

Question 13

What is a duplex kidney?

Answer 13

1 kidney, 2 ureters
varies from bifid pelvis to complete division and two ureters
can cause reflux and obstruction

Question 14

What is hydronephrosis?

Answer 14

dilation and swelling of the kidney due to increased back pressure

Question 15

What investigations are used In the diagnosis of urinary tract abnormalities?

Answer 15

majority of conditions are identified through antenatal scanning 
but other investigations include:
- USS
- DMSA scan 
- MCUG/VCUG 
- Plain abdo xray

Question 16

What is hypospadias?

Answer 16

• opening onto the ventral surface of the penis at any point
• common congenital abnormality
• meatus may be stenotic
• foreskin absent ventrally as used in reconstruction
• if associated with ventral curvature of the penis requires surgical management

Question 17

What are the presenting features of neuropathic bladder?

Answer 17

urinary incontinence 
UTI 
Kidney infection 
Kidney injury 
Kidney stones 
Erectile dysfunction in later life 

May need self catheterise or supress bladder activity

Question 18

What are the causes of neuropathic bladder?

Answer 18

• May be under or overactive detrusor or sphincter
• Loss of coordination also an issue.
• Brainstem = Pontine Micturition Centre (PMC)coordinates urethral sphincter and detrusor.
• Spinal cord control vital especially in children up to 3-4 years.