Nephrology Presentations Flashcards
Outline the pathophysiology of haematuria
Gross = blood that you can see
- 10% chance of finding cancer
Microscopic = blood that can only be seen under the microscope
- 3% chance of finding cancer
Outline the aetiology of haematuria
UTI
Pyelonephritis
Bladder/kidney stone
BPH
Prostatitis
Glomerulonephritis – IgA nephropathy
Cancer
Sickle cell anaemia
Kidney injury
Medication = anti-cancer drug cyclophosphamide, penicillin, aspirin, heparin
Strenuous exercise
What are the symptoms of haematuria?
Pink/red coloured urine
Passing clots = pain
UTI = persistent urge to urinate, pain and burning with urination, and extremely strong-smelling urine, fever
Pyelonephritis = fever, flank pain
Anaemia = pallor
How is haematuria investigated?
Urine dipstick
Urine analysis
Urine culture = suspected infection
Bloods = FBC, U+Es, coag
Imaging = CT, MRI, US
Cystoscopy
Abdo exam = assess for palpable kidneys
Genitalia exam
Kidney biopsy = in cases of: significant haematuria, abnormal renal function, recurrent persistent haematuria, serologic abnormalities, recurrent gross haematuria, FH of end-stage renal disease
How would you manage haematuria?
Asymptomatic = generally doesn’t require treatment
Abx = UTI
Medication to shrink prostate
Shock wave therapy to break up stones
Tumour/cancer = surgery
Outline HTN in children
HTN = BP above the 95th percentile for height, age, sex
Aetiology = renal parenchymal disease, renal vascular disease, aortic coarctation, endocrine causes, essential HTN, iatrogenic, renal tumours
S+S = vomiting, headache, facial palsy, HTN retinopathy, convulsions, proteinuria
Mx = weight loss, low salt, exercise, avoid smoking/alcohol, ACEi, BB, CCB, thiazide diuretic
What is Acute renal failure, how does it present and what is its DDx?
Acute decline in renal function characterized by an increase in blood urea nitrogen (BUN) and serum creatinine values, often accompanied by hyperkalaemia, metabolic acidosis, and HTN
S+S = haemorrhage, fever, rash, abdo pain, pale skin, swelling, abdo mass, oliguria (<0.5ml/kg/h)
DDx =
- prerenal (most common) = sepsis, D+V, dehydration, DI, diuretics, adrenal insufficiency, shock burns, pancreatitis
- intrinsic = haemolytic uraemic syndrome (HUS)
- postrenal = stones, posterior urethral valves
stage 1 = SCr 150-200% baseline, <0.5ml/kg/h >8h
stage 2 = SCr 200-300% baseline, <0.5ml/kg/h >16h
stage 3 = SCr >300% baseline, 0.3ml/kg/h, >24h
What is Chronic renal failure, how does it present and what is its DDx?
GFR <15ml/min per 1.73 m2
S+S = poor appetite, bone pain, vomiting, headache, stunted growth, recurrent UTI, tissue swelling, poor muscle tone, anorexia, polydipsia, HTN, normochromic normocytic anaemia
DDx =
- Prolonged obstruction
- Alport syndrome = deafness, progressive kidney damage, and eye defects.
- Nephrotic syndrome = proteinuria, low protein in the blood, high cholesterol levels, oedema
- Polycystic kidney disease = growth of numerous cysts
- Cystinosis = amino acid cystine accumulates within lysosomes in the kidney
What is glomerulonephritis, how does it present and what is its DDx?
Glomeruli become inflamed and impair the kidney’s ability to filter urine
S+S = HTN, dark brown urine, sore throat, diminished urine output, fatigue, lethargy, increased breathing effort, headache, seizures, rash, weight loss, joint pain, pale, oedema
DDx = strep, Alport syndrome, SLE, polyarteritis nodosa group, Wegener vasculitis
What are the urinary tract abnormalities, how do they present and what is its DDx?
Posterior urethral valves, hydronephrosis and hydroureters, severe vesico-ureteric reflux, duplex kidney, ureteropelvic junction obstruction, megaureter, renal agenesis, multicystic dysplastic kidney (MCDK), autosomal recessive/dominant polycystic kidney disease
S+S = recurrent UTI, anatomical abnormality, nonsyndromic
Outline the pathophysiology and aetiology of cystitis (LUTI)
Colonization with ascending spread - commonly e.coli
Hematogenous spread
Periurogenital spread
Shorter length of the female urethra allows uropathogens easier access to the bladder
What are the signs and symptoms of cystitis?
Parent report = vomiting, fever, lethargy, poor feeding, failure to thrive
Dysuria
Urinary urgency and frequency
Sensation of bladder fullness or lower abdo discomfort
Suprapubic tenderness
Flank pain and costovertebral angle tenderness (present in cystitis but suggest upper UTI)
Bloody, cloudy, offensive smelling urine
Fevers, chills, and malaise (noted in pts with cystitis, more frequently associated with upper UTI)
How is cystitis investigated?
Dipstick = leucocytes ++, protein ++, nitrites +
Infant with unexplained temp 38 = urgent urine microscopy + culture (clean catch sample) (10^5 pure growth CFU)/mm3)
USS = <6w old, sepsis, poor urine flow, abdo/bladder mass, raised serum creatinine, no response to Abx in 28h, non-E.coli MO, recurrent (2 UUTI, 1 UUTI 1 lUTI, 3 LUTI)
Dimercaptosuccinic acid (DMSA) 4-6m following acute infection = atypical, recurrent
Micturating cystourethogram (MCUG) (ONLY <6m) = atypical, recurrent
How would you manage cystitis? and how can it be prevented?
Lower uncomplicated = 3 day nitrofurantoin
Lower complicated = 5-7 day nitrofurantoin
General = paracetamol, increased fluid intake
PREVENT = hydrated, toilet more often, timed toilet sessions, empty bladder completely, double voiding, front to back wipe, avoid constipation, avoid nylon/synthetic/tight underwear, no bubble baths
Describe the pathophysiology of pyelonephritis
Bacterial invasion of the renal parenchyma
Bacteria usually reach the kidney by ascending from the lower urinary tract or the blood stream
