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Paediatrics > Paediatric Nephritic Syndrome > Flashcards

Paediatric Nephritic Syndrome Flashcards

1
Q

What do we mean by ‘macroscopic’ and ‘microscopic’ haematuria?

A
  • macroscopic means you can see the blood in the urine

- microscopic means that there is blood in the urine but detected on Dipstix

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2
Q

What are common causes of both macroscopic and microscopic haematuria in children?

A
  • UTI
  • trauma
  • stones
  • glomerulonephritis
  • post infectious glomerulonephritis
  • IgA/ HSP
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3
Q

What is nephritic syndrome?

A

a clinical diagnosis describing glomerulonephritis

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4
Q

What defines nephritic syndrome?

A
  • haematuria and proteinuria
  • reduced GFR (resulting in oliguria and fluid overload (signs such as JVP and oedema)
  • hypertension
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5
Q

What can worsening renal failure in association with nephritic syndrome suggest?

A

progression to Rapidly Progressive glomerulonephritis

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6
Q

What blood work up would you do to investigate the cause of nephritic syndrome?

A
  • creatinine
  • FBC (check for haemolyisis)
  • albumin
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7
Q

What other work up would you consider when investigating nephritic syndrome?

A

-urine dipstix -exclude UTI
-protein:creatinine ratio
-renal US
-throat swab
-ANCA
antistreptolysin O antibody (ASO - made against group A strep))

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8
Q

What is a common cause of glomerulonephritis in children?

A

post-infectious glomerulonephritis

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9
Q

What is post infectious glomerulonephritis?

A

a nephritic syndrome in which a child tends to have had either a throat or a skin infection (usually caused by group A beta haemolytic streptococci) 1-6 weeks previously
-the skin or throat infection results in immune complexes being formed and these can get clogged up in the GBM leading to inflammation and damage in the glomerulus that allows large molecules like RBCs and proteins to get through

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10
Q

How is post infectious glomerulonephritis diagnosed?

A
  • bacterial culture
  • positive ASOT (antibody against group A strep)
  • low c3 normalises
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11
Q

How is post infectious glomerulonephritis treated?

A
  • tends to be self limiting
  • may give antibiotics
  • may give diuretics to relieve fluid overload/ hypertension
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12
Q

What is the outcome of acute post-infectious glomerulonephritis?

A

not recurrent

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13
Q

What are other causes of glomerulonephritis presenting as nephritic syndrome?

A
  • IgA nephropathy/ HSP
  • membranoproliferative GN
  • lupus nephritis
  • ANCA positive vasculitis

other glomerulopathies such as haemolytic uraemic syndrome, Alport’s syndrome or Thin Basement Membrane Disease

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14
Q

What is IgA nephropathy?

A
  • the most common glomerulonephritis worldwide
  • it is a type 3 hypersensitivity reaction involving the body’s own IgA and results in immune deposition in the mesangium
  • tends to occur after URTI or GI infection
  • deposits in mesangium trigger inflammation and damage to the glomerulus
  • this means that RBCs and protein leak out, resulting in haematuria and proteinuria
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15
Q

How is IgA nephropathy diagnosed?

A
  • clinical picture

- biopsy

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16
Q

How would you manage IgA nephropathy?

A
  • ACEi to treat proteinuria and control BP

- may consider prednisolome to inhibitors immune complex formation

17
Q

What is the outcome of IgA nephropathy?

A

cumulative damage from IgA nephropathy over decades can result in end stage renal failure

18
Q

What is Henoch Schonlein Purpura?

A
  • an IgA vasculitis
  • onset 5-15 years
  • follows 1-3 days post URTI
  • IgA mistakenly binds t blood vessel walls and inflammation occurs causing damage to them and this can happen all round the body, including the kidney capillaries
19
Q

What are symptoms associated with Henoch Schonlein Purpura?

A
  • joint pain
  • abdominal pain
  • bloody diarrhoea
  • haematuria
  • palpable purpura on buttocks and/or legs
20
Q

How is Henoch Schonlein Purpura diagnosed?

A 
-MUST have palpable purpura
one of 4:
-abdominal pain
-renal involvement (haematuria)
-arthritis or arthralgia
-biopsy showing IgA deposition

is different to IgA nephropathy due to systemic upset

21
Q

How is Henoch Schonlein Purpura (IgA vasculitis) treated?

A
  • symptomatically for the joints and gut e.g. analgesic paracetamol
  • glucocorticoid therapy e.g. prednisolone or cyclophosphamide
  • immunosuppression
22
Q

What long term screening is required on diagnosis of Henoch Schonlein Purpura?

A

hypertension and proteinuria screening

Paediatrics (25 decks)

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