paediatric nephrology Flashcards
4 functions of the kidney
fluid and electorlyte homeostasis
excreiton of waste products and drugs
hormonal
acid-base homeostasis
hormones involves in the kidneys 4
vit d
ertyhrypoetin
renin
prostaglandin
top 5 renal disease presentations
- Flank mass
- Haematuria
- Proteinuria with/without oedema
- Polyuria/oliguria
- Hypertension
name for bilateral absent kidneys
potters syndrome
-renal agenesis
how do kidneys appear in muticystic dysplastic kidneys
irregular cysts w no normal renal tissue
define a duplex kideny
two ureters coming from one kidney
describe the ureters in a duplex kidney and how they can lead to pathology
upper pole ureter
-obstruct and can be assocated with a ureterocoele
lower pole ureter
-tends to reflux
-vesicoureteric reflux
what causes a horseshoe or pelvic kidney
abnormal caudal migration
-causes kdineys to fuse together and cause this shape
where do horseshoe kidneys tend to fuse
in the midline at the lower poles
what can an obsturction of teh urinary tract cause 3
bladder diverticulae
hydroureters
hydronephrosis
three common obstructions of the urinary tract (anatomically)
posterior urethral valves
vesicoureteric obstruction
pelviureteric obstruction
what does an obstruction from posterior urethral valves cause 3
bladder hypertrophy
unilateral or bilateral hydronephrosis
renal failure
top 4 cuases of oedema in children
heart failure
nephrotic syndrome
liver failure
malnurition
values indicitative of nephrotic syndrome 3
proteinuria >1g/m^2/day
hypoalbuinaemia <25g/L
high protein to creatinet ratio in early morning urine sample (>150mg/mmol)
*-also oedema
classifications of nephrotic syndrome 3
idiopathic
secondary
congenital
types of idopathic nephrotic syndrome 2
minimal change disease (80-90%)
focal segmental glomeruloscelrosis (10-20%)
types of secondary nephrotic syndrome 2
HSP
SLE
investigations for nephrotic syndrome 7
FBC,
UEs,
LFTs,
C3/C4
varicella status
ASOT
urine -protein creatine ratio
-culture
BP
complications of nephrotic syndrome 4
hypovolaemia - intravuascualry depleted
thrombosis
infection (loss of Ig and complement in urine)
hypertension
treatment for nephrotic syndrome 5
prednisolone - inital high dose w reducing course
20% albuim + furosemid for hypovolaemia or symptomatic oedema
pneumococcal vaccination
penicillin prophlyaxis for risk of encapsulated organism infection
salt/fluid restirction
presenation of nephrotic syndrome in children
suually swelling of face
-then followed by swelling of the entire body
foamy urine
triad of nephrotic syndrome
oedema, substantial proteinuria (> 3.5 g/24 hours) and SERUM hypoalbuminaemia (< 30 g/L)
causes of proteinuria 3
glomerular disease -Glomerulosclerosis, Glomerulonephritis (GN), Nephrotic
syndrome, Familial haematuria, Disease related
tubular
physilogical stress- strenous exercise, exposure to cold, febrile illness or CHF
how can haematuria be split
macro and microscopic
non-glomerular cuases of haematuria 9
o Infection (commonest)
o Trauma
o Stones
o Sickle Cell
o Coagulopathy/Bleeding disorder
o Renal Vein Thrombosis
o Tumour
o Structural abnormality (PUJ obstruction)
o Munchausen by proxy
glomerular causes of haematuria
acute or chornic glomeruonephritis
IgA nephropahty
familial nephritis
history of haematuria 7
pain -presence, site and nature
timing - at begining middle or end of micturition
trauma
recent URTI
rash
meds
FHx of renal disease or early deafness
investgations for haematuria
blood tests 6
-FBC,
UnEs
Coag
ASOT
ANF (ANA ab)
complement
investigations for haematuria
Urine 5
MC&S
oxalate
calcium
phosphate and urate levels
calcium creatine ration
other investigations for haematuria excluding blood and urine 3
AXR
renal USS ± renal biopsy
which children commonly get UTIS 1
ones with structular urinary tract abnormalities
-slightly more girls than boys 3% v 1%
when can a UTI in a child lead to scarring
in the prescence of a vesicoureteric reflux
-imaging is needs to exclude a VUR
main phyiological cause of UTI
incomplete bladder emptying
why do children have imcomplete bladder empyting 6
infrequent voiding
vulvitis
hurried mictrution
constipation
VUR
neuropathic bladder
top 5 bacteria causing UTIs in children
o E-Coli (85%)
o Proteus (common in boys)
o Staphylococcus
o Klebsiella, Enterococcus
o Pseudomonas (may indicate structural abnormality)
symptoms of a UTI during infancy 7
fever
vomitng
lethargy
irritabilituy
poor feeding
failure to thrive
sepsis ± shock
symptoms of UTI in older children 10
frequency
dysuria
change in continence
abdo pain
loin tenderness
fever
malaiase
vomiting
haematuria
symptoms of upper tract UTI 3
bacteruira
fever
loin pain
investgations for UTI
urgent micrsopy and cultre in <3mnths
urine dipstick
MSSU culture and sensitity -GOLD STANDARD
imaging
regarding UTI culture what results would indicate a positive diagnosis of a UTI 3
Bacteruria (organisms seen) ± Pyuria (pus cells)
-treat as UTI
Pyuria + clinical features - treat as UTI
what urine dipstick results would indicate treatment for a UTI - 3 different scenarios
If leukocyte and nitrite positive – culture and treat
If Nitrite positive and leukocyte negative – culture and treat
If leukocyte positive and nitrite negative – culture but only treat if
clinically UTI
what value indicates a positve MSSU
> 10(x5) organism/ml
USS in a UTI for <6mnth old
acute USS if reccurent or atypical UTI
otherwise USS at 6 weeks
USS in a UTI for >6mnth old
Atypical infection: USS acutely and DMSA at 4-6 months (if less than
3 years)
Recurrent infection: USS 6 weeks post infection and DMSA at 4-6
months
DMSA- scintigraphy scan - also uses technetium
treatment for UTI in children
IV ABx if <3mnths
guided by sensitivites and cultures
AWARE-most UTIs are resistant to Amox
prevention of reccurrent of UTi in children 4
o Fluids
o Prevention or treatment of constipation
o Complete bladder emptying
o Good perineal hygiene in girls
methods of collecting urine in children and babies 5
Clean catch- sterile silver foil dish placed strategically and patiently wait whilst
encouraging oral fluids. Used in young children and babies unable to do an MSSU.
MSSU (mid-stream specimen urine/clean catch): ‘Gold standard’ mid stream urine
into a sterile pot
CSU (catheter specimen urine): sample taken from a catheter
SPA (suprapubic aspiration)- rarely if ever used
Urine Bags – not sterile, better for volume measurement
define acute renal failure and a value
sudden reduction in renal function
oliguira <0.5ml/kg/hr
pre-renal causes of acute renal failure 2
hypovolaemia
cardiac faliure
renal causes of acute renal failure 4
vascular - HUS
tubular -Acute tubular necrosis
glomerular -eg glomerulonephritis
interstitial - Drugs (NSAIDs)
post renal causes of acute renal failure 1
urinary obstruction
5 indications for dialysis
severe volume overload
severe hyperkalaemia
symptomatic uraemia
severe metabolic acidosis
removal of toxins
