paediatric nephrology Flashcards
At what age does the egfr begin to match what it is in adulthood
2 years old
What are the functions of the kidney
- waste handling (urea + creatinine)
- water handling
- salt balance (sodium / potassium / calcium / phosphate)
- Acid base control (bicarbonate)
- endocrine (Renin aldosterone angiotensin system / PTH / activation of Vitamin D (Vit D = sterole) / Erythropoietin)
What is the classical sign of glomerular injury
Proteinuria
What proteinuria level on dipstick is abnormal
greater than or equal to 3+
What is the best way to check protein creatinine ratio in children
Early morning urine is best
What is a normal protein:creatinine ratio
Less than 20mg/mmol
Nephrotic range>250mg/mmol
what is the gold standard for measuring proteinuria in children
24 hour urine collection
What is nephrotic syndrome characterised by
- Nephrotic range proteinuria - protein 3+ or protein creatinine ratio 1200mg/mmol
- Hypoalbuminaemia
- Oedema
- Hyperlipidemia
What is the most common nephrotic syndrome in children
Minimal change disease
What is the presentation of nephrotic syndrome in children
- Normal blood pressure
- No frank haematuria
- Normal renal function
- Proteinuria and oedema
What is the treatment of nephrotic syndrome
Prednisolone for 8 weeks
What does a nephrotic syndrome which is very steroid responsive suggest
Minimal change disease
What does a poor steroid response in nephrotic syndrome suggest
Focal segmental glomerulonephritis
What is the presentation of nephritic syndrome
- Haematuria
- Porteinuria
- Reduced GFR
- Oliguria
- Fluid overload
- Hypertension
What is the usual cause of post infectious glomerulonephritis (post streptococcal glomerulonephritis)
Group A strep
What is the management of acute post infectious glomerulonephritis
- Antibiotics
- Electrolytes
- Diuretics for fluid overload
What is the presentation of IgA nephropathy
- Occurs 1-2 days after URTI
- Recurrent macroscopic haematuria and chronic microscopic haematuria
How is IgA nephropathy diagnosed
Biopsy
What is the treatment of IgA nephropathy
- ACEi with mild disease
- Immunosuppression in severe disease
What is the presentation of Henoch Schonlein Purpura - IgA related vasculitis
- Age 5-15 years
-
Palpable purpura need to be present
one of the following: - Abdominal pain
- Renal involvement
- Arthritis or arthralgia
What is the treatment of IgA vasculitis
- Symptomatic
- Glucocorticoids ie prednisolone
What defines AKI
- Serum creatinine >1.5x normal baseline
- Anuria or oliguria <0.5ml/kg/hour for >8 hours
- Hypertension with fluid overload
Describe AKI 1 in paediatrics
Creatinine 1.5/2x reference creatinine range
Describe AKI 2 in paediatrics
Measured creatinine 2-3x reference creatinine
Describe AKI 3 in paediatrics
Serum creatinine >3x reference creatinine
What is the management of an AKI
3 Ms:
- Monitor (BP, Urine output and weight)
- Mantain (good hydration and acid base balance)
- Minimise drugs
What is a pre-renal cause of AKI
Perfusion problem
What are the renal causes of AKI
- Glomerular disease: haemalytic uraemic syndrome + glomeluronephritis
- Tubular injury: acute tubular necrosis
- Interstitial nephritis: NSAID + autoimmune
What are the post renal causes of AKI
Obstructive uropathies such as BPH or urethral stones etc…
What is found on investigation in hameolytic uraemic syndrome
- Packed cell volume <30%
- Haemoglobin < 10g/dl
- fragmented erythrocytes on blood film
- Platelets < 150x10 to the 9
- Serum creatinine raised
- GFR<80
- Proteinuria
What is the usual cause of HUS (haemolytic uraemic syndrome)
E.coli
What is the usual presentation of Haemolytic uraemic syndrome (HUS)
Triad of:
- Microangiopathic haemolytic anaemia
- Thrombocytopenia
- AKI
What is the management to provent HUS
Intravascular volume expansion
what is the management of haemolytic uraemic syndrome
- Monitor (kidney function)
- Mantain (IV normal saline and fluid)
- Minimise (no antibiotics or Damn drugs)
What is the definition of a UTI according to NICE
Clinical signs + bacterial culture from Midstream urine sample
Why are UTIs worrysome in paediatrics
Vesico-ureteric reflux which can result in the infection ascending
What investigations are done in UTIs in children
- Ultrasound within 6 weeks
- DMSA
- Micturating cysto-urethrogram - takes image while child urinated
What is the treatment for a lower tract UTI in children
3 day oral antibiotic
What is the treatment of an upper tract UTI such as pyelonephritis
Antibiotics for 7-10 days orally if they are systemically well
What is the gold standard device to measure blood pressure
Sphygmomanometer
