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Paediatrics > Paediatric Nephrology > Flashcards

Paediatric Nephrology Flashcards

1
Q

What are the features of the glomerular filtration barrier?

A

Fenestrated endothelial cells
Glomerular basement membrane
Podocytes

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2
Q

What are some causes of acquired glomerulopathy?

A

SLE

IgA nephropathy

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3
Q

What are the differences between nephritic syndrome and nephrotic syndrome?

A 
Nephritic syndrome (increasing haematuria, intravascular overload) 
Nephrotic syndrome (increasing proteinuria, intravascular depletion)
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4
Q

What is nephrotic syndrome?

A

Nephrotic range proteinuria causing hypoalbuminaemia and oedema

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5
Q

What is the presentation of nephrotic syndrome?

A

Oedema (periorbital, pitting oedema legs)
Pale
Frothy urine

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6
Q

How is proteinuria tested?

A

Dipstix
Protein creatinine ratio (early morning urine best)
24hr urine collection

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7
Q

What other investigations can be used for proteinuria?

A

Bloods (low albumin, normal creatinine)

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8
Q

What is the treatment for nephrotic syndrome?

A

Prednisolone 8 weeks

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9
Q

What are the side effects from high dose glucocorticoids?

A

Behaviour
Susceptibility to infection (varicella status, pneumococcal vaccinated)
Hypertension

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10
Q

What are the causes of macroscopic haematuria?

A 
UTI 
Trauma 
Stones 
Glomerularnephritis 
Clotting abnormalities
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11
Q

What are the causes of microscopic haematuria?

A 
UTI 
Trauma 
Stones 
Nephrotic syndrome 
Sickle cel disease 
Glomerularnephritis 
HSP
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12
Q

What are the features of nephritic syndrome?

A 
Haematuria 
Proteinuria 
Oliguria 
Rased JVP 
Oedema 
Hypertension 
Worsening renal failure
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13
Q

What investigations should be used to diagnose nephritic syndrome?

A

Bloods (raised creatinine)
Urine culture
US

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14
Q

What are the causes of glomerulonephritis?

A 
Post Infect GN
IgA nephropathy / HSP
Membranoproliferative GN
Lupus Nephritis  
ANCA positive vasculitis
Haemolytic uraemic syndrome
Alport’s syndrome
Thin Basement Membrane Disease
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15
Q

What is the common cause of acute post infectious GN?

A

Group A strep

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16
Q

How is a diagnosis acute post infectious GN?

A

Bacterial culture

17
Q

What is the treatment for acute post infectious GN?

A

Antibiotics

Diuretics for hypertension and overload

18
Q

What are the features of IgA nephropathy?

A

Recurrent macroscopic haematuria
Chronic microscopic haematuria
Varying degree of proteinuria

19
Q

How is a diagnosis of IgA nephropathy made?

A

Biopsy

20
Q

What is the treatment for IgA nephropathy?

A

ACE inhibitors

21
Q

What are the features of HSP (IgA related vasculitis)?

A 
Palpable purpura - mandatory 
Abdominal pain 
Renal involvement 
Arthritis or arthralgia 
Biopsy (IgA deposition)
22
Q

What is the treatment for IgA vasculitis?

A

Symptomatic treatment of joints and gut
Glucocorticoid therapy
Immunosuppression
Long term hypertension and proteinuria screening

23
Q

What are the main features of acute kidney injury?

A

Anuria/oliguria
Rapid rise in plasma creatinine
Hypertension with fluid overload

24
Q

What is the management for acute kidney injury?

A

Prevention
Monitor urine output, PEWs, BP, weight
Maintain good hydration
Minimise drugs

25
Q

What are the causes of acute kidney injury?

A 
Glomerulonephritis 
HUS 
Acute tubular necrosis 
NSAID
Autoimmune 
Obstructive (post renal)
26
Q

What are the causes of haemolytic uraemia syndrome?

A

E Coli
Pneumococcal infection
Drugs

27
Q

What are the presenting symptoms of HUS?

A

Bloody diarrhoea
Abdominal pain
Fever
Vomiting

28
Q

What occurs with HUS?

A

Microangiopathic haemolytic anaemia
Thrombocytopenia
Acute renal failure

29
Q

What is the management of HUS?

A 
Monitor fluid balance, electrolytes, acidosis, hypertension
Maintain IV normal saline and fluid, renal replacement therapy 
Minimise drugs (no antibiotics)
30
Q

What are the long term consequences of acute kidney injury?

A

Blood pressure
Proteinuria monitoring
Evolution to CKD

31
Q

What are the causes of chronic kidney disease?

A

Congenital anomalies of kidney and urinary tract (CAKUT)
Glomerulonephritis
Cystic kidney disease

32
Q

What are the stages of CKD?

A

2 GFR 60-89
3 GFR 30-59
4 GFR 15-29
5 end stage renal disease

33
Q

What is the presentation of CKD?

A

Bladder dysfunction

34
Q

How is a urine sample obtained in children?

A

Clean catch urine or mid stream sample
Collection pads, urine bags
Cather samples
Suprapubic aspiration

35
Q

How is a diagnosis of UTI made in children?

A

Dipstix
Microscopy
Culture

36
Q

What investigations can be used in children for urology?

A

US
DMSA (isotope scan)
Micturating cystourethrogram (MAG)

37
Q

What is the treatment for children with UTIs?

A

3 days oral antibiotics (lower tract)
7-10 antibiotics (upper tract/ pyelonephritis)
Prevention with fluids, hygiene

38
Q

What factors affect the progression of CKD?

A 
Late referral 
Hypertension 
Proteinuria 
High intake of protein, phosphate and salt 
Bone health 
Acidosis 
Recurrent UTIs

Paediatrics (20 decks)

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