Paediatric Nephrology Flashcards
What are the features of the glomerular filtration barrier?
Fenestrated endothelial cells
Glomerular basement membrane
Podocytes
What are some causes of acquired glomerulopathy?
SLE
IgA nephropathy
What are the differences between nephritic syndrome and nephrotic syndrome?
Nephritic syndrome (increasing haematuria, intravascular overload) Nephrotic syndrome (increasing proteinuria, intravascular depletion)
What is nephrotic syndrome?
Nephrotic range proteinuria causing hypoalbuminaemia and oedema
What is the presentation of nephrotic syndrome?
Oedema (periorbital, pitting oedema legs)
Pale
Frothy urine
How is proteinuria tested?
Dipstix
Protein creatinine ratio (early morning urine best)
24hr urine collection
What other investigations can be used for proteinuria?
Bloods (low albumin, normal creatinine)
What is the treatment for nephrotic syndrome?
Prednisolone 8 weeks
What are the side effects from high dose glucocorticoids?
Behaviour
Susceptibility to infection (varicella status, pneumococcal vaccinated)
Hypertension
What are the causes of macroscopic haematuria?
UTI Trauma Stones Glomerularnephritis Clotting abnormalities
What are the causes of microscopic haematuria?
UTI Trauma Stones Nephrotic syndrome Sickle cel disease Glomerularnephritis HSP
What are the features of nephritic syndrome?
Haematuria Proteinuria Oliguria Rased JVP Oedema Hypertension Worsening renal failure
What investigations should be used to diagnose nephritic syndrome?
Bloods (raised creatinine)
Urine culture
US
What are the causes of glomerulonephritis?
Post Infect GN IgA nephropathy / HSP Membranoproliferative GN Lupus Nephritis ANCA positive vasculitis Haemolytic uraemic syndrome Alport’s syndrome Thin Basement Membrane Disease
What is the common cause of acute post infectious GN?
Group A strep
How is a diagnosis acute post infectious GN?
Bacterial culture
What is the treatment for acute post infectious GN?
Antibiotics
Diuretics for hypertension and overload
What are the features of IgA nephropathy?
Recurrent macroscopic haematuria
Chronic microscopic haematuria
Varying degree of proteinuria
How is a diagnosis of IgA nephropathy made?
Biopsy
What is the treatment for IgA nephropathy?
ACE inhibitors
What are the features of HSP (IgA related vasculitis)?
Palpable purpura - mandatory Abdominal pain Renal involvement Arthritis or arthralgia Biopsy (IgA deposition)
What is the treatment for IgA vasculitis?
Symptomatic treatment of joints and gut
Glucocorticoid therapy
Immunosuppression
Long term hypertension and proteinuria screening
What are the main features of acute kidney injury?
Anuria/oliguria
Rapid rise in plasma creatinine
Hypertension with fluid overload
What is the management for acute kidney injury?
Prevention
Monitor urine output, PEWs, BP, weight
Maintain good hydration
Minimise drugs
What are the causes of acute kidney injury?
Glomerulonephritis HUS Acute tubular necrosis NSAID Autoimmune Obstructive (post renal)
What are the causes of haemolytic uraemia syndrome?
E Coli
Pneumococcal infection
Drugs
What are the presenting symptoms of HUS?
Bloody diarrhoea
Abdominal pain
Fever
Vomiting
What occurs with HUS?
Microangiopathic haemolytic anaemia
Thrombocytopenia
Acute renal failure
What is the management of HUS?
Monitor fluid balance, electrolytes, acidosis, hypertension Maintain IV normal saline and fluid, renal replacement therapy Minimise drugs (no antibiotics)
What are the long term consequences of acute kidney injury?
Blood pressure
Proteinuria monitoring
Evolution to CKD
What are the causes of chronic kidney disease?
Congenital anomalies of kidney and urinary tract (CAKUT)
Glomerulonephritis
Cystic kidney disease
What are the stages of CKD?
2 GFR 60-89
3 GFR 30-59
4 GFR 15-29
5 end stage renal disease
What is the presentation of CKD?
Bladder dysfunction
How is a urine sample obtained in children?
Clean catch urine or mid stream sample
Collection pads, urine bags
Cather samples
Suprapubic aspiration
How is a diagnosis of UTI made in children?
Dipstix
Microscopy
Culture
What investigations can be used in children for urology?
US
DMSA (isotope scan)
Micturating cystourethrogram (MAG)
What is the treatment for children with UTIs?
3 days oral antibiotics (lower tract)
7-10 antibiotics (upper tract/ pyelonephritis)
Prevention with fluids, hygiene
What factors affect the progression of CKD?
Late referral Hypertension Proteinuria High intake of protein, phosphate and salt Bone health Acidosis Recurrent UTIs
