Paediatric Nephrology Flashcards
define UTI
urinary tract growing bacteria, with a single bacteria 10 to the power 5 grown on urine culture
(although any growth on suprapubic aspiration = UTI)
categorise UTIs
upper UTI = acute pyelonephritis
lower UTI = acute cystitis
what are long term complications of UTIs?
kidney scarring, hypertension, CKD
what dipstick results come up in UTI
leukocytes and nitrites
infants younger than 3 months should have what if you suspect a UTI?
urine microscopy, culture, sensitivities (MCS)
how do you collect urine from an infant?
clean catch is best
urine collection pads (risk of contamination) /bag
catheter samples
suprapubic aspiration
most common UTI bug in children?
e.coli
which children with UTIs should you admit?
children <3 months
systemically unwell children
significant risk factors (one kidney etc)
how would you treat the child <3 months admitted with suspected UTI
IV cefuroxime 2-4 days then switch to oral abx
how would you treat a child >3 months who has (uncomplicated, sustemically well):
LUTI?
UUTI?
LUTI - 3 days oral abx with trimethoprim
UUTI - 7 days oral abx with cefalexin
what children with UTIs need further investigation (ie imaging)
those presenting with atypical UTI
- non ecoli UTI
- septicaemia
- poor urine flow
- abdo/bladder mass
- raised creatinine
OR those with recurrent UTIs
name the types of imaging investigations you can do for UTIs and what they are good for and their limitations
US KUB - good for obstruction and rare stuff like duplex kidney, horseshoe kidney, single kidney (structural abnormalities) and is non invasive but observer dependent
MCUG - micturating cystourethrogram - BEST FOR VESICOUTERIC REFLUX identification but invasive
DMSA scan - nuclear medicine scan using radio-isotopes - good for seeing renal scarring (e.g due to recurrent UTIs maybe)
what does oedema in a child present as?
swelling, pitting oedema, facial puffiness, ascites
what are the causes of oedema in a child?
blockages:
- lymph drainage (turners)
- venous drainage (DVT)
lowered oncotic pressure: low albumin/protein
- nutritional (poor intake)
- decreased production (liver problems)
- increased loss (nephrotic syndrome)
salt and water retention
impaired GFR
what is nephrotic syndrome? described the triad
- heavy proteinuria (frothy/foamy urine and confirmed on dip)
causing. ..
- hypoalbuminemia (low albumin in the blood)
causing. ..
- oedema (as low serum albumin leads to fluid retention)
other than a urine dip, what test would you do on the urine sample in suspected nephrotic syndrome and what would you find in a positive result?
protein creatinine ratio
normal = <20mg/mmol
in nephrotic syndrome, could be over 1000s
what are the three different types of nephrotic syndrome in children?
congenital
steroid sensitive
steroid resistant
how do you treat most nephrotic syndromes in children? - condition and symptomatic
PREDNISOLONE
- high for 4 weeks then lower dose on alternate days for 4 weeks
symptomatic in the meantime:
- diuretics
- salt and water intake moderation (dietary mods)
- pen V - prophylaxis for infection
- chickenpox and pneumococcal vaccinations
- DO NOT GIVE live vaccinations (MMR, BCG)
What is nephritic syndrome? and how would they typically present?
acute inflammation in the kidney, most commonly post -strep glomerular nephritis (2 weeks after ‘tonsillitis’ etc)
Haematuria (LOTS - coco cola coloured urine)
proteinuria (a bit)
impaired GFR
salt and water retention- (hypertension, oedema)
management of nephritic syndrome
The treatment of primary pathology ranges from watchful waiting, as in postinfectious GN, to treatment with immunosuppressive medication, such as steroids or cyclophosphamide in lupus.
supportive treatment;
fluid balance – measurements of input/output, fluid moderation, diuretics, salt restriction
Correction of other imbalances: potassium, acidosis
Dialysis – uncommon but might need it
Antibiotics
causes of nephrotic syndrome
idiopathic, though to be immune mediated
or
secondary to another illness: HSP - henoch-schonlein purpura
causes of nephritic syndrome
IgA nephropathy
Post-streptococcal glomerulonephritis
Hemolytic uremic syndrome
Henoch–Schönlein purpura
what is HSP?
type of IgA vasculitis
- Red purpura on the lower limbs and buttocks
- multisystem involvement: Skin, joints, gut, kidneys
- Joint pain
- May have blood in the stool and bad abdo pain: intersussuption/GI bleed
- Inflamed kidneys – the most dangerous as can lead to CKD : can either give nephrotic or nephritic picture –> can lead to hypertension
