Paediatric Nephrology

Question 1

define UTI

Answer 1

urinary tract growing bacteria, with a single bacteria 10 to the power 5 grown on urine culture
(although any growth on suprapubic aspiration = UTI)

Question 2

categorise UTIs

Answer 2

upper UTI = acute pyelonephritis

lower UTI = acute cystitis

Question 3

what are long term complications of UTIs?

Answer 3

kidney scarring, hypertension, CKD

Question 4

what dipstick results come up in UTI

Answer 4

leukocytes and nitrites

Question 5

infants younger than 3 months should have what if you suspect a UTI?

Answer 5

urine microscopy, culture, sensitivities (MCS)

Question 6

how do you collect urine from an infant?

Answer 6

clean catch is best
urine collection pads (risk of contamination) /bag
catheter samples
suprapubic aspiration

Question 7

most common UTI bug in children?

Answer 7

e.coli

Question 8

which children with UTIs should you admit?

Answer 8

children <3 months
systemically unwell children
significant risk factors (one kidney etc)

Question 9

how would you treat the child <3 months admitted with suspected UTI

Answer 9

IV cefuroxime 2-4 days then switch to oral abx

Question 10

how would you treat a child >3 months who has (uncomplicated, sustemically well):

LUTI?
UUTI?

Answer 10

LUTI - 3 days oral abx with trimethoprim

UUTI - 7 days oral abx with cefalexin

Question 11

what children with UTIs need further investigation (ie imaging)

Answer 11

those presenting with atypical UTI

• non ecoli UTI
• septicaemia
• poor urine flow
• abdo/bladder mass
• raised creatinine

OR those with recurrent UTIs

Question 12

name the types of imaging investigations you can do for UTIs and what they are good for and their limitations

Answer 12

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)

Question 13

what does oedema in a child present as?

Answer 13

swelling, pitting oedema, facial puffiness, ascites

Question 14

what are the causes of oedema in a child?

Answer 14

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

Question 15

what is nephrotic syndrome? described the triad

Answer 15

• 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)

Question 16

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?

Answer 16

protein creatinine ratio
normal = <20mg/mmol
in nephrotic syndrome, could be over 1000s

Question 17

what are the three different types of nephrotic syndrome in children?

Answer 17

congenital
steroid sensitive
steroid resistant

Question 18

how do you treat most nephrotic syndromes in children? - condition and symptomatic

Answer 18

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)

Question 19

What is nephritic syndrome? and how would they typically present?

Answer 19

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)

Question 20

management of nephritic syndrome

Answer 20

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

Question 21

causes of nephrotic syndrome

Answer 21

idiopathic, though to be immune mediated

or

secondary to another illness: HSP - henoch-schonlein purpura

Question 22

causes of nephritic syndrome

Answer 22

IgA nephropathy
Post-streptococcal glomerulonephritis
Hemolytic uremic syndrome
Henoch–Schönlein purpura

Question 23

what is HSP?

Answer 23

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