Paediatric Nephrology Flashcards
What is the approach to a child with proteinuria and/or haematuria?
Haematuria:
Macroscopic/frank = investigate
Microscopic = dipstix adequate (investigate > trace on 2 occasions, haemaglobinuria = stix +ve and microscopy -ve)
If associated with proteinuria = glomerular disease.
What is the presentation of, types of and management of nephrotic syndrome?
Presentation: nephrotic range proteinuria, hypoalbuminaemia, oedema (face, legs)
Types of: minimal change or steroid sensitive nephrotic syndrome, focal segmental NS, membranoproliferative glomeronephritis
Management: if typical features = prednisolone 8 weeks
What is the presentation and management of acute post infectious glomeronephritis?
Presentation: haematuria and proteinuria, reduced GFR (oliguria, fluid overload so raised JVP and oedema, hypertension and worsening renal failure)
Management: bacterial culture and treat with antibiotic and support the five renal functions, can offset the fluid overload/hypertension with diuretics. Usually self limiting and not recurrent.
What is presentation and management of Henoch Schonlein Purpura?
Presentation: 5-15yo, mandatory palpable purpura and one of - abdominal pain, renal involvement, arthritis or arthralgia, biopsy showing IgA deposition
Management: symptomatic eg joints, gut, glucocorticoid therapy (not helpful in mild), immunosuppression (trail in moderate to severe renal disease, longer term is hypertension and proteinuria screening
What is the difference with assessing blood pressure in children?
Gold standard is sphigmanometer, oscillometry with correct technique and correct bladder size
BP affected by sex, age, height
What methods are used to collect urine in children?
Clean catch urine or midstream urine
Infants = catheter samples or suprapubic aspiration
How do urinary tract infections present in children, and how are they treated, followed up and investigated and what are the complications?
Presentation: clinical signs (neonates = fever, vomiting, lethargy, irritability. children pre verbal = fever, abdo pain or loin tenderness, vomiting, poor feeding. children verbal = abdo pain or loin tenderness, fever, malaise, vomiting)
PLUS bacteria cultured from midstream urine, any growth on suprapubic aspiration or catheter
Investigations: dipstix, microscopy, urine culture.
If suspecting scarring: uss for structure, DMSA to look for scarring/function, mictursting cysts-urethrogram (MAG3 scan) as it is dynamic.
Treatment: lower tract = 3 days oral antibiotic, upper tract/pyelonephritis = antibiotics 7-10 days, prevention, fluids, hygiene, constipation and manage voiding dysfunction
Complications: vescico-ureteric reflux + UTI + vulnerable kidney = scarring of kidney
What are the associated problems with and management of chronic kidney disease?
Associated problems:
Congenital eg anomalies of kidney and urinary tract causing reflux nephropathy, dysplasia, obstructive uropathy
Hereditary eg cystic kidney disease, cystinosis
Glomeronephritis
Variable symptoms depending on which function of kidney affected
Management: depends on function affected.
How does haemolytic uraemic syndrome present and what are it’s common causes?
Presentation: triad of microangiopathic haemolytic anaemia, thrombocytopenia, acute kidney injury/acute renal failure
Post-Infection with e.coli O157:H7, with bloody diarrhoea
Causes: typical - post diarrhoea, pneumococcal infection, drugs, atypical
What is the presentation of and management of IgA nephropathy?
Presentation: 1-2 days after URTI (non streptococcal). Usually older children and adults. Recurrent macroscopic haematuria, +- microscopic haematuria and varying degree of proteinuria. Clinical diagnosis.
Management: mild = ACEI, moderate to severe = immunosuppression (KDIGO)
