Paediatric Nephrology

Question 1

What does proteinuria or haematuria indicate in children?

Answer 1

Glomerular disease aka nephrotic or nephritic syndrome

Question 2

What is the cause of AKI in children?

Answer 2

Haemolytic uraemic syndrome

Question 3

What is the cause of CKD in children?

Answer 3

Developmental anomalies such as reflux

Question 4

What is the GFR in children?

Answer 4

GFR

neonate 20-30ml/min/1.73m²

Question 5

What are the 5 functions of the kidney?

Answer 5

Waste handling - urea and creatinine

Water handling

Salt balance - sodium/potassium/calcium/phosphate

Acid base control - bicarb

Endocrine (RAAS, PTH, Vit D activation and erythropioetin production)
- red cells / blood pressure / bone health

Question 6

What makes up the glomerular filtration barrier?

Answer 6

Endothelial cell
GBM
Podocytes
Mesangial Cells

Question 7

Endothelial cell structure

Answer 7

Fenestrated and susceptible to immune mediated injury

Question 8

GBM structure

Answer 8

Made up of Type IV collagen and laminin

Question 9

What makes up podocytes?

Answer 9

Podocin and nephrin

Question 10

What is the function of mesangial cells?

Answer 10

Glomerular structural support that are embedded in GBM

They regulate blood flow of glomerular capillaries

Question 11

What characterises nephritic syndrome?

Answer 11

Increasing haematuria and intravascular overload

Question 12

What characterises nephrotic syndrome?

Answer 12

Increasing proteinuria

Intravascular depletion

Question 13

What does minimal change disease affect?

Answer 13

Podocytes

Question 14

What does Post Infectious Glomerulonephritis affect?

Answer 14

Basement Membrane

and endothelial cells

Question 15

What does Haemolytic Uraemic Syndrome affect?

Answer 15

Endothelial cells

Question 16

What does IgA nephropathy affect?

Answer 16

Mesangial cell

Question 17

When does the PCR (protein creatinine ratio) suugeset nephrotic syndrome?

Answer 17

> 250mg/mmol

Question 18

When does a 24 hour urine collection indicate nephrotic syndrome?

Answer 18

> 1gm^2/24 hrs

Question 19

Define nephrotic syndrome ?

Answer 19

Nephrotic range proteinuria =

Hypoalbuminaemia =

Oedema
- increasing 3rd space fluid volume

Question 20

What are glucocorticoid side effects?

Answer 20

Cushings Syndrome and mood changes e.g Behaviour

Mood lability, Sleep disturbance

Question 21

What form of nephrotic syndrome is steroid sensitive?

Answer 21

Minimal change disease

Question 22

What form of nephrotic syndrome is particularly steroid resistant?

Answer 22

FSGS

Question 23

What are the causes of haematuria?

Answer 23

Systemic
- clotting disorders

Renal
 - Glomerulonephritis
 - Tumour
       Wilm’s - nephroblastoma
 - Cysts

Malignancies - sarcomas
Stones
UTI
Trauma
Urethritis

Question 24

What is the most common form of childhood vasculitis?

Answer 24

IgA vasculitis

Question 25

What is the most common glomerulonephritis?

Answer 25

IgA nephropathy

Question 26

How does acute renal failure present?

Answer 26

Anuria/oliguria (<0.5ml/kg/hr) Hypertension with fluid overload Rapid rise in plasma creatinine

Question 27

What are the intrinsic renal problems which cause AKI?

Answer 27

Glomerular disease Tubular injury Interstitial Nephritis

Question 28

When does HUS present?

Answer 28

Post diarrhoea

Question 29

What branch of E.Coli is usually the cause of HUS?

Answer 29

E.Coli O157

Question 30

What is the triad of HUS?

Answer 30

Microangiopathic haemolytic anaemia Thrombocytopenia Acute Kidney Injury / Acute Renal Failure

Question 31

What is the presentation of CKD?

Answer 31

Loss of appetite, weight loss and itch Polyuria Lethargy UTIs