Paediatric Nephrology Flashcards
What does proteinuria or haematuria indicate in children?
Glomerular disease aka nephrotic or nephritic syndrome
What is the cause of AKI in children?
Haemolytic uraemic syndrome
What is the cause of CKD in children?
Developmental anomalies such as reflux
What is the GFR in children?
GFR
neonate 20-30ml/min/1.73m²
What are the 5 functions of the kidney?
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
What makes up the glomerular filtration barrier?
Endothelial cell
GBM
Podocytes
Mesangial Cells
Endothelial cell structure
Fenestrated and susceptible to immune mediated injury
GBM structure
Made up of Type IV collagen and laminin
What makes up podocytes?
Podocin and nephrin
What is the function of mesangial cells?
Glomerular structural support that are embedded in GBM
They regulate blood flow of glomerular capillaries
What characterises nephritic syndrome?
Increasing haematuria and intravascular overload
What characterises nephrotic syndrome?
Increasing proteinuria
Intravascular depletion
What does minimal change disease affect?
Podocytes
What does Post Infectious Glomerulonephritis affect?
Basement Membrane
and endothelial cells
What does Haemolytic Uraemic Syndrome affect?
Endothelial cells
What does IgA nephropathy affect?
Mesangial cell
When does the PCR (protein creatinine ratio) suugeset nephrotic syndrome?
> 250mg/mmol
When does a 24 hour urine collection indicate nephrotic syndrome?
> 1gm^2/24 hrs
Define nephrotic syndrome ?
Nephrotic range proteinuria =
Hypoalbuminaemia =
Oedema
- increasing 3rd space fluid volume
What are glucocorticoid side effects?
Cushings Syndrome and mood changes e.g Behaviour
Mood lability, Sleep disturbance
What form of nephrotic syndrome is steroid sensitive?
Minimal change disease
What form of nephrotic syndrome is particularly steroid resistant?
FSGS
What are the causes of haematuria?
Systemic
- clotting disorders
Renal
- Glomerulonephritis
- Tumour
Wilm’s - nephroblastoma
- Cysts
Malignancies - sarcomas Stones UTI Trauma Urethritis
What is the most common form of childhood vasculitis?
IgA vasculitis
What is the most common glomerulonephritis?
IgA nephropathy
How does acute renal failure present?
Anuria/oliguria (<0.5ml/kg/hr)
Hypertension with fluid overload
Rapid rise in plasma creatinine
What are the intrinsic renal problems which cause AKI?
Glomerular disease
Tubular injury
Interstitial Nephritis
When does HUS present?
Post diarrhoea
What branch of E.Coli is usually the cause of HUS?
E.Coli O157
What is the triad of HUS?
Microangiopathic haemolytic anaemia
Thrombocytopenia
Acute Kidney Injury / Acute Renal Failure
What is the presentation of CKD?
Loss of appetite, weight loss and itch
Polyuria
Lethargy
UTIs
