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Paediatrics > paediatric nephrology > Flashcards

paediatric nephrology Flashcards

1
Q

functions of kidneys

A
  • waste handling
  • water handling
  • salt balance
  • acid base control
  • endocrine
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2
Q

neonate GFR

A

20-30ml/min/1.73m2

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3
Q

3 major components of glomerular basement membrane

A
  1. fenestrated endothelial cells
  2. glomerular basement membrane
  3. podocyte with slit diaphragms
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4
Q

what does proteinuria indicate

A

glomerular injury

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5
Q

features of nephritic syndrome

A
  • increasing haematuria

- intravascular overload

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6
Q

features of nephrotic syndrome

A
  • increasing proteinuria

- intravascular depletion

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7
Q

what component of glomerular filter is damaged in minimal change disease

A

epithelial cell

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8
Q

what component of glomerular filter is damaged in post infectious glomerulonephritis

A

basement membrane

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9
Q

what component of glomerular filter is damaged in haemolytic uraemic syndrome

A

endothelial cell

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10
Q

what component of glomerular filter is damaged in IgA nephropathy

A

mesangial cell

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11
Q

ways of measuring proteinuria

A
  1. dipstix
  2. protein creatinine ratio
  3. 24hr urine collection (gold standard
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12
Q

what is a normal Pr:CR ratio

A

<20mg/mmol

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13
Q

what is a normal nephrotic range

A

> 250mg/mmol

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14
Q

what effect does nephrotic syndrome have on albumin levels

A

hypoalbuminaemia

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15
Q

typical features of paediatric nephrotic syndrome

A
  • age 1-10
  • normal blood pressure
  • no frank haematuria
  • normal renal function
  • proteinuria
  • hypoalbuminaemia
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16
Q

atypical features of paediatric nephrotic syndrome

A
  • suggestions of autoimmune disease
  • abnormal renal function
  • steroid resistance
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17
Q

treatment of nephrotic syndrome with typical features

A

prednisolone 8 weeks

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18
Q

side effects from high dose glucocorticoids

A
  • change of behaviour
  • sleep disturbance
  • increased infection risk
  • hypertension
  • ‘moon face’
  • GI distress
  • increased growth
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19
Q

what percentage of paediatric nephrotic syndromes relapse

A

80%

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20
Q

name an acquired type of steroid resistant nephrotic syndrome

A

focal segmental glomerulosclerosis

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21
Q

when would you investigate paediatric microscopic haematuria

A

trace on 2 occasions

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22
Q

when would you immediately investigate paediatric haematuria

A

macroscopic/ frank

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23
Q

lower urinary tract causes of haematuria

A
  • sarcomas
  • stones
  • uti
  • trauma
  • urethritis
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24
Q

renal causes of haematuria

A
  • glomerulonephritis
  • tumour
  • cysts
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25
Q

components of nephritic syndrome

A
  • haematuria
  • proteinuria
  • reduced GFR
  • fluid overload
  • raised JVP
  • hypertension
  • worsening renal failure
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26
Q

what component of glomerular filter is damaged in lupus

A

epithelial cell
endothelial cell
mesangial cell

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27
Q

what component of glomerular filter is damaged in FSGS

A

epithelial cell

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28
Q

what component of glomerular filter is damaged in post infectious glomerulonephritis (PIGN)

A

basement membrane

endothelial cell

29
Q

what component of glomerular filter is damaged in membranous glomerulopathy

A

basement membrane

30
Q

what component of glomerular filter is damaged in haemolytic uraemic syndrome

A

endothelial cell

31
Q

what component of glomerular filter is damaged in membranoproliferative glomerulonephritis

A

endothelial cell

32
Q

what component of glomerular filter is damaged in ANCA vasculitis

A

endothelial cell

33
Q

how long would a throat infection take to develop into acute post-infectious glomerulonephritis

A

7-10 days

34
Q

how long would a skin infection take to develop into acute post-infectious glomerulonephritis

A

2-4 weeks

35
Q

treatment of acute post-infectious glomerulonephritis

A
  • antibiotics
  • support 5 renal functions
  • manage fluid overload/ hypertension with diuretics
36
Q

what is required for clinical diagnosis of Henoch Schonlein Purpura

A 
mandatory palpable purpura
1/4 of:
1. abdo pain
2. renal involvement
3. arthritis or arthralgia
4. biopsy (IgA deposition)
37
Q

what is Henoch Schonlein Purpura

A

IgA related vasculitis

38
Q

treatment of IgA vasculitis

A
  • immunosuppression (trial in moderate to severe renal disease)
  • long term screening for hypertension and proteinuria
39
Q

whats the most common glomerulonephritis

A

IgA nephropathy

40
Q

treatment of IgA nephropathy (mild disease)

A

proteinuria with ACEI

41
Q

treatment of moderate to severe IgA nephropathy

A

immunosuppression

42
Q

define acute kidney injury

A

abrupt loss of kidney function, resulting in the retention of urea and other nitrogenous waste products and in the dysregulation of extracellular volume and electrolytes

43
Q

define acute renal failure

A
  • anuria/ oliguria (<0.5ml/kg/hr)
  • hypertension with fluid overload
  • rapid rise in plasma creatinine
44
Q

AKI 1

A

measured creatinine >1.5-2x reference

45
Q

AKI 2

A

measured creatinine 2-3x reference

46
Q

AKI 3

A

serum creatinine >3x reference

47
Q

management of acute kidney injury

A
  • paediatric early warning scores
  • urine output
  • weight
  • good hydration
  • drugs
48
Q

intrinsic renal problem acute kidney injury

A
  • Haemolytic uraemic syndrome
  • glomerulonephritis
  • acute tubular necrosis
  • NSAIDs
  • autoimmune
  • drugs
49
Q

post renal causes of AKI

A

obstructive uropathies

50
Q

typical cause of haemolytic-uraemic syndrome

A

post diarrhoea (e.coli), up to 14 days after onset of diarrhoea

51
Q

clinical presentation of haemolytic-uraemic syndrome

A

triad of:

  • microangiopathic haemolytic anaemia
  • thrombocytopenia
  • AKI/ acute renal failure
52
Q

what is this the clinical presentation of:

  • microangiopathic haemolytic anaemia
  • thrombocytopenia
  • AKI/ acute renal failure
A

haemolytic-uraemic syndrome

53
Q

management of haemolytic-uraemic syndrome

A

3Ms

  1. Monitor:
    - 5 kidney functions
    - aware of other organs
  2. maintain
    - IV normal saline and fluid
    - renal replacement therapy
  3. minimise
    - no antibiotics/ NSAIDs
54
Q

potential other organ complications of haemolytic-uraemic syndrome

A
  • seizures
  • acute abdomen
  • diabetes
  • adrenal crisis
55
Q

chronic kidney disease 2

A

GFR 60-89

56
Q

CKD3

A

30-59

57
Q

CKD4

A

15-29

58
Q

CKD5

A

0-15

59
Q

below what GFR will you start to experience symptoms

A

<60

60
Q

diagnosis of UTI

A 
- clinical signs 
plus
- bacteria culture from MSSU
or 
- any growth on suprapubic aspiration or catheter
61
Q

test results suggestive of UTI

A
  • leucocyte esterase activity, nitrates
  • pyuria
  • bacturia
62
Q

what could UTIs in children indicate

A

vescico-ureteric reflux

63
Q

what UTIs to investigate in paeds

A
  • upper tract symptoms
  • younger
  • recurrent
64
Q

recurrent UTI investigations

A
  • USS
  • DMSA (isotope scanning)
  • micturating cysto-urethrogram
65
Q

treatment of lower tract UTI

A

3 days oral antibiotics (trimethoprim)

66
Q

upper tract UTI/ pyelonephritis

A
  • antibiotics 7-10 days
  • no role for prophylaxis
  • hydration
  • hygiene
  • manage voiding dysfunction
67
Q

factors affecting progression of CKD

A
  • delayed referral
  • hypertension
  • proteinuria
  • high intake of protein, phosphate and salt
  • bone health
  • acidosis
  • recurrent UTIs
68
Q

treatment principles of metabolic bone disease

A
  • low phosphate diet
  • oral phosphate binders
  • active vitamin D
  • growth hormone?

Paediatrics (23 decks)

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