paediatric nephrology Flashcards
functions of kidneys
- waste handling
- water handling
- salt balance
- acid base control
- endocrine
neonate GFR
20-30ml/min/1.73m2
3 major components of glomerular basement membrane
- fenestrated endothelial cells
- glomerular basement membrane
- podocyte with slit diaphragms
what does proteinuria indicate
glomerular injury
features of nephritic syndrome
- increasing haematuria
- intravascular overload
features of nephrotic syndrome
- increasing proteinuria
- intravascular depletion
what component of glomerular filter is damaged in minimal change disease
epithelial cell
what component of glomerular filter is damaged in post infectious glomerulonephritis
basement membrane
what component of glomerular filter is damaged in haemolytic uraemic syndrome
endothelial cell
what component of glomerular filter is damaged in IgA nephropathy
mesangial cell
ways of measuring proteinuria
- dipstix
- protein creatinine ratio
- 24hr urine collection (gold standard
what is a normal Pr:CR ratio
<20mg/mmol
what is a normal nephrotic range
> 250mg/mmol
what effect does nephrotic syndrome have on albumin levels
hypoalbuminaemia
typical features of paediatric nephrotic syndrome
- age 1-10
- normal blood pressure
- no frank haematuria
- normal renal function
- proteinuria
- hypoalbuminaemia
atypical features of paediatric nephrotic syndrome
- suggestions of autoimmune disease
- abnormal renal function
- steroid resistance
treatment of nephrotic syndrome with typical features
prednisolone 8 weeks
side effects from high dose glucocorticoids
- change of behaviour
- sleep disturbance
- increased infection risk
- hypertension
- ‘moon face’
- GI distress
- increased growth
what percentage of paediatric nephrotic syndromes relapse
80%
name an acquired type of steroid resistant nephrotic syndrome
focal segmental glomerulosclerosis
when would you investigate paediatric microscopic haematuria
trace on 2 occasions
when would you immediately investigate paediatric haematuria
macroscopic/ frank
lower urinary tract causes of haematuria
- sarcomas
- stones
- uti
- trauma
- urethritis
renal causes of haematuria
- glomerulonephritis
- tumour
- cysts
components of nephritic syndrome
- haematuria
- proteinuria
- reduced GFR
- fluid overload
- raised JVP
- hypertension
- worsening renal failure
what component of glomerular filter is damaged in lupus
epithelial cell
endothelial cell
mesangial cell
what component of glomerular filter is damaged in FSGS
epithelial cell
what component of glomerular filter is damaged in post infectious glomerulonephritis (PIGN)
basement membrane
endothelial cell
what component of glomerular filter is damaged in membranous glomerulopathy
basement membrane
what component of glomerular filter is damaged in haemolytic uraemic syndrome
endothelial cell
what component of glomerular filter is damaged in membranoproliferative glomerulonephritis
endothelial cell
what component of glomerular filter is damaged in ANCA vasculitis
endothelial cell
how long would a throat infection take to develop into acute post-infectious glomerulonephritis
7-10 days
how long would a skin infection take to develop into acute post-infectious glomerulonephritis
2-4 weeks
treatment of acute post-infectious glomerulonephritis
- antibiotics
- support 5 renal functions
- manage fluid overload/ hypertension with diuretics
what is required for clinical diagnosis of Henoch Schonlein Purpura
mandatory palpable purpura 1/4 of: 1. abdo pain 2. renal involvement 3. arthritis or arthralgia 4. biopsy (IgA deposition)
what is Henoch Schonlein Purpura
IgA related vasculitis
treatment of IgA vasculitis
- immunosuppression (trial in moderate to severe renal disease)
- long term screening for hypertension and proteinuria
whats the most common glomerulonephritis
IgA nephropathy
treatment of IgA nephropathy (mild disease)
proteinuria with ACEI
treatment of moderate to severe IgA nephropathy
immunosuppression
define acute kidney injury
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
define acute renal failure
- anuria/ oliguria (<0.5ml/kg/hr)
- hypertension with fluid overload
- rapid rise in plasma creatinine
AKI 1
measured creatinine >1.5-2x reference
AKI 2
measured creatinine 2-3x reference
AKI 3
serum creatinine >3x reference
management of acute kidney injury
- paediatric early warning scores
- urine output
- weight
- good hydration
- drugs
intrinsic renal problem acute kidney injury
- Haemolytic uraemic syndrome
- glomerulonephritis
- acute tubular necrosis
- NSAIDs
- autoimmune
- drugs
post renal causes of AKI
obstructive uropathies
typical cause of haemolytic-uraemic syndrome
post diarrhoea (e.coli), up to 14 days after onset of diarrhoea
clinical presentation of haemolytic-uraemic syndrome
triad of:
- microangiopathic haemolytic anaemia
- thrombocytopenia
- AKI/ acute renal failure
what is this the clinical presentation of:
- microangiopathic haemolytic anaemia
- thrombocytopenia
- AKI/ acute renal failure
haemolytic-uraemic syndrome
management of haemolytic-uraemic syndrome
3Ms
- Monitor:
- 5 kidney functions
- aware of other organs - maintain
- IV normal saline and fluid
- renal replacement therapy - minimise
- no antibiotics/ NSAIDs
potential other organ complications of haemolytic-uraemic syndrome
- seizures
- acute abdomen
- diabetes
- adrenal crisis
chronic kidney disease 2
GFR 60-89
CKD3
30-59
CKD4
15-29
CKD5
0-15
below what GFR will you start to experience symptoms
<60
diagnosis of UTI
- clinical signs plus - bacteria culture from MSSU or - any growth on suprapubic aspiration or catheter
test results suggestive of UTI
- leucocyte esterase activity, nitrates
- pyuria
- bacturia
what could UTIs in children indicate
vescico-ureteric reflux
what UTIs to investigate in paeds
- upper tract symptoms
- younger
- recurrent
recurrent UTI investigations
- USS
- DMSA (isotope scanning)
- micturating cysto-urethrogram
treatment of lower tract UTI
3 days oral antibiotics (trimethoprim)
upper tract UTI/ pyelonephritis
- antibiotics 7-10 days
- no role for prophylaxis
- hydration
- hygiene
- manage voiding dysfunction
factors affecting progression of CKD
- delayed referral
- hypertension
- proteinuria
- high intake of protein, phosphate and salt
- bone health
- acidosis
- recurrent UTIs
treatment principles of metabolic bone disease
- low phosphate diet
- oral phosphate binders
- active vitamin D
- growth hormone?
