Paediatric Nephrology Flashcards
What is the difference between nephrotic and nephritic syndrome?
Nephritic syndrome is associated with increasing haematuria and intravascular overload.
Nephrotic syndrome is associated with increasing proteinuria and intravascular depletion.
Which is more common; acquired or congenital glomerulopathies?
Acquired
What are some examples of acquired glomerulopathies?
Minimal change disease
Post infectious glomerulonephritis
Haemolytic uraemic syndrome
IgA nephropathy
What are some examples of congenital glomerulopathies?
Congenital nephrotic syndrome
Alport syndrome
Thin basement membrane disease
How can proteinuria be measured?
Dipstix- measures concentration, 3 or more positive usually abnormal. Can give false positives and negatives
Protein creatinine ratio- early morning urine best, normal Pr:Cr ratio is <20mg/mmol, nephrotic range is >250
24hr urine collection- gold standard, normally <60mg/m²/24hrs, nephrotic range in children is >1g/m²/24hrs
When does nephrotic syndrome occur?
Nephrotic syndrome occurs when nephrotic range proteinuria progresses to hypoalbuminaemia, which progresses to oedema
What are the typical features of nephrotic syndrome in children?
Aged 1-10 (2-5 most common)
Normal blood pressure
No frank haematuria
Normal renal function
How is nephrotic syndrome treated?
8 weeks of prednisolone
Second line = immunosuppression
What are the side effects of glucocorticoids in children?
Behaviour and mood changes
Sleep disturbance
Increased infection risk
Hypertension
What is the spectrum of steroid sensitivity in paediatric nephrotic syndrome?
Non relapsing Infrequently relapsing Frequently relapsing Steroid dependent Steroid resistant
What are the causes of acquired steroid resistant nephrotic syndrome?
Acquired- focal segmental glomerulosclerosis
Congenital
What is nephritic syndrome?
Nephritic syndrome is a clinical diagnosis describing glomerulonephritis.
What are the symptoms of nephritic syndrome?
Haematuria Proteinuria Reduced GFR Oliguria Fluid overload (raised JVP, oedema) Hypertension Worsening renal failure
What can nephritic syndrome cause?
Acute kidney injury
What is the most common cause of acute post-infectious glomerulonephritis?
Group A strep, usually affecting the throat or skin
How is acute post-infectious glomerulonephritis diagnosed?
Bacterial culture
Positive ASOT (antistreptolysin O titre)
Low C3- normalises
How is acute post-infectious glomerulonephritis treated?
Antibiotics
Support renal function with electrolytes etc
Diuretics if overload/hypertension present
Who is IgA related vasculitis most common in?
Ages 5-15
Usually associated with non-streptococcal post infectious glomerulonephritis
How is IgA related vasculitis diagnosed?
Diagnosis can be made if there are palpable purpura with at least one of the following:
•Abdominal pain
•Renal involvement
•Arthritis or arthralgia
•IgA deposition on biopsy (rarely required for diagnosis, usually just used for staging severity of vasculitis)
Which vessels does IgA related vasculitis affect?
The small vessels
What is the timeline of IgA vasculitis?
IgA vasculitis usually occurs 1-3 days after the trigger, which is most commonly a viral URTI in children but can also be streptococcus or drugs. Symptoms usually last 4-6 weeks and ~1/3 will relapse
How is IgA vasculitis treated?
Symptomatic treatment for joints, gut etc
Glucocorticoid therapy (not useful in mild disease, may help with GI involvement)
Immunosuppression (in moderate-severe disease only)
Long term hypertension and proteinuria screening
When does IgA nephropathy occur and who does it occur in?
Usually occurs 1-2 days after an URTI
Most common in older children and adults
What are the clinical features of IgA nephropathy?
Recurrent macroscopic haematuria
Potential chronic microscopic haematuria
Varying degree of proteinuria
