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paediatrics > paediatric nephrology > Flashcards

paediatric nephrology Flashcards

1
Q

neonate GFR

A

20-30

age 2yrs equals adults 90-120

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2
Q

5 kidney functions

A 
waste handling: urea, creatinine 
water handling 
salt balance
acid base control
endocrine e.g. renin aldosterone angiotensin system
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3
Q

glomerular filtration barrier: endothelial cell

A

fenestrated

vulnerable to immune mediated injury

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4
Q

glomerular filtration barrier: glomerular basement membrane

A

2 proteins: TIV collagen and laminin

synthesis from podocytes and endothelial cells

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5
Q

glomerular filtration barrier: mesangial cells

A

smooth muscle like pericytes embedded in basement membrane

glomerular structural support
regulates blood flow of glomerular capillaries

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6
Q

what does proteinuria signify

A

glomerular injury

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7
Q

acquired glomerulopathy: epithelial cell (podocyte) affected

A

minimal change disease

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8
Q

acquired glomerulopathy: basement membrane affected

A

post infectious glomerulonephritis

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9
Q

acquired glomerulopathy: endothelial cells affected

A

post infectious glomerulonephritis

haemolytic uraemic syndrome

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10
Q

acquired glomerulopathy: mesangial cells affected

A

HSP nephritis

IgA nephropathy

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11
Q

congenital glomerulopathy: podocyte cytoskeletal integrity affected

A

congenital nephrotic syndrome

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12
Q

congenital glomerulopathy: basement membrane proteins affected

A

alport syndrome

thin basement membrane disease (AD)

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13
Q

congenital glomerulopathy: endothelial/microvascular integrity

A

membranoproliferative glomerulonephritis

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14
Q

ways of measuring proteinuria

A

dipstix - measures concentration (if 3+ then abnormal)

protein creatinine ratio (early morning urine = best)

24hr urine collection (gold standard)

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15
Q

normal and nephrotic range of protein creatinine ratio

A

normal = <20mg/mmol

nephrotic range = >250mg/mmol

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16
Q

24hr urine collection: normal and nephrotic range

A

normal <60mg/m^2/24hs

nephrotic range >1g/m^2/24hs

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17
Q

what is nephrotic synrome

A

nephrotic range protein proteinuria

causing hypoalbuminaemia and oedema

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18
Q

examination findings nephrotic syndrome

A 
inflated weight 
pale
periorbital oedema 
pitting oedema legs 
ascited
pleural effusions
frothy urine

normotensive, hypertensive or hypotensive

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19
Q

typical features of minimal change disease

A

age 1-10
normotensive
no frank haematuria
normal renal functiom

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20
Q

atypical features of minimal change disease

A

suggestions of autoimmune disease
abnormal renal function
steroid resistance

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21
Q

nephrotic syndrome treatment

A

if typical features = prednisolone 8wks

or glucocorticoids

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22
Q

side effects of high dose glucocorticoids that are more common in kids

A 
behaviour
mood liability
infection risk
GI distress - more acidic 
sleep disturbance
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23
Q

steroid resistant nephrotic syndrome causes

A

acquired: focal segmental glomeruloscresosis
congenital: NPHS1 - nephrin, NPHS 2 - podocin, podocyte loss

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24
Q

causes of haematuria

A 
clotting disorders
glomerulonephritis
tumours - nephroblastoma 
cysts 
malignancies
stones
UTIs
trauma
urethritis
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25
Q

nephritic syndrome

A

clinical diagnosis - describes glomerulonephritis

haematuria and proteinuria

reduced GFR

intrarenal cause of AKI

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26
Q

typical microorganism causing acute post-infectious glomerulonephritis

A

group a strep

27
Q

diagnosing acute post-infectious glomerulonephritis

A

bacterial culture
positive anti-streptolysin O titre
low C3

28
Q

treatment acute post-infectious glomerulonephritis

A

antibiotics
support renal functions - electrolyte/acid base
overload/htn - diuretics

29
Q

IgA nephropathy

A

most common glomerlonephritis

1-2 days after UTI, usually older kids/adults

30
Q

clinical features IgA nephropathy

A

recurrent macroscopic haematuria

+/- chronic microscopic haematuria

varying degree of proteinuria

31
Q

treating IgA nephropathy

A

mild: proteinuria with ACEi

mod - severe: immunosuppression

32
Q

henoch schonlein purpura IgA related vasculitis (aka HSP nephritis) clinical diagnosis

A

mandatory palpable purpura

one of

  • abdo pain
  • renal involvement
  • arthritis/arthralgia
  • biopsy: IgA deposition
33
Q

IgA vasculitis

A

small vessel vasculitis

overlapping with IgA nephropathy

34
Q

IgA vasculitis features

A

1-3days post trigger - viral, streptococcus

nephritis - mesangial cell injury

35
Q

x

A

x

36
Q

acute kidney injury

A

abrupt loss of kidney function

retention of urea and other waste products and dysregulation of extracellular volume and electrolytes

37
Q

AKI features - kids

A

anuria/oliguria (<0.5ml/kg/hr)

htn with fluid overload

rapid rise in plasma creatinine

38
Q

AKI diagnostic definition

A

serum creatinine >1.5x age specific reference creatinine (or previous baseline if known)

urine output <0.5ml/kg >8hrs

39
Q

AKI warning score: AKI 1

A

creatinine >1.5-2x reference

40
Q

AKI warning score: AKI 2

A

creatinine 2-3x reference

41
Q

AKI warning score: AKI 3

A

creatinine >3x reference

42
Q

AKI management

A

3 Ms

monitor: paediatric early warning scores, urine output, weight
maintain: good hydration, electrolytes, acid-base
minimise: drugs

43
Q

causes of AKI: pre-renal

A

perfusion problem

volume depletion
renal hypoperfusion: drugs, renal a. stenosis, hepato-renal syndrome
haemorrhage
hypotension

44
Q

causes of AKI: intrinsic renal problem

A

glomerular disease: haemolytic uraemic syndrome, glomerulonephritis

tubular injury: acute tubular necrosis

interstisial nephritis: NSAID, autoimmune

45
Q

causes of AKI: post-renal

A

obstructive uropathies

46
Q

haemolytic uraemic syndrome

A

haemolysis - packed cell volume <30%, hg level <10 and fragmented erythrocytes on blood film

thrombocytopenia - platelet count <150

AKI - inc serum creatinine, GFR <80

47
Q

typical HUS causes

A

post (bloody) diarrhoea

entero-haemorrhagic e.coli - produce shiga toxic

other - pneumococcal infection, drugs

48
Q

atypical HUS

A

genetic condition resulting in overactivation of alternative complement pathway

49
Q

HUS triad

A

microangiopathic haemolytic anaemia

thrombocytopenia

AKI/acute renal failure

50
Q

management of HUS

A

monitor: 5 kidney functions
maintain: IV normal saline and fluid, renal replacement therapy
minimise: no antibiotics/NSAIDs

51
Q

longterm consequences of AKI

A

htn
proteinuria monitoring
evolution to CKD

52
Q

CKD causes: congenital

A

reflux nephropathy
dysplasia
obstructive uropathy

53
Q

CKD causes: hereditary

A

cystic kidney disease

cystinosis

54
Q

when do CKD signs/symptoms start to show

A

<60% renal function (stage 3)

55
Q

presentation of CKD

A

inc urea: lose appetite, weight loss, itch, cardio/neuro functio

water handling: polyuria or oliguria

salt/acid base - lethargy, poor growth

endocrine - lethargy, hyper-/hypo-tensive, anaemic

bladder: UTIs

56
Q

most common symptoms of UTI in neonates

A

fever
vomiting
lethargy
irritability

57
Q

diagnosing UTI

A

dipstix - white cells, nitrtites

microscopy - pyuria, bacturia

culture >10^5 colony forming units

58
Q

treatment UTI

A

lower tract - 3 days oral antibiotic

upper tract - antibiotic 7/10 days, oral is systemically well

59
Q

radiology diagnosing UTI

A

USS

DMSA isotope scan

micturition cysto-urethrogram

60
Q

factors affecting progression of CKD

A 
late referral 
htn 
proteinuria 
high intake protein, phosphate, salt
bone health 
acidosis 
recurrent UTIs
61
Q

IgA nephropathy vs post-strep GN

A

IgA nephropathy soon after or alongside URTI

PSGN - week(s) after

62
Q

transient proteinuria

A

proteinura following acute event e.g. seizure, infection

resolves within 24hrs/when underlying cause treate

63
Q

orthostatic proteinuria

A

asymptomatic, well
increasing proteinuria throughout day
adoescents
AM and PM protein dip

64
Q

HSP management

A

glucocorticoid therapy
immunosuppression
long term HTN and proteinuria screening

paediatrics (68 decks)

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