Paediatric Nephrology - Chronic Kidney Failure Flashcards

1
Q

CKD - aetiology

A
  • Congenital anomalies of kidney and urinary tract
    • Can be standalone or associated with – turners, trisomy 21, Branchio-oto-renal, prune belly syndrome
    • 55%
  • Hereditary conditions
    • Cystic kidney disease
    • Cystinosis
    • 17%
  • Glomerulonephritis
    • 10%
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2
Q

CKD - staging

A
  • CKD2 60-89
  • CKD3 30-59
    • CKD3a 45-59
    • CKD3b 30-44
  • CKD4 15-29
  • CKD5 (end stage renal disease)
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3
Q

CKD - presentation

A

Symptoms variable depending on which function affected:

  • Waste handling
    • Increased appetite
  • Water handling
    • Polyuric or oliguric
  • Salt balance
    • Hyponutramia which may affect growth, or hypernatraemia which may affect cardiac health
  • Acid base control
    • Affects growth
  • Endocrine
    • Anaemia, hypertension if oliguric, hypotensive if polyuric
  • Bladder dysfunction
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4
Q

UTI - aetiology

A
  • Normally E-coli
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5
Q

UTI - diagnosis

A
  • Clinical signs plus
    • Bacterial culture from midstream urine
    • Any growth on suprapubic aspiration or catheter
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6
Q

What are clinical findings for UTIs in:

  • neonates
  • pre verbal children
  • verbal children
A
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7
Q

UTI - investigations

A
  • Mid-stream urine sample
  • If acutely unwell, do not delay treatment
  • Making the diagnosis
    • Urine dipstix
      • Leucocyte esterase activity, nitrates
    • Microscopy
      • Pyruria
      • Bacteruria
    • Culture – gold standard
      • >105 colony forming units/ml
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8
Q

How can UTI precipitate kidney injury?

A
  • May cause kidney injury through vescico-ureteric reflux
    • Causing scarring
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9
Q

Who with a UTI should have their kidneys investigated?

A
  • Upper tract symptoms
  • Younger
  • Recurrent
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10
Q

What investigations can be done to look at kidneys in UTI?

A
  • USS
    • Structure
  • DMSA (isotope scan)
    • Scarring/function
  • Micturating cysto-urethrogram MAG 3 scan
    • Dynamic
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11
Q

UTI - treatment

A
  • Lower tract
    • 3 days oral antibiotics
  • Upper tract/pyelonephritis
    • Antibiotics for 7-10 days
  • Prevention
    • Fluids, hygiene, avoid constipation
  • Manage voiding symptoms
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12
Q

What factors affect progression of CKD?

A
  • Late referral
  • Hypertension
  • Proteinuria
  • High intake of protein, phosphate and salt
  • Bone health
    • PTH
    • Phosphate
    • Vitamin D
  • Acidosis
  • Recurrent UTIs
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13
Q

What factors affect normal BP in children?

A
  • Sex
  • Age
  • Height
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14
Q

What is hypertension in children defined as?

A

Hypertension is >= 95th percentile for parameters, borderline is >=90th percentile

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15
Q

CKD - management

A

Variable depending on which function altered:

  • Waste handling
    • Reduce protein intake
  • Water handling
    • Fluid restriction or free access
  • Salt balance
    • Sodium restriction or supplementation
  • Acid base control
    • Bicarbonate replacement
  • Endocrine
    • Control BP with ACE inhibitors
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16
Q

CKD - complications

A
  • Metabolic bone disease
  • Cardiovascular risk
    • Accelerated atherosclerosis
17
Q

How can CKD lead to metabolic bone disease?

A
  • Kidneys wee out phosphate
    • High phosphate causes increase PTH
  • Kidneys activate vitamin D3
18
Q

Metabolic bone disease - treatment principles

A
  • Low phosphate diet
  • Phosphate binders
  • Active vitamin D
  • Growth hormone – if ongoing poor growth