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%
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)
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
4
Q
UTI - aetiology
A
- Normally E-coli
5
Q
UTI - diagnosis
A
- Clinical signs plus
- Bacterial culture from midstream urine
- Any growth on suprapubic aspiration or catheter
6
Q
What are clinical findings for UTIs in:
- neonates
- pre verbal children
- verbal children
A
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
- Urine dipstix
8
Q
How can UTI precipitate kidney injury?
A
- May cause kidney injury through vescico-ureteric reflux
- Causing scarring
9
Q
Who with a UTI should have their kidneys investigated?
A
- Upper tract symptoms
- Younger
- Recurrent
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
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
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
13
Q
What factors affect normal BP in children?
A
- Sex
- Age
- Height
14
Q
What is hypertension in children defined as?
A
Hypertension is >= 95th percentile for parameters, borderline is >=90th percentile
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